Diastasis Recti (Separated Stomach Muscles)
During pregnancy the two long muscles that run down the front of the abdomen separate at the midline to make room for the growing uterus. At Modern Physio we focus on understanding the root-cause of your problem & personalizing your treatment for lasting results.
Understanding Diastasis Recti (Separated Stomach Muscles)
During pregnancy the two long muscles that run down the front of the abdomen separate at the midline to make room for the growing uterus. This is normal, and it happens to most women. The separation usually narrows on its own in the first weeks after delivery. When it does not, the abdomen can look domed or feel soft in the middle, and a ridge may appear along the midline when you sit up. The size of the gap matters less than most people expect. What matters is whether the tissue between the two muscles can hold tension, because that is what lets the trunk transfer load. That is what is assessed here, and it is what treatment works on. Assessment is by Dr. Surabhi Bansal, a female physiotherapist, in Hindi or English.
Common Symptoms
- A visible ridge or dome along the middle of the abdomen when sitting up from lying
- A soft or hollow feeling along the midline when pressing gently
- An abdomen that still looks pregnant months after delivery
- A sense that the middle of the body is weak or unsupported when lifting
- Low back pain or pelvic pain that accompanies the abdominal change
- Difficulty getting up from lying flat without rolling to one side
- Bloating or a feeling of pressure in the abdomen towards the end of the day
How Common Is It?
Separation of the abdominal muscles during pregnancy is normal rather than exceptional, and the separation commonly narrows without treatment in the early weeks after delivery. Persistent separation with functional symptoms is less common, and is what physiotherapy addresses.
Causes & Risk Factors
- Pregnancy itself, which stretches the midline tissue in almost every woman
- A large baby, a multiple pregnancy, or more than one pregnancy close together
- Returning to abdominal exercises that load the midline before it can hold tension
- Repeated bearing down when lifting, coughing or straining at stool
- Pelvic floor and deep abdominal muscles that have not been retrained after delivery
Our Diagnosis Process
- Measuring the width of the separation above, at and below the navel
- Assessing whether the midline tissue can hold tension under load, which predicts function better than the width alone
- Watching how you get up from lying, lift and cough, since these show the problem more clearly than any static test
- Assessing pelvic floor and deep abdominal function, with consent, because these work as one system with the abdominal wall
- Checking breathing pattern and rib position, both of which change how the abdominal wall is loaded
- Referral for medical assessment if there is a hernia or if a lump is present at the midline
Our Treatment Approach
- Restoring the coordination of breathing, deep abdominal muscles and pelvic floor before any strengthening starts
- Graded loading that builds the ability to hold tension across the midline, progressed by what you can control
- Removing the specific movements that repeatedly dome the abdomen, until you can perform them without doming
- Teaching how to get up from lying, lift and carry without bearing down
- Progressing towards the strength you actually need, including returning to gym work where that is your goal
- Where a hernia is suspected, referral for surgical opinion, with physiotherapy alongside rather than instead of it
Recovery & Prevention Tips
- Roll to your side and push up with your arms instead of sitting straight up from flat
- Watch for doming along the midline during any exercise, and treat doming as a sign to regress that exercise rather than push through it
- Avoid traditional sit-ups and crunches until you have been assessed
- Treat constipation, because repeated straining works directly against the tissue you are trying to load
- Expect change over months rather than weeks, and judge progress by function rather than by appearance
Evidence & Sources
Separation of the abdominal muscles during pregnancy is common and usually returns towards normal in the weeks after the birth.
NHS — Your post-pregnancy bodyFrequently Asked Questions
How many finger widths of separation is too much?
Finger widths are a rough measure and a poor predictor on their own. Two women with the same gap can have completely different function. What is assessed here is whether the midline can hold tension under load, because that is what determines whether the abdomen supports you when you lift, cough or carry.
Will it close completely?
Sometimes, and sometimes not. Some women retain a measurable gap and have a fully functional abdominal wall with no symptoms. The goal of treatment is function, and no honest clinician can promise a particular final measurement.
Can exercise make it worse?
The wrong exercise can. Sit-ups, crunches and heavy loading before the midline can hold tension tend to increase doming. Graded work that avoids doming does not make it worse, and is the treatment.
Do I need surgery?
Most women do not. Surgery is considered for a true hernia, or where a large separation continues to cause symptoms after a proper course of rehabilitation. That decision belongs to a surgeon, not to a physiotherapist. Physiotherapy here runs alongside your obstetrician or gynaecologist, never instead of them. Dr. Surabhi Bansal is a physiotherapist, not a physician: the clinic does not prescribe medication and has no imaging or scanning on site.
When should I start after delivery?
Gentle breathing and deep abdominal work can usually start in the early weeks, including after a caesarean. Loaded work starts later and is guided by assessment. Ask at your postnatal check, and get assessed rather than following a video.
Medically Reviewed
This content was reviewed for medical accuracy by Dr. Surabhi Bansal, BPT, MPT (Ortho) with 14+ years of clinical experience.
At Modern Physio, all medical content undergoes a thorough review process to ensure accuracy and alignment with current physiotherapy standards. Our content is created to educate and should not replace professional medical advice. Learn more about our review process.
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