Postnatal Recovery: Diastasis Recti and Rebuilding Core Strength

After having a baby, many women notice a bulge or "pooch" in the middle of the stomach, especially when sitting up. This is often diastasis recti, a separation of the two sides of the six-pack muscle.

What diastasis recti is

During pregnancy, the growing baby stretches the abdominal wall. The tissue running down the middle (the linea alba) widens and thins to make room. This is a normal part of pregnancy, and it happens in a large proportion of women.

For many, the gap narrows naturally in the first few months after birth. For some, it persists.

How to check

1. Lie on your back with knees bent and feet flat.
2. Place your fingertips across your midline, just above the belly button.
3. Lift your head and shoulders slightly off the floor.
4. Feel for a gap between the muscles, and how firm or soft the tissue in the gap feels.
5. Repeat above and below the belly button.

A physiotherapist can assess this more accurately, including how well the tissue tightens when you engage your deep core.

The first weeks after birth

• Rest and recover. Your body has done something huge.
• Start pelvic floor exercises gently when you feel ready.
• Practise deep breathing and gentle deep core activation: breathe out and gently draw your lower stomach in.
• Roll to your side to get out of bed, rather than sitting straight up.
• Gentle walking, increasing gradually.

If you had a caesarean section, follow your doctor's guidance about lifting and activity.

Rebuilding core strength

Exercises that are often used:

• Heel slides
• Bridges
• Side-lying leg lifts
• Bird-dog (on hands and knees, extend the opposite arm and leg)
• Modified planks on knees, as strength allows

Breathe out on effort, and watch your stomach. If it domes or bulges along the midline, the exercise may be too hard for now.

Returning to high-impact exercise

Running, jumping and heavy lifting are commonly delayed until at least around 12 weeks postnatally, and only once you can manage lower-level exercise without leaking, heaviness or pain.

When to get help

See a pelvic health physiotherapist if you have a noticeable gap that isn't improving, back pain, leaking, a feeling of heaviness in the pelvis, or pain during sex. These are common, but treatable.