Diastasis Recti In Pregnancy
Diastasis Recti After Pregnancy: What It Is & How to Support Recovery
Written by Dr. Fiona Callender, Naturopathic Doctor and Pelvic Floor Therapist
Pregnancy asks a lot of your abdominal wall. As your uterus grows, the abdominal muscles and the connective tissue between them have to stretch and adapt to make room. One of those normal changes is diastasis recti, sometimes called abdominal separation. While it happens to some degree in every pregnancy, some people continue to notice changes in their abdominal wall for longer postpartum.
You might notice a gap between your abdominal muscles, a feeling of weakness through your core, or bulging or “coning” along the midline with certain movements. You might also have no symptoms at all.
As we go through learning about diastasis, it’s important to keep in mind that it isn’t all about the size of the gap. Recovery is about more than trying to get your pre-pregnancy stomach back.
What is diastasis recti?
Your rectus abdominis muscles - the muscles people often think of as the “six-pack” muscles - run vertically along the front of your abdomen. Between them is a band of connective tissue called the linea alba.
As pregnancy progresses, the linea alba stretches and thins to allow your abdomen to expand and accomodate your growing baby. This is a normal adaptation in pregnancy.
After birth, your abdominal wall begins another period of adaptation. For some people, the distance between the abdominal muscles decreases considerably on its own. For others, some separation remains. When the space remains, this is known as diastasis recti abdominis (DRA).
You may notice:
a visible or palpable space between the abdominal muscles
bulging or “coning” along the centre of the abdomen during certain movements
changes in how strong or supported your core feels
difficulty managing pressure during lifting, exercise or everyday activities
The width of the gap is only one piece of the picture. How well you can generate tension through the abdominal wall, coordinate your core with your breathing and pelvic floor, and comfortably perform the activities that matter to you, can often tell us much more than a measurement alone.
Do you need to “close the gap”?
Not necessarily.
There can be a lot of pressure online to “fix” diastasis or get your stomach back after pregnancy. The goal of postpartum rehabilitation doesn't have to be achieving a perfectly flat abdomen or completely eliminating the space between your abdominal muscles. Ideally, we start with function!
We might ask ourselves:
How well is your abdominal wall functioning and managing the loads placed upon it?
Your abdominal muscles don't work in isolation. Your diaphragm, abdominal wall, back muscles and pelvic floor work together to help manage pressure within your abdomen.
There are a lot of activities you do - immediately postpartum! - that require those abdominal muscles to function. Think about picking up your baby, getting out of bed, carrying a car seat, coughing, running or lifting a weight. All of these activities will increase pressure through your abdomen.
Exercises and support can help you learn to manage that pressure while gradually rebuilding strength and confidence.
What about abdominal “coning”?
You may have heard that seeing any coning or doming through your abdomen means you're causing damage or worsening your diastasis. That’s simply not accurate. Coning can give us useful information about how your abdominal wall is responding to a particular movement or load. Rather than automatically labelling the movement as “bad,” we can look at whether changing your breathing, technique, position or level of difficulty improves how you manage it.
Sometimes your body needs more time and progressive strengthening before that particular exercise feels comfortable.
The goal isn't to avoid challenging your core forever! We want to build the capacity needed to handle increasingly challenging movements.
Can you exercise with diastasis recti?
Yes! You may have seen long lists of exercises to avoid with diastasis recti, including crunches, planks and heavy lifting. This is largely incorrect - or at least hugely simplified. There isn't one universally “bad” exercise for everyone with diastasis. What matters is your current capacity, your symptoms, your goals and how your body responds to the exercise.
Early postpartum rehabilitation might start with breathing, coordination and relatively simple strengthening exercises. From there, we can gradually increase the challenge. Depending on your goals, that might eventually mean progressing toward planks, heavier strength training, running, Pilates, sports or whatever activities are important to you.
You don't need to spend the rest of your life protecting your abdominal wall from load. Progressive loading is how tissues and muscles become stronger.
How long does diastasis recti recovery take?
There isn't one universal timeline. Your abdominal wall continues to change during the months after pregnancy, and recovery can look very different from person to person.
Rather than focusing on a timeline or a particular gap size, it can be more helpful to track changes in things like:
abdominal strength and endurance
your ability to generate tension through your abdominal wall
coordination between your breath, core and pelvic floor
symptoms during everyday activities
confidence returning to exercise
your ability to progressively tolerate more load
The appearance of your postpartum abdomen doesn’t give us all the information we need to know if you have recovered. We don’t need to look how we did pre-pregnancy for recovery to be “successful”.
How can pelvic floor therapy help with diastasis recti?
The pelvic floor and abdominal wall are part of the same pressure-management system, which is why pelvic floor therapy can be helpful during postpartum diastasis recti rehabilitation. During an assessment, we can look beyond simply measuring the distance between your abdominal muscles. We may assess your breathing, abdominal wall tension, pelvic floor coordination, strength, movement patterns and how your body responds to the activities that matter to you. From there, your treatment plan can progress based on your individual starting point and goals.
For one person, that might mean comfortably lifting and carrying their baby. For someone else, it might mean returning to running or strength training.
There isn't one perfect postpartum exercise program - though you may find lots of people trying to sell that online!
If you are looking for support with diastasis recti in Toronto, having an individual assessment can make a huge difference. As a Naturopathic Doctor and Pelvic Floor Therapist, I work with patients during pregnancy and postpartum to understand how their abdominal wall, pelvic floor, breathing and movement are working together.
The goal isn't to “fix” your postpartum body. It's to help you understand it, build strength and get back to the activities that matter to you with confidence.
Feel free to book a meet and greet appointment to see if we might be a good fit to work together.