Diastasis recti: symptoms, treatment and how long it takes to heal

The abdomen has four layers of muscle. The rectus abdominis forms the top layer and runs from the bottom of the ribcage to the pubic bone. Bedfordshire Hospitals explains that its two halves are joined in the middle by connective tissue called the linea alba.

In pregnancy the tummy muscles are stretched by the baby and the linea alba becomes softer because of pregnancy hormones. It can thin, and the gap widens. That widening is diastasis recti, also known as DRAM or DRA.

NHS Tayside describes this as a common change in pregnancy rather than an injury. The question that matters is not whether a gap exists but whether the muscles can control movement and support the pelvis, posture and breathing.

NHS Tayside says you may notice bulging, doming, coning or dipping along the middle of the tummy during effortful movements such as sitting up from lying, getting out of bed or lifting your baby. Many people notice only the shape of the tummy and have no pain.

The Bedfordshire Hospitals leaflet lists these signs and symptoms:

• A doming or bulge along the middle of the tummy, particularly when you sit up from lying down.

• A gap between the middle of the stomach muscles.

• Some discomfort along the middle of the tummy, especially if you have been more active.

• Poor posture and lower back pain.

• Symptoms of incontinence (leaking urine, stool or wind).

• Symptoms of prolapse.

For many people the first step is protecting the stretched muscles while they recover. NHS Tayside says some natural improvement happens in the first 8 weeks after delivery, and in this time the focus should be on abdominal activation, pelvic floor exercises and a gradual return to gentle exercise.

If the separation is particularly large or bothersome you will likely be referred to a physiotherapist, who can assess your abdominal muscles and give specific exercises. NHS Tayside says they will also advise on pelvic floor strengthening, because it affects abdominal muscle function.

Sometimes a compression garment or abdominal support can help in the early stages. NHS Tayside says your physiotherapist will help with guidance on this.

The sources used for this page describe physiotherapy and exercise only. They do not describe surgical repair, so this page does not cover it.

Bedfordshire Hospitals gives two ranges. A small diastasis normally recovers within 4 to 8 weeks after pregnancy. A larger one may take 6 to 12 months and requires input from a specialist physiotherapist to prevent long-term problems such as back pain and incontinence.

The cause is stretching and thinning of the linea alba, driven by the growing baby and pregnancy hormones. Bedfordshire Hospitals lists factors that put someone at higher risk of a larger separation:

• Twin pregnancy or a large baby.

• Being petite.

• Poor posture.

• Poor abdominal muscle tone or strength.

• Separation in a previous pregnancy.

• Obesity or being overweight.

• Genetics.

• Pregnancies close together.

NHS Tayside says stretching of the linea alba occurs in every pregnancy by 36 weeks and can continue after the birth. Bedfordshire Hospitals gives a similar figure, with up to 100% of women showing separation by week 35.

NHS Tayside says regular exercise before and during pregnancy can help reduce the risk of an ongoing separation, and suggests aiming for 150 minutes of moderate exercise a week in an uncomplicated pregnancy. The NHS says the same: it is safe for you and your baby, and it is usually fine to keep doing activities you already do. Speak to your midwife about what is safe for you if you have a health condition.

After the birth, NHS Tayside says you can return to exercise and activity when you feel ready, and encourages gentle abdominal and pelvic floor exercises from week 1.

Bedfordshire Hospitals advises protecting the weakened muscles by avoiding movements that cause doming or bulging.

To get out of bed, bend your knees so your feet are flat, roll onto the side you want to get out of, bring your legs over the edge and push up with your arms rather than sitting straight up.

When lifting your baby or anything heavy, keep your back straight, bend your knees, keep the load close, squeeze your pelvic floor and pull your tummy in towards your spine without holding your breath.

• Avoid sit-ups, planks and crunches straight away, especially in the early days after birth.

• Build up strength gradually with gentle core exercises and walking; Pilates or yoga are suggested.

• Avoid high-impact exercise such as jumping or running until you are stronger.

• Avoid constipation with a good fluid intake and a balanced diet, and use a stool under your feet when emptying your bowels.

• NHS Tayside says that avoiding sit-ups, planks, high-intensity exercise and repeated heavy lifting is for the first instance and "not forever", as strength returns.

Ask your midwife, health visitor or GP about referral to a pelvic health or women's health physiotherapist if the gap does not seem to be improving, if you have back pain, or if you leak urine, stool or wind.

The NHS says to see a GP if you have a lump in or around your vagina or any other symptoms of pelvic organ prolapse. These include a feeling of heaviness, discomfort or pressure in the lower tummy or vagina, a bulge, and bladder or bowel problems.

Diastasis recti is not an emergency in itself. For any sudden severe tummy pain, use NHS 111, or call 999 in an emergency.

On the NHS, a midwife, health visitor or GP can refer you to a pelvic health physiotherapist, and some trusts publish self-help exercise guidance for the postnatal period. Private physiotherapy is also available. Whichever route you use, look for a physiotherapist with experience in postnatal and pelvic health.