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Health condition

Post-pregnancy abdominal wall separation, what it is, what helps - and when to ask for a review.

A gap between the tummy muscles after pregnancy is common, is not a tear and is not a hernia. Most women improve over the first months, and there is good, practical help for those who do not.

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Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NICE postnatal guidance, pelvic health physiotherapy resources and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects a rehabilitation-first approach, with surgery kept for the small group whose symptoms persist.

Key facts

Abdominal wall separation at a glance.

The essentials, in plain English - what it is, what it is not, and how it is usually looked after in the UK.

  • What it is

    A widening of the gap between the two rectus abdominis muscles, caused by stretching of the linea alba - the strip of connective tissue that joins them down the midline. Also called diastasis recti.

  • Not a tear

    Nothing has torn or broken. The tissue between the muscles has stretched and thinned to make room for a growing baby, which is a normal response to pregnancy.

  • Not a hernia

    A hernia is a defect through which contents protrude. Separation is a wider, softer midline that may dome, but there is no hole. The two can occasionally sit side by side, which is why an examination matters.

  • Common timing

    Very common in late pregnancy and the early postnatal weeks. Most women find it narrows and firms up over the first months without any specific treatment.

  • First-line care

    Reassurance, time and - where symptoms persist - a postnatal women’s health physiotherapy assessment with gradual, progressive core work.

  • Surgery

    Considered only when symptoms and everyday limitation persist after proper rehabilitation. It is usually not NHS-funded when the reason is cosmetic.

Why this guide matters

Common, understandable and very often improvable.

Many women are told very little about this after birth, or worry that something has been damaged. The three points below shape everything else on this page.

  • It is common and not your fault

    A gap between the tummy muscles is a normal effect of a growing baby. Having had several pregnancies, twins, a larger baby or a caesarean can make it more likely, but it is not a sign of doing anything wrong.

  • Separation and hernia are different

    Separation is a soft stretch of the midline. A hernia is a defect with contents pushing through it. Telling them apart matters, because a trapped hernia is urgent and separation is not.

  • Rehabilitation comes before surgery

    Time, then guided physiotherapy, help most women. Surgery is reserved for persisting symptoms that limit daily life after proper rehabilitation.

How the diagnosis is made

From a simple examination to a clear plan.

The diagnosis is made by examination, not by a scan. These are the steps a GP or women’s health physiotherapist will normally follow.

  1. 01

    Assessing

    Your story

    When you first noticed it, how many pregnancies you have had, any twins or a larger baby, any caesarean, and how your back, pelvis, bladder and bowel are behaving.

  2. 02

    Assessing

    Relaxed examination

    Lying on your back with knees bent, the clinician gently presses along the midline and measures the gap in finger-widths, usually above, at and below the navel.

  3. 03

    Assessing

    Small head lift

    You lift your head and shoulders a little. The clinician checks for doming or a ridge and how firm the midline feels - how well it holds tension matters as well as its width.

  4. 04

    Confirming

    Rule out a hernia

    The navel, the midline above it and any caesarean scar are checked for a defined bulge with an edge that does not flatten, which would point to a hernia rather than separation.

  5. 05

    Confirming

    Ultrasound, only if unsure

    Scans are rarely needed. An abdominal ultrasound may be offered if the examination cannot separate a hernia from a stretched midline.

  6. 06

    Planning

    Pelvic floor and function check

    Leaking, heaviness or dragging, back or pelvic girdle ache and difficulty with lifting or getting out of bed are asked about, because they shape the rehabilitation plan.

  7. 07

    Planning

    A plan and a review

    A graded exercise and movement plan, then a re-check after some weeks. A surgical opinion is only discussed if things have not settled after proper rehabilitation.

Typical timeline: an answer at the first appointment, with a review after a few weeks of rehabilitation.

Symptoms

What separation can look and feel like.

Some women notice a visible midline ridge, others mainly feel weak or achy. Some have no symptoms at all. And one sign that is not separation.

  • Midline doming

    A soft ridge or bulge down the middle of the tummy when you sit up, strain or get out of bed, often settling when you lie flat.

  • A persisting “pooch”

    A rounded lower tummy that does not match how strong or well you otherwise feel, even after weight has settled.

  • Lower back ache

    A dull ache across the lower back, often worse after standing, carrying your baby or a long feed.

  • Core weakness

    A feeling that your middle is not switched on, or that you cannot “brace” to lift, cough or stand up smoothly.

  • Pelvic floor symptoms

    Leaking when you cough or sneeze, urgency, or a heavy, dragging feeling can sit alongside separation and are worth mentioning.

  • Awkward everyday moves

    Getting out of bed, lifting a car seat or rolling over may feel unsteady or pull through the middle of the tummy.

  • A soft, finger-wide gap

    A gap you can feel between the two muscle bellies, which clinicians measure in finger-widths and re-check over time.

  • Red flag - a firm, tender lump

    A lump that is painful, hard or will not go back in is not separation and needs prompt assessment.

Treatment

How abdominal wall separation is managed in the UK.

Reassurance and time first, guided physiotherapy for those with symptoms - and surgery only for the small group whose difficulties persist after rehabilitation.

  • Reassurance and time

    Most separation improves over the first months as the tissue recovers. Knowing it is common, harmless and not your fault is part of the treatment.

  • Postnatal physiotherapy assessment

    A women’s health physiotherapist can assess the midline, your pelvic floor and your posture, and tailor a plan to your birth, your baby and your daily routine.

  • Deep core and pelvic floor training

    Gentle work for the deep abdominal muscle (transversus abdominis) and pelvic floor, coordinated with breathing, forms the base of most rehabilitation plans.

  • Gradual, progressive core work

    Exercise is built up in stages, from lying to sitting to standing to loaded movement, and paced to how your midline responds rather than to a fixed timetable.

  • Posture and safe movement

    Rolling onto your side to get out of bed, breathing out on effort and lifting close to the body reduce strain on the midline through the day.

  • Modifying early exercise

    If a movement makes the midline dome, it is sensible to pause repeated crunches, sit-ups and heavy straining early on and return to them with guidance.

  • Supportive garments

    A binder or support band can feel comfortable, particularly on your feet all day. It is for comfort only and does not close the gap or replace exercise.

  • Surgery - abdominoplasty or plication

    Considered only for persisting symptoms with a real effect on daily life after proper rehabilitation. It is usually not NHS-funded when cosmetic, and timing around future pregnancies matters.

What this guide is based on

The sources behind every claim on this page.

UK national guidance, specialist physiotherapy resources and peer-reviewed research, current at the time of last review.

Key references

Guidelines and studies we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP or physiotherapist can examine you and tell you which parts apply to you. If in doubt, get seen.

  • NICE. Postnatal care (NG194).

  • Pelvic, Obstetric and Gynaecological Physiotherapy (POGP). Patient information on pelvic health and exercise after childbirth.

  • NHS. Guidance on your body after pregnancy and returning to exercise.

  • Benjamin DR, van de Water ATM, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy, 2014.

Red flags

When to seek help without waiting.

Separation itself is not dangerous. These are the features that suggest something else, such as a hernia, and need prompt medical assessment.

  • A tender lump that will not go back in

    A firm, painful bulge that cannot be gently eased back may be a trapped hernia. Seek urgent medical help - call 999 or go to A&E if it is severe.

  • Severe or worsening tummy pain

    Sudden, severe or steadily worsening pain, especially around a lump, needs same-day assessment and should not be put down to muscle strain.

  • Vomiting with a lump or pain

    Repeated vomiting, a swollen tummy, or being unable to pass wind or open your bowels alongside a lump can signal a bowel obstruction. Go to A&E.

  • A skin change over a bulge

    Redness, heat or a dusky, purplish colour over a lump suggests the blood supply may be affected. This is an emergency.

  • A bulge at a caesarean scar

    A lump at or near your caesarean scar may be an incisional hernia rather than separation. Ask for an examination promptly - see our incisional hernia guide.

  • Wound problems after a caesarean

    Spreading redness, discharge, the wound opening, or a fever after caesarean should be checked by your GP, midwife or maternity unit without delay.

  • A firm, defined lump

    Soft doming that comes and goes is typical of separation. A firm lump with a clear edge is different and deserves a proper examination.

  • Leaking or heaviness that persists

    Ongoing leaking, or a dragging heaviness in the vagina, is common but treatable. It is worth a pelvic health assessment rather than waiting it out.

  • Low mood or feeling overwhelmed

    Worry about how your body looks or feels can weigh on mood in the postnatal months. Please tell your GP or health visitor - support is available and asking is not a burden.

Living with it

A common condition, with steady, practical help.

Four things that make the biggest difference day to day - patience with your body, gentle regular movement, easier everyday technique and knowing when to ask for a review.

A quiet reminder

Recovery after birth is not a race.

Small, steady habits kept up over weeks and months do more than any quick fix, and asking for help is a sensible step, not a sign of failure.

  1. 01 Mindset

    Be kind to your body

    Your body did something remarkable. Separation is a normal, common response and does not mean you have done anything wrong or “let yourself go”.

  2. 02 Movement

    Little and often

    Short walks and gentle, guided exercises usually help more than occasional hard sessions. Build up as your midline shows it can cope.

  3. 03 Technique

    Make everyday moves easier

    Roll to your side to get out of bed, breathe out as you lift, and keep loads close. These small habits protect the midline while it recovers.

  4. 04 Support

    Ask for a review

    If it is not improving, or it limits what you can do, ask your GP or a women’s health physiotherapist. Early advice is easier than years of putting up with it.

Frequently asked

Everything we get asked about abdominal wall separation.

Quick answers on tears, hernias, exercise, support garments and surgery.

  • Is abdominal wall separation a tear?

    No. The two rectus abdominis muscles are not torn. The connective tissue between them, the linea alba, has stretched and thinned during pregnancy, which lets the gap widen. It is a stretch of tissue rather than an injury, and it is very common.

  • Is it the same as a hernia?

    No. A hernia is a defect in the abdominal wall through which tissue can protrude, and it tends to feel like a defined lump. Separation is a wider midline that may dome softly when you strain. The two can occasionally occur together, so a clinician should examine you if you notice a firm or tender lump.

  • Will it go away on its own?

    For most women it improves over the first months after birth. Some gap can remain while the tummy still works well, and how well the midline holds tension matters as much as how wide it is. If you have symptoms that are not settling, a physiotherapy assessment is worthwhile.

  • Should I avoid sit-ups and crunches?

    Early on, it is sensible to pause repeated crunches, sit-ups and heavy straining if they make the midline dome or you feel pulling. This is not a permanent ban. A physiotherapist can guide you back to these movements in stages as your core control improves.

  • Do belly bands and support garments help?

    They can feel comfortable and supportive, particularly on long days on your feet. They are for comfort only. They do not close the gap or strengthen the muscles, so they work best alongside a graded exercise plan rather than instead of one.

  • When is surgery considered?

    Only when symptoms and functional limitation persist after a proper period of rehabilitation. Procedures such as abdominoplasty with plication of the midline are usually not NHS-funded when the reason is cosmetic. It is also sensible to be settled about future pregnancies before deciding.

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