Diastasis recti describes a widening of the midline tissue (linea alba) between the two sides of your “six-pack” muscles. It is common during pregnancy and after birth. However, it can also occur with significant abdominal strain, weight changes, or repeated heavy lifting.

Many people notice a “doming” or bulge along the middle of the tummy when they sit up, roll in bed, cough, or lift. Others feel core weakness, back or pelvic pain, or reduced confidence with exercise. Many people benefit from early physiotherapy guidance focused on core control, breathing, and pelvic floor coordination, which is explained further in our pelvic floor exercises resource.

A physiotherapist can assess your abdominal wall, breathing and pelvic floor coordination, and how you load the trunk in daily tasks. Then, they can guide a plan that suits your body, symptoms, and goals.

What is diastasis recti?

Diastasis recti means the two rectus abdominis muscles sit further apart than usual. During pregnancy, hormones and abdominal stretching allow the belly to expand. After birth, the tissue often tightens over time. Still, some people keep a wider gap and ongoing symptoms.

Importantly, the “gap” number alone does not tell the whole story. Strength, control, pressure management, and symptom levels matter more than chasing a perfect measurement.

Common causes and risk factors

Diastasis recti often relates to the combined effects of abdominal stretching and repeated pressure through the abdominal wall. Risk factors may include:

• Pregnancy and the early postpartum period
• Multiple pregnancies
• Higher abdominal load (frequent lifting, carrying, or straining)
• Persistent constipation and breath-holding habits
• Reduced trunk and pelvic floor coordination after birth

Some people also have pelvic floor symptoms at the same time. If that sounds like you, start with these PhysioWorks resources including pelvic floor exercises, stress incontinence, and prolapse.

Symptoms you might notice

Diastasis recti varies. You might notice one or more of the following:

• A visible midline bulge or “doming” with effort
• A soft or “unsupported” feeling through the tummy
• Difficulty returning to exercise, running, or heavier lifting
• Lower back discomfort, pelvic girdle pain, or reduced trunk endurance

If back or pelvic pain sits alongside your abdominal symptoms, these pages may help including pregnancy back pain and sacroiliac joint pain (SIJ).

How a physiotherapist assesses diastasis recti

A physiotherapist usually checks:

• Midline tissue tension and control (not just the gap)
• Breathing mechanics and ribcage position
• Pelvic floor coordination and pressure control
• How your trunk behaves during rolling, lifting, coughing, and exercise

In some cases, ultrasound supports assessment and progress tracking.

Physiotherapy management that often helps

A good plan focuses on function first. That usually means improving pressure control and loading tolerance, then building strength and confidence over time. A physiotherapist may recommend:

• Breathing and ribcage positioning drills to reduce “doming”
• Graded deep core and trunk strengthening (progressed week to week)
• Pelvic floor and abdominal coordination, as needed
• Technique changes for lifting, carrying, and getting up from the floor
• A return-to-exercise plan based on symptoms and goals

For exercise ideas that suit pregnancy and early postpartum stages, see the safe pregnancy exercises guide. If you feel “weak” pelvic floor symptoms, information on underactive pelvic floor may also help.

Diastasis recti – common questions

Can diastasis recti cause back pain? It can contribute. A reduced ability to manage trunk pressure and load may increase strain through the lower back and pelvis. Still, back pain has many causes. A physiotherapist can assess your movement patterns and build a plan that targets your main drivers.

Anticipated results

Many people improve with consistent, progressive rehab. You may notice:

• Less doming with daily tasks
• Better trunk endurance and control
• More comfort with lifting, exercise, and returning to sport

Outcomes vary. Some people improve quickly, while others need a longer plan, especially if symptoms have persisted for months or years.

When surgery is considered

Surgery may be an option when:

• Symptoms stay limiting despite a well-run rehab plan
• There is a significant functional issue, such as persistent bulging with everyday tasks
• Other abdominal wall issues (such as hernia) need medical review

A physiotherapist can help you prepare for a medical discussion and support post-operative rehab if you proceed.

Related PhysioWorks articles

• Pelvic Floor Exercises
• Stress Incontinence
• Prolapse
• Pregnancy Back Pain
• Underactive Pelvic Floor
• Safe Pregnancy Exercises Guide

What to do next

Start with simple daily changes: exhale during effort, avoid breath-holding, and reduce activities that trigger strong doming. Next, begin a graded core and pelvic floor plan that matches your stage of recovery and your symptoms. If you feel unsure, book a physiotherapy assessment so you can train with confidence.

References

1. Theodorsen NM, Bø K, Fersum KV, Haukenes I, Moe-Nilssen R. Pregnant women may exercise both abdominal and pelvic floor muscles during pregnancy without increasing the diastasis recti abdominis: a randomised trial. J Physiother. 2024. doi:10.1016/j.jphys.2024.02.002. https://www.sciencedirect.com/science/article/pii/S1836955324000031
2. Soto-González M, et al. Effect of hypopressive and conventional abdominal exercises on inter-recti distance in postpartum women: a randomised trial. PLOS One. 2024. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0314274