Abdominal Separation After Birth: Physio’s Guide to Diastasis Recti Recovery

If you’ve noticed a soft gap or “belly bulge” down the middle of your tummy since having your baby, you’re not alone, and you’re not stuck with it. Diastasis recti abdominis (DRAM), also known as abdominal separation, is a normal physiological change that becomes increasingly common through the third trimester and remains common well into the postpartum period. The good news is that current research gives us a much clearer, more encouraging picture of how to recover than we had even a few years ago.

As women’s health physiotherapists in Cheltenham, this is one of the most common concerns we see in our postnatal clients, so we’ve pulled together an up-to-date guide covering what DRAM is, how to check for it, and what actually helps.

What Is Diastasis Recti (DRAM)?

Diastasis recti abdominis is the widening or stretching of the linea alba, the connective tissue running down the midline between your left and right rectus abdominis (“six-pack”) muscles. It’s a normal, expected physiological change that allows your abdominal wall to accommodate your growing baby, driven largely by pregnancy hormones softening and lengthening this connective tissue.

It’s very common. Research shows that separation tends to develop gradually during pregnancy, peaking in the late third trimester and early postpartum period, with the gap tending to narrow naturally over the following months. Around 60% of women have a measurable separation at six weeks postpartum, reducing to approximately 33% by twelve months. Clinically, DRA is typically defined as an inter-rectus distance (IRD) of 20mm (2cm) or more, measured at, above, or below the belly button.

What Causes It?

DRAM develops as your uterus expands and abdominal tissues stretch to make room for your baby. Factors that can influence the degree of separation include:

• Multiple pregnancies
• Larger baby size or multiple babies (twins/triplets)
• Reduced core and pelvic floor strength going into pregnancy
• Genetics and connective tissue quality
• Poor management of intra-abdominal pressure during pregnancy and early postpartum

How Do I Know If I Have DRAM?

Many women feel or see a visible gap or doming (“bulging”) along the midline of their tummy, particularly when tensing the abdominals or sitting up out of bed. You might also notice:

• A feeling of weakness or instability through your core
• Changes in posture
• A “belly bulge” that doesn’t resolve with weight loss alone

Try this simple self-check:

1. Lie on your back with your knees bent.
2. Place two fingers over your belly button.
3. Lift your head and shoulders slightly off the floor, as if starting a curl-up.
4. Feel between your left and right abdominal muscles for a gap, and note how many finger-widths fit into it.

A gap of roughly two finger-widths (around 2cm) or more suggests DRAM. This is a useful starting guide, but a physiotherapy assessment gives a far more accurate picture. We use it alongside a functional assessment of how your deep core is actually working, not just the size of the gap.

Is DRAM Linked to Back Pain?

This is an area the research has continued to explore. Older guidance often stated there was no link at all between DRAM and low back pain, but that is not always what we would see clinically. More recent systematic reviews paint a more nuanced picture: some studies have found a weak association between DRAM and low back or pelvic girdle pain, while others have found no difference between women with and without DRAM. What’s more consistently supported is a link between DRAM and reduced abdominal muscle strength and abdominal pain. Some newer research has also explored a possible relationship between DRAM and pelvic floor dysfunction, though findings here are still mixed and this remains an active area of study. In short, DRAM on its own doesn’t guarantee pain or dysfunction, but if you’re experiencing back, pelvic, or pelvic floor symptoms alongside it, it’s worth having both assessed together. This is exactly what we do in a postnatal physiotherapy assessment or pelvic health physiotherapy assessment, depending on what your main concerns are.

What Helps DRAM Recovery?

This is where the research has genuinely moved forward, with consistent findings that structured, supervised abdominal and core exercise programs significantly reduce inter-rectus distance compared to no treatment. Because every body and every birth is different, we recommend an individualised program rather than a generic one-size-fits-all routine.

Things to be mindful of in the early weeks

In the early weeks postpartum, and until you’ve been assessed by your physio, it’s sensible to avoid movements that place excessive strain through the midline, such as:

• Sitting straight up from lying (log-roll onto your side first instead)
• Lifting or pushing anything heavier than your baby
• Heavy housework, vacuuming, or moving furniture
• Heavy gym lifting or high-load ab work
• Vigorous or unsupervised abdominal exercises before assessment

There is no fixed timeframe that applies to everyone; the right time to progress your exercise will depend on your symptoms, your birth, and how your body is responding, which is why an early assessment is so valuable.

What actually helps

Guided, progressive core exercise: gradually loaded exercise programs (including curl-up/crunch-type movements once appropriately progressed) are more effective for closing the gap than avoidance alone.

Comprehensive core training: current evidence favours programs that engage both the deep and superficial abdominal muscles in combination with functional movement, rather than deep core activation (such as “draw your belly button in”) in isolation.

Clinical Pilates: regular, appropriately modified Pilates throughout pregnancy and postpartum is associated with better abdominal wall outcomes, which is why it’s a core part of our program here at Inner Strength Bayside.

Individualised assessment, because what helps one person’s DRAM can aggravate another’s, depending on presentation.

What About Abdominal Binders and Support Garments?

Wearing an abdominal binder or support garment in the early weeks postpartum can help some women feel more supported and may assist short-term recovery, particularly immediately after birth or caesarean section. However, current evidence suggests binders work best alongside an active, exercise-based recovery program rather than in place of one. We’re happy to talk through whether a support garment is appropriate for you as part of your assessment.

What Is Abdominal “Doming” or “Coning”?

Doming (or coning) is when the tummy bulges or ridges along the midline during exertion, for example when sitting up from lying. It reflects poor coordination of intra-abdominal pressure and reduced control across the whole abdominal canister, rather than the outer abdominal muscles simply being “too strong.” Doming can be a visible sign associated with DRAM, but the two aren’t the same thing, and doming can occur even in the absence of significant separation.

Ready to Get Started?

Every postpartum body is different, and the most effective DRAM recovery program is one tailored to you, your birth, your symptoms, and your goals. At Inner Strength Bayside, our physiotherapists who are trained in women’s health, provide individualised postnatal assessments, combining pelvic floor and pelvic health physiotherapy with core rehabilitation, Mums & Bubs sessions, and Clinical Pilates, so you can rebuild strength safely and confidently.

If you’d like support, our team is here to help. Call us on (03) 8555 4099

Click here to book an initial physiotherapy or pelvic health appointment.

This article is general information and is not a substitute for individual physiotherapy assessment. If you have concerns about abdominal separation, pelvic floor symptoms, or postpartum recovery, please book an assessment with one of our physiotherapists.

Written by Caitlin Collenette, Physiotherapist

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