Abdominal separation (diastasis recti)

Where are my abdominal muscles?

Think about the area on your tummy where the ‘six-pack’ muscles appear. This is the area we mean when we talk about the abdominal muscles.

There are several different abdominal muscles:

• the external oblique muscles
• the internal oblique muscles
• the rectus abdominis muscles
• the transversus abdominis muscles

Your abdominal muscles support your body and give you core stability.

What is abdominal separation?

Abdominal separation is a common condition. It is also called ‘diastasis recti’ or ‘DRAM’ (diastasis of rectus abdominis muscle).

The long muscles of your abdomen (rectus abdominis) run from your chest to your pelvis. They lie just under the skin, down the middle of your belly. Abdominal separation is when these 2 long muscles separate from each other.

Abdominal separation may start in the second half of your pregnancy. It’s a natural adaption to your growing baby.

Abdominal separation often gets better in the first 6 to 8 weeks after having your baby.

What are the signs and symptoms of abdominal separation?

If you have abdominal separation you may be able to see a gap between your abdominal muscles. The separation isn’t painful.

You may feel that your core has become weak, for example when lifting something like a laundry basket.

You can check if you have an abdominal separation by trying this:

• lie on your back with your knees bent up
• place your flat fingertips across your belly at the level of your belly button
• lift your head and shoulders away from the floor and feel for the sides of your abdominal muscles coming together
• if you can feel a gap wider than one finger, then you may have a separation

You might also notice a canoe-shaped ’pouch’ in the middle of your stomach. This is easier to see when your abdominal muscles are being used. You can look when you try to sit up from lying down.

If you have abdominal separation, you may also get lower back pain. This is because your abdominal muscles also support your back. When these muscles are stretched and separated, they don’t work so well.

People with abdominal separation can also have pelvic floor issues.

If you think you may have abdominal separation, see your doctor or maternal health service.

What causes abdominal separation?

Abdominal separation is due to:

• the pressure of your growing baby
• stretching of the muscles and connective tissue in your abdomen
• the hormonal changes that take place during pregnancy
• weight gain

Abdominal separation is more likely if you:

• have had more than one pregnancy
• are aged over 35 years
• are having twins or triplets (or more)
• are overweight or obese

Any activity that involves raising the pressure in your abdomen can add to abdominal separation. For example, pushing during the labour and delivery of your baby, straining on the toilet, and being overweight.

How is abdominal separation diagnosed?

Your doctor, midwife or physiotherapist can check to see if you have an abdominal separation. They can measure the separation with:

• their fingers
• a measuring tape
• by ultrasound

Does abdominal separation go away by itself?

Abdominal separation usually goes away in the weeks after the birth of your baby. Up to 1 in 3 people still report an abdominal separation a year after the birth.

How can abdominal separation be prevented during pregnancy?

Strengthening your core muscles before you get pregnant or in the early stages of pregnancy might help you avoid abdominal separation.

Exercise during pregnancy can help you to get fit for the birth and labour.

You can do exercises to strengthen your deep abdominal and pelvic floor muscles. A safe way to do this and improve core strength is by drawing in your muscles without moving your spine. To do this, try to imagine sucking your belly button in towards your spine.

Try not to put too much strain on your outer abdominal muscles while pregnant.

Try not to cough a lot or get constipated. See your doctor or pharmacist for advice on how to manage a cough or constipation.

How can I strengthen my abdominal muscles?

Doing abdominal exercises every day after you give birth can help you regain your strength and help with back and stomach support. Don't do sit-ups for at least 12 weeks after giving birth. Instead, it's best to do pelvic tilts and abdominal bracing exercises.

To perform pelvic tilts:

• lie, stand or sit with your knees bent and your feet flat
• gently flatten the curve of your lower back by tilting your pelvis backwards
• hold for 3 to 5 seconds
• repeat 5 to 10 times

To perform abdominal bracing:

• lie, sit or stand
• gently draw your belly button in towards your spine
• hold for 5 to 10 seconds
• repeat 5 to 10 times

How is abdominal separation after the birth treated?

Try these tips to stop your separation getting worse:

• don’t lift things that weigh more than your baby
• roll onto your side when getting out of bed or sitting up
• choose exercises that strengthen your deeper stomach muscles
• skip activities and movements that can make abdominal separation worse, such as sit-ups (crunches), oblique curls and some yoga poses

There is a good chance that with time and care, your muscles will come back together.

If you have abdominal muscle separation, your doctor may refer you to a specialist physiotherapist. They will give you a special exercise program.

You can also wear a supportive brace or special underwear to help support your back.

If your abdominal separation continues to limit your ability to do daily tasks you can ask your doctor about surgery.

Resources and support

If you notice that your stomach muscles feel different you can check with your doctor, midwife or physiotherapist.

You can find a physiotherapist near you using the Service Finder.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

You can read more about physiotherapy after pregnancy here.

You can learn more about your pelvic floor at Pelvic Floor First.