Diastasis rectus abdominus muscle – advice and management

Your stomach has 4 layers of muscles. The top layer is called the rectus abdominis.
It runs from the bottom of your ribs down to your pelvis. It has 2 sides (left and right).
The two sides are joined in the middle by a strong band called the linea alba.
During pregnancy, your body makes hormones that change how your muscles and ligaments work.
These hormones make your muscles and ligaments softer and more relaxed.
This helps your body get ready for pregnancy and giving birth.
As your hormones change and your baby grows, your womb (uterus) gets bigger.
This can make the tissue between your stomach muscles stretch, becoming thinner and wider.
This is normal during pregnancy and after having a baby.
Many women get this condition during pregnancy: about 33% by the second trimester, and up to 100% by the third trimester.

Diastasis rectus abdominus muscle graphic

You may see your stomach bulge or “dome” in the middle when you move in certain ways.
You might also notice a gap between your stomach muscles down the centre.
If this happens, try to change how you move. Use your deep stomach muscles to help support your body.

After your baby is born, you might still see a gap or bulging (doming) in your stomach muscles during some movements.
If this happens, try to change how you move to make it easier on your body
You may also have lower back pain or feel weak in your stomach and core muscles.
Your pelvic floor muscles work together with your tummy muscles to support your back and pelvis.
They also help support your bladder, bowel, and sexual function.
Try the exercises below to help strengthen your deep stomach and pelvic floor muscles.

Deep Abdominal Exercise

Your deep abdominal muscles help to support and strengthen your back and pelvis.
Gently draw lower tummy muscles in towards your spine. Hold this position for up to 10 seconds as you continue to breathe normally. Avoid bracing your abdomen or holding your breath. Rest for 5-10 seconds, then repeat until you get tired or for a maximum of 10 repetitions.
You can exercise these muscles in any position; for example, lying on your side, sitting, on all fours and standing.

Deep Abdominal Exercise

To progress this exercise, lift one arm in front whilst you keep your deep abdominal muscles drawn in. Keep your shoulder blades still and your back level. Hold this position for up to 10 seconds and then bring back to the resting position. Repeat up to 8-10 times alternating arms.

Tighten the muscles around your back passage (bottom), vagina, and front passage (urethra)
It should feel like you are trying to stop yourself from passing wind and urine (pee) at the same time
Don’t stop and start your pee when you go to the toilet
This is not a safe or recommended way to exercise your pelvic floor muscles
You should aim to do 10 long holds and 10 short lifts 3 times each day.
Practice these in lying or sitting to start with and then aim to progress into standing.
Apps such as NHS Squeezy can be helpful to get you into a good routine. For the first 12 weeks postnatal you should do these 5-6 times per day.

This helps make your muscles stronger and able to work for longer.

This helps the pelvic floor so that it can react to stresses such as coughing, laughing or exercise.

Avoid heavy lifting graphic

Avoid sit ups/stomach crunches or similar exercises.
Try to avoid heavy lifting. If you must lift, try to bend down on one knee rather than bending from your back (see picture). Draw in your lower stomach muscles and buttock (bottom) muscles to help support your back and pelvis as you return to standing.
Keep good posture when bathing or caring for your baby.
Make sure surfaces are at a comfortable height.
This helps you avoid bending too far down or reaching too high.
Avoid straining on the toilet. Sit down fully on the toilet, with your feet supported on a stool and your arms resting comfortably on your legs.
Take care getting in and out of bed. Try to bend your knees, roll on to your side and use your arms to push yourself up.
If you are not sure which stomach exercises to do or avoid, ask your physiotherapist for advice

If things are not getting better, or you are worried about your stomach muscles during or after pregnancy, speak to your GP.
Ask your GP to refer you to your local physiotherapy service