Clinically reviewed by What is diastasis recti
Diastasis recti is a widening of the gap between the two halves of the straight abdominal muscle at the front of your stomach. The two sides are joined by a band of tissue that stretches in pregnancy to make room for the baby.
Most women have some separation by the end of pregnancy. It is a normal adaptation, not an injury, and most of it narrows on its own in the first two months after delivery. In around a third it is still there six to twelve months later, which is when it is worth treating. Locally it is described as pait ka bahar nikla rehna.
The bulge is not fat. It is a soft midline that is not holding pressure.
Symptoms you might have
- A gap you can feel down the middle of your stomach, above or below the navel
- A ridge or dome that pops up along the midline when you sit up from lying
- A stomach that still looks pregnant months after delivery, whatever your weight
- Lower back pain, usually worse by the end of the day
- Leaking urine or a heaviness low down, because the pelvic floor almost always needs work too
Why it happens
- Pregnancy, which is the cause in almost every case
- A large baby, twins or more, or a lot of fluid
- Several pregnancies close together
- Crunches, sit ups and planks continued into pregnancy or restarted too early afterwards
- Repeated heavy lifting with a held breath, including an older toddler and buckets of water
- Chronic constipation and straining
- Sitting straight up out of bed instead of rolling onto your side
When you should see a physiotherapist
Come any time after your six week check, once your doctor has cleared you for exercise. If the stomach still bulges at three months, that is a sensible time to start, and it is still treatable years later.
If you had a caesarean, the scar needs to be fully healed first. The c-section recovery page covers the order of events.
See a doctor if there is a soft lump at your navel or along the midline that stays up when you relax, is tender, or will not push back in. That may be a hernia, which is a surgical question.
Go to a hospital immediately if a lump in the abdomen becomes hard and painful with vomiting or fever. A trapped hernia is an emergency.
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How it is treated
The assessment measures how wide the gap is, how deep it is, and whether the midline tightens when you work. Tension matters more than width. A narrow gap that cannot hold pressure is a worse problem than a wider gap that can.
- Breathing retraining, so the diaphragm, abdominal wall and pelvic floor work together instead of against each other
- Deep abdominal activation, learning to draw the lower stomach in gently without gripping or holding the breath
- Pelvic floor training alongside it, because the two nearly always need treating together
- Graded loading, progressing from lying, to side lying, to all fours, to standing, and finally to real lifting
- Manual therapy to the lower back, ribs and hips, which get stiff while the middle is weak
- A support binder for the early weeks if it makes you more comfortable, worn for activity and not all day. It does not close the gap by itself
Surgery is not the first answer. A repair is a surgeon's decision, considered for a true hernia or a large separation still causing problems after six months of proper training. Electrotherapy, ultrasound, TENS and dry needling are not used over a caesarean scar.
Exercises, and what to avoid
What helps
- Breathing on your back with knees bent, feeling the lower stomach draw in as you breathe out
- Heel slides and single leg taps, keeping the midline flat and the breath moving
- Side lying and all fours work, which load the abdomen without pushing it forward
- Standing strength and sit to stand as control improves, because real life is upright
What to avoid
- Sit ups, crunches and double leg lowering. They raise the pressure inside the abdomen and push the two sides apart
- Planks and press ups until the midline can hold pressure without doming
- Any exercise where you can see a ridge appear along the middle. That dome is the signal to stop
- Bracing hard and holding your breath to lift, and sitting straight up out of bed
What you can do at home
The self check: lie on your back with knees bent. Place two or three fingers across the midline just above the navel and lift your head a little. Feel how many finger widths wide the gap is, and whether it feels like a firm floor or a soft hole.
Up to about two finger widths is normal. Wider than that, or a soft base you can sink into, is worth assessing.
Roll onto your side to get out of bed, every single time. This one habit protects the midline more than any exercise.
Breathe out as you lift the baby, stand up or carry anything, and never lift with a held breath. Deal with constipation, because straining pushes outwards on the weakest point.
Heat and ice are not treatments here.
How long it takes
In the first eight weeks after delivery most of the narrowing happens on its own. Work in that window is breathing, posture and gentle activation, not chasing the gap.
With a programme started after the six week check, most women see a useful change in the gap and a bigger change in how the middle works within eight to twelve weeks, improving further over three to six months.
An old separation, five or ten years on, still responds, but expect about six months of consistent work.
Be aware the gap may not reach zero, and it does not need to. A midline that holds pressure, no doming when you lift and no back pain is a good result even with a small gap remaining.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
حمل کے دوران پیٹ کے درمیانی پٹھے الگ ہو جاتے ہیں۔ اس کو ڈائسٹیسس ریکٹائی کہتے ہیں۔ زچگی کے بعد پہلے دو مہینے میں یہ خود کافی ٹھیک ہو جاتا ہے۔
اگر کچھ مہینے بعد بھی پیٹ باہر نکلا رہے اور درمیان میں نرم جگہ محسوس ہو، تو علاج سے فائدہ ہوتا ہے۔ یہ چربی نہیں ہے۔
بیٹھنا اپس، کرنچز اور پلینک اس مسئلے کو بڑھا دیتے ہیں۔ ان سے پرہیز کریں۔
فائدہ سانس کی ورزش، پیٹ کے اندر کے پٹھوں کی ورزش، پیڑو کے پٹھے کی ورزش، اور وزن اٹھاتے وقت سانس باہر چھوڑنے سے ہوتا ہے۔ بستر سے اٹھتے وقت پہلے کروٹ لیں۔
ناف پر نرم گانٹھ ہو جو اندر نہ جائے تو ڈاکٹر سے ملیں۔ ورزش سے پہلے ڈاکٹر سے اجازت ضروری ہے۔
Roman Urdu
Hamal ke doran pait ke darmiyani pathay alag ho jate hain. Is ko diastasis recti kehte hain. Delivery ke baad pehle do mahine mein ye khud kaafi theek ho jata hai.
Agar kuch mahine baad bhi pait bahar nikla rahe aur darmiyan mein naram jagah mehsoos ho, to ilaj se faida hota hai. Ye charbi nahi hai.
Sit ups, crunches aur plank is masle ko barha dete hain. In se parhez karen.
Faida saans ki warzish, pait ke andar ke pathon ki warzish, pelvic floor ki warzish, aur wazan uthate waqt saans bahar chhorne se hota hai. Bistar se uthte waqt pehle karwat len.
Naaf par naram ganth ho jo andar na jaye to doctor se milen. Warzish se pehle doctor se ijazat zaroori hai.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
How do I know if I have diastasis recti?
Will abdominal separation close on its own?
Can it be fixed years after my last baby?
Why are crunches bad for diastasis recti?
Does a belly binder close the gap?
Related conditions
- Pelvic floor weakness and exercises
- Back pain in pregnancy
- Lower back pain in women
- Recovery after a C-section
- Pelvic girdle pain treatment