How Pelvic Floor Physical Therapy Treats Diastasis Recti

    Have you noticed a bulge or ridge running down the center of your belly? Do you feel like your core is weak or unsteady, or are you experiencing persistent back pain or changes in posture? If so, you might be dealing with diastasis recti, a condition that’s more common than you think, especially among women during and after pregnancy. But don’t worry—you’re not alone, and there are effective ways to heal and regain your strength.

    What Is Diastasis Recti?

    Diastasis recti happens when the connective tissue between your abdominal muscles stretches and thins, causing the left and right sides of your abdominal muscles to pull apart. This creates a gap or separation in the middle of your belly. While some stretching is normal during pregnancy to make room for your baby, the condition becomes problematic when the muscles don’t come back together after childbirth.

    Other Names for Diastasis Recti

    • Abdominal separation
    • Postpartum belly gap
    • Rectus diastasis

    While diastasis recti is most commonly associated with pregnancy, it can also occur in men, older adults, or anyone who’s experienced significant strain on their abdominal wall, such as from weightlifting, rapid weight gain, or abdominal surgery.

    How to Recognize Diastasis Recti

    Diastasis recti can present in several ways. If you have this condition, you might notice:

    • A bulge or ridge running down the center of your belly: This is often most noticeable when you sit up from a lying position.
    • Weakness in your core: You might feel that your abdominal muscles aren’t as strong or connected as they should be.
    • Lower back pain: Core weakness can cause your back muscles to overcompensate, leading to discomfort or pain.
    • Postural changes: You might notice a swayback or other shifts in your alignment.
    • Pelvic floor issues: These can include bladder leaks or a feeling of pressure in your pelvic area.
    • Digestive issues: Bloating or constipation can sometimes accompany this condition.

    What Causes Diastasis Recti?

    Diastasis recti occurs when there’s too much pressure on the abdominal wall, causing the connective tissue (called the linea alba) to stretch and weaken. Here are some common causes:

    1. Pregnancy:
      • The growing uterus stretches your abdominal muscles and connective tissue.
      • Hormonal changes, like increased levels of relaxin, soften connective tissue.
      • Multiple pregnancies or carrying large babies increase the risk.
    2. Improper Exercise: Exercises like crunches or heavy lifting without proper technique can strain the abdominal wall.
    3. Rapid Weight Gain or Obesity: Excess fat around the abdomen increases pressure on the muscles and connective tissue.
    4. Chronic Cough or Straining: Repeated coughing or straining (e.g., during bowel movements) can lead to abdominal separation.
    5. Genetics: Some people have naturally weaker connective tissue, making them more prone to diastasis recti.

    How Is Diastasis Recti Diagnosed?

    A simple physical exam is often enough to diagnose diastasis recti. During the exam, you’ll lie on your back and lift your head slightly while your healthcare provider or pelvic floor physical therapist checks the gap between your abdominal muscles. A gap wider than two fingers is typically considered diastasis recti.

    Photo of manual therapy for diastasis recti
    Manual therapy is an important component of treatment of diastasis recti

      The Role of Pelvic Floor Physical Therapy in Healing

      If you’ve been told to "just do crunches" or "give it time," you’ll be happy to know that pelvic floor physical therapy offers a much more effective and realistic solution. This specialized therapy focuses on safely strengthening your core and pelvic floor, which are essential for healing diastasis recti.

      Here’s how pelvic floor physical therapy can help:

      • Core Strengthening Exercises: Learn gentle, targeted movements that engage your deep abdominal muscles (like the transverse abdominis) without worsening the separation.
      • Breathing Techniques: Proper breathing, like diaphragmatic breathing, reduces pressure on the abdominal wall and promotes healing.
      • Postural Corrections: Your therapist will help you improve your posture to reduce strain on your core and back.
      • Hands-On Techniques: Manual therapy can release tension in surrounding muscles and improve blood flow to the area. 
      • Safe Movement Education: You’ll learn how to move, lift, and even get out of bed in ways that protect your abdominal muscles and speed recovery.

      Other Treatment Options

      While pelvic floor physical therapy is highly effective, additional treatments may be helpful for some people:

      • Abdominal Support Garments: Postpartum belly bands can provide gentle compression and support during the healing process.
      • Surgical Repair: In severe cases, surgery (like a tummy tuck) may be recommended to close the gap. With pelvic floor therapy, you are likely to fully recover without the need for any surgical intervention or the pain and recovery it then requires.

      Preventing Diastasis Recti

      Although diastasis recti isn’t always preventable, you can reduce your risk with these tips. Working with Joint Action before and/or during your pregnancy is a fantastic way to speed recovery postpartum and potentially avoid diastasis recti entirely.

      • Strengthen Your Core Before Pregnancy: A strong core helps your abdominal muscles handle the demands of pregnancy.
      • Practice Safe Exercises During Pregnancy: Focus on core-safe movements and avoid high-impact or strenuous activities.
      • Use a Maternity Belt: Wearing a supportive belt during pregnancy can reduce pressure on your abdominal wall.
      • Learn Proper Techniques: Avoid movements like jackknife sit-ups or heavy lifting without proper form.
      • Start Recovery Early Postpartum: Begin with gentle pelvic floor and core exercises as soon as your healthcare provider gives the go-ahead.

        Why Choose Pelvic Floor Physical Therapy?

        Unlike general physical therapy, pelvic floor PT is tailored to address the unique needs of the core and pelvic floor. At Joint Action Pelvic Health, we offer personalized, one-on-one care to help you heal diastasis recti, reduce pain, and rebuild your confidence. We understand how this condition can impact your daily life, and we’re here to guide you every step of the way.

        Let’s Work Together

        Are you ready to feel strong and supported in your body again? At Joint Action Pelvic Health, our mission is to help you regain your strength and confidence. Schedule a consultation and take the first step toward healing diastasis recti. You deserve to feel your best—and we’re here to help you get there.

        Request Initial Consultation

        Additional Sources:

        • Mota, P., Pascoal, A. G., Sancho, F., & Bo, K. (2015). Diastasis recti abdominis in pregnancy and postpartum period: Risk factors, functional implications, and resolution. Physical Therapy in Sport, 16(1), 38-46.
        • Benjamin, D. R., van de Water, A. T., & Peiris, C. L. (2014). Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: A systematic review. Physiotherapy, 100(1), 1-8.
        Heather Luckey, PT, DPT, OCS

        Heather Luckey, PT, DPT, OCS

        Principal Practitioner Joint Action Physical Therapy
        http://www.jointactionpt.com/

        Heather Luckey is a leading expert in pelvic floor physical therapy. With a Doctorate in Physical Therapy, the distinction of being Board Certified in Orthopaedic Physical Therapy, and as a Pregnancy and Postpartum Corrective Exercise Specialist, Heather is among the top professionals in her field.

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