The abdominal wall is made up of lines of dense connective tissue, running vertically and horizontally through the top layer of abdominal muscle (the rectus abdominis). The muscle is separated in this ‘six pack’ fashion so that it makes it much easier to stretch and give during an advancing pregnancy – the human body really is so incredible.  

A Rectus Abdominis Diastasis (RAD) is the name given when the middle vertical line widens and stretches (it’s not an actual physical gap or separation or split in the muscles!). This is most commonly due to pregnancy but can also be seen at other times too with prolonged abdominal distension. A RAD is a completely normal and necessary part of the physiological changes that occur during pregnancy and we should not be trying to prevent this. It has been observed in up to 100% of pregnancies that reach 35 weeks (1). 

Most (66%) RAD resolve on their own within the first eight weeks after delivery. Specific rehabilitation exercises may have to be undertaken, if the RAD has not resolved itself after the first eight weeks (2). Unresolved RAD is especially important in sports such as golf due to the reduction in trunk strength and rotational power(3). 

How will you know if you have an unresolved RAD? 

You might not know. A RAD is not painful and there is no set list of signs and symptoms. Sometimes people who have an ongoing RAD report still looking pregnant (having a bump still in the early days and weeks post-natally are entirely normal). With an unresolved RAD, you might see ‘doming’ along the midline during movement and tasks that use your abdominal muscles (see diagram – doming on left and non-doming midline on right).  

The type of delivery you had, if it’s your second or more, has been shown to have some influence on the presence of an unresolved RAD or not. Those who have had two C-sections had a higher rate of RAD when compared with those who have had two vaginal deliveries(4). 

  A pelvic health physiotherapist is the best person to check you for a RAD and to then give you tailored exercises to resolve it if necessary. The exercises will need to include movements that load and challenge your abdominal wall in order to strengthen the muscles and connective tissue again. 

Is there anything you can do to increase the chances of natural recovery in the first few weeks after delivery?

  • Diaphragmatic breathing

  • Take the first six weeks seriously – rest and recovery

  • Pelvic floor exercises

  • Staying well hydrated

  • Eating a nutritious diet, especially with regular sources of protein

  • Build up to short daily walks (as circumstances allow, e.g., 10-minute walks from two weeks, 20 minutes from four weeks and 30 minutes from six weeks)

References

[1] Fernandes da Mota et al (2015). Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Man Ther 2015 Feb;20(1):200-5. doi: 10.1016/j.math.2014.09.002 

[2] Coldron et al (2008). Postpartum characteristics of rectus abdominis on ultrasound imaging. Manual Therapy, May;13(2):112-21.  

[3] Jackson et al (2022). The Legacy of Pregnancy: Elite Athletes and Women in Arduous Occupations. Exerc. Sport Sci. Rev., Vol. 50, No. 1, pp. 14–24  

[4] Turan et al (2011). Prevalence of diastasis recti abdominis in the population of young multiparous adults in Turkey. Ginekol Pol, Nov;82(11):817-21.