Advice and Management of Diastasis Rectus Abdominis

You may notice your abdomen ‘doming’ or see a gap between the muscles down the middle of your abdomen when doing certain movements. If you notice this you should try to modify how you do these movements and use your deep abdominal muscles.

After your baby is born you may still notice a gap or doming between your abdominal muscles during certain movements or activities; you should still try to modify these movements.

You may also experience lower back pain or feel a general weakness around your stomach area and ‘core’ muscles. Your pelvic floor muscles work with your abdominal muscles to support your back and pelvis. They also support your pelvic organs and are involved in bladder and bowel control and sexual function.

You should try the following exercises to strengthen your deep abdominal muscles and your pelvic floor muscles.

Your pelvic floor muscles work with your deep abdominal muscles to provide support around the lower abdominal area.

How do I do a pelvic floor “squeeze”?

Tighten the muscles around your back passage, vagina and front passage as if trying to stop yourself passing wind and urine at the same time. Do not stop and start your urine flow when going to the toilet. This is not a recommended form of pelvic floor exercise.

You should aim to do 10 long holds and 10 short holds 3 times each day

Practice these in lying or sitting to start with and then aim to progress into standing. Apps such as Squeezy can be helpful to get you into a good routine. For the first 12 weeks after delivery you should do these 5-6 times per day

Long holds

This helps build strength and endurance.

• Hold this contraction for up to 10 seconds.
• Rest for 10 seconds, then repeat until the muscles get tired or for a maximum of 10 repetitions.

Short holds 

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

• Tighten the pelvic floor muscles and then relax them fully.
• Repeat this, tightening and relaxing steadily up to 10 times. Aim for a strong muscle tightening with each contraction.

Your deep abdominal muscles help to support and strengthen your back and pelvis.

Draw your lower tummy muscles in towards your spine. Hold this position for up to 10 seconds as you continue to breathe normally. Avoid bracing your whole tummy or holding your breath.

You can exercise these muscles in any position; for example standing, sitting, lying down or on all fours.

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 5 seconds and then bring back to the resting position. Repeat up to 8-10 times alternating arms. 

To progress further, extend one leg behind as you keep your abdominal muscles drawn in. Be careful to keep your pelvis and back still and level as you extend the leg behind. Hold for up to 5 seconds and then repeat 8-10 times alternating each leg. 

•  ​​​​​​Avoid sit ups / stomach crunches or similar exercises unless guided by your physiotherapist.

• If you have to lift something heavy, try to bend down on one knee rather than bending from your back (see picture). Draw in your lower tummy muscles and buttock muscles to help support your back and pelvis as you return to standing.
• Ensure good posture when bathing or caring for your baby. Ensure surfaces are at the right height for you to prevent stooping down or reaching up.
• Avoid straining on the toilet. Sit down fully on the toilet, with your feet raised up on a step 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 unsure of what abdominal exercises to do or to avoid then please ask your physiotherapist.

If you feel this is not improving or you are concerned about your abdominal muscles after delivery then please contact your GP and request a referral to your local physiotherapy service. Please note that unfortunately we are unable to see women after 6 weeks following delivery.

Pelvic (Women’s) Health Physiotherapy, Elizabeth Garrett Anderson Wing, UCLH 25 Grafton Way, London, WC1E 6DB

Voicemail service: 0203 447 6546

Switch board: 020 3456 789