Diastasis Recti After Pregnancy: What It Is and When Physiotherapy Helps

About 60 percent of women have some degree of abdominal separation by the third trimester of pregnancy. By six weeks postpartum, some of that has already closed on its own. For a significant number of women, it has not. The advice they receive at that point is often incomplete.

This post covers what diastasis recti actually is, what the evidence says about exercise and recovery, and when a pelvic floor physiotherapist can help.

What Diastasis Recti Actually Is

Diastasis recti is a separation of the linea alba, the band of connective tissue that runs vertically down the centre of the abdomen. It connects the two sides of the rectus abdominis (the paired muscles that run from your ribs to your pelvis), but the muscles themselves do not split. The tissue between them stretches and loses tension as the uterus expands during pregnancy.

The clinical term for the gap is the inter-recti distance. Most definitions use a threshold of 2 cm or more at the navel to classify a separation as clinically significant, though research uses varying thresholds, which is part of why the literature can feel contradictory.

The Finger-Width Test Is a Starting Point, Not a Verdict

You may have heard of checking for diastasis recti by lying on your back, lifting your head, and counting how many fingers fit into the gap at your navel. This is a rough guide at best.

Gap width matters, but tissue tension matters more. A separation that is 3 cm wide with good tissue tension, meaning the linea alba firms up when you load it, often functions better than a 1.5 cm gap where the tissue offers no resistance at all. Finger-width counting does not measure tension. It only measures width.

A physiotherapy assessment checks both. The clinician is looking at how the tissue responds when you breathe, bear down, or try to generate force. Not just how wide the gap is when you're relaxed.

Natural Resolution: What to Expect in the First Eight Weeks

Most cases of diastasis recti narrow substantially within six to eight weeks postpartum. The body's natural repair process, combined with the reduction in uterine size, accounts for much of this improvement without any specific intervention.

This is why the six-week postpartum check feels like a clearance. In many cases, it is. But there are two things the six-week check does not tell you. First, it does not measure tissue tension or functional load capacity. It only tells you whether the gap has narrowed. Second, even a fully closed gap does not mean the deep core system (the transversus abdominis and pelvic floor working together) has recovered its coordination. That takes longer, and it often needs guidance.

What the Evidence Actually Says About Exercise

The old rule (avoid crunches, avoid sit-ups, avoid anything that makes your belly dome) is not wrong, exactly. But it is oversimplified in a way that leaves many women avoiding exercise unnecessarily for months.

What the evidence points to is this: the problem is intra-abdominal pressure management, not specific exercises. A crunch creates intra-abdominal pressure. So does picking up a heavy grocery bag, coughing, sneezing, or carrying a toddler on your hip. Avoiding crunches while doing all of those other things without modification does not actually reduce your pressure load. It just makes you feel like you are doing something.

The question a physiotherapist is asking is not "is she doing crunches?" It is "can she manage pressure through her core and pelvic floor effectively during loaded movement?" If the answer is yes, a lot of exercises that are on the prohibited list become fine. If the answer is no, some movements that seem benign (like certain breathing patterns) are worth modifying first.

Signs That Warrant a Physiotherapy Assessment

Not every case of diastasis recti requires treatment. If the tissue is closing well, there are no pelvic floor symptoms, and you can load your core without visible coning or doming, you may be recovering on track.

The signs that a pelvic floor physiotherapist can help include:

Visible coning or doming. When you do any kind of forward flexion (getting up from lying down, doing an abdominal exercise, or even sitting up quickly from a reclining position), the tissue at the midline protrudes in a cone or dome shape rather than staying flat. This tells you that load is not distributing across the abdominal wall the way it should.

Pelvic floor symptoms alongside the separation. Diastasis recti and pelvic floor dysfunction often appear together. If you are experiencing any leaking with activity (running, jumping, sneezing), a feeling of heaviness or pressure in the pelvis, or difficulty with bladder urgency, the two conditions are likely connected and benefit from being treated together.

Persistent core weakness past three to four months postpartum. Some loss of core strength is normal in the early weeks. If you are still struggling to generate any meaningful core engagement, or if you feel like your midsection is not responding to exercise, a functional assessment can identify why.

Pain. Low back pain, pelvic girdle pain, or discomfort around the pubic symphysis that is not resolving are all reasons to be assessed.

What a Physiotherapy Assessment Covers

A pelvic floor physiotherapy assessment for diastasis recti is not just a measuring exercise. The clinician will assess:

The quality and tension of the linea alba tissue, not just the gap width. How the deep core (specifically the transversus abdominis) activates relative to the pelvic floor. Whether your breathing mechanics are loading the linea alba in a way that works against healing. How you manage pressure during functional movements: getting up from the floor, lifting, carrying.

From there, the program is built around restoring coordination and load capacity, not around a list of exercises to avoid. The early stages often focus on breath work and low-load movement. The later stages progress to the full range of things you actually need to do: lifting, running, returning to sport, and carrying children.

The Connection Between Diastasis Recti and Pelvic Floor Health

The two structures are functionally linked. The linea alba, the pelvic floor, the transversus abdominis, and the deep spinal muscles all contribute to a pressure management system. When one part loses function, the others are affected.

This is why treating diastasis recti in isolation, without addressing pelvic floor coordination, often produces incomplete results. A physiotherapist who specialises in pelvic health treats both together.

Coverage in BC

Pelvic floor physiotherapy is covered by most extended health plans in BC. The session is coded as a standard physiotherapy visit. At Launch Rehab, we offer direct billing to the major extended health insurers, which means you do not need to pay out of pocket and wait for reimbursement.

If you are in the Metro Vancouver area and want to know whether your plan covers this, call the clinic nearest to you before booking and we can check your benefits.

Booking at Launch Rehab

Our pelvic floor physiotherapists work across all five of our Metro Vancouver studios: Lougheed, North Burnaby, Coquitlam, Richmond, and New Westminster. You can book directly at launch.janeapp.com and select the studio closest to you. If you are not sure which therapist to see, book a physiotherapy initial assessment and note that your concern is postpartum core or pelvic health. We will match you to the right clinician.

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This post is for general education. It is not a substitute for assessment or advice from a regulated health professional.