You Have Diastasis Recti. Now What?

Alright, so you went to your 6 week appointment and your doctor said something about a gap. Next, you went down a google rabbit hole at 11pm with someone at Mayo or Cleveland Clinics or WebMD saying you’ll never do crunches again and you might need surgery. Maybe a friend posed the idea that the reason your core looks and feels different is because of diastasis. So, now you are now staring at this diagnosis wondering what on earth you are supposed to do with it.

Here is the good news: diastasis recti is very treatable. And the approach that actually works is probably not what you have been reading about online.

First, Take a Breath

Diastasis recti is not an emergency. It is not a reason to stop exercising, avoid lifting your kids, or spend the next six months doing nothing but bird dogs and dead bugs. It is a change in how your core system is functioning, and like any other system in your body, it responds really well to the right kind of input.

Research shows that diastasis recti affects a significant number of postpartum women, with a prevalence of around 60% at six weeks postpartum and 30% at twelve months.[1] That means you are far from alone, and the fact that it does not always resolve on its own is not a reflection of anything you did wrong. It just means your body needs some targeted support to get things working well again.

What Recovery Actually Looks Like

Diastasis recovery is not linear and it is not one size fits all. What it does follow is a general progression that moves from reconnection and coordination, to building load capacity, to full strength and function. Here is what that tends to look like in practice:

Phase one is about reconnection. Before you can strengthen something, you need to be able to feel it and coordinate it. This phase focuses on breathing mechanics, learning how to manage intra-abdominal pressure, and reconnecting the deep core system (the diaphragm, the pelvic floor, the transverse abdominis) so they are working as a team again. This is not the fun work but it is the foundation everything else is built on.

Phase two is building capacity. Once the system is coordinating well, you start progressively loading it. This means graduating from foundational movements to more challenging ones, adding resistance, and training across multiple planes of movement. Bending, lifting, twisting. Not just lying on your back doing isolated core contractions. Research supports that exercise programs focusing on deep and superficial muscles, pelvic floor coordination, and functional movements show promising results in reducing diastasis and improving related dysfunction.[2]

Phase three is return to full activity. This is where you get back to the gym, the pilates studio, the running trail, the weight rack, or whatever your version of normal looks like. While we look at how the gap is closing, our goal is to have a core that can handle whatever life demands of it without symptoms or difficulty.

What Actually Moves the Needle

The research is fairly consistent on this: abdominal training combined with pelvic floor muscle training is more effective than either approach alone.[3] Which is exactly why treating diastasis in isolation where we just do core exercises without addressing the pelvic floor and pressure management will tend to lead to a plateau.

What tends to make the biggest difference in recovery:

• Breathing mechanics: How you breathe under load directly affects how your core manages pressure. Learning to exhale on effort, rather than holding your breath or bearing down, changes how the entire system functions.

• Progressive loading: Your core needs to be trained like any other muscle group: gradually, consistently, with increasing challenge over time. Too much too soon stalls progress. Too little for too long does the same.

• Whole body approach: Diastasis does not exist in isolation. Hip strength, thoracic mobility, posture, and movement patterns all influence how your core functions. A good recovery program addresses all of it, not just the abs.

• Pelvic floor assessment: The pelvic floor is a direct partner to the core in pressure management. If it is not assessed and addressed as part of diastasis treatment, you are leaving a significant piece of the puzzle on the table.

When to Seek Help

If you have been doing core work consistently and not seeing improvement, if you are noticing doming or coning with exercises that should feel manageable, if you have symptoms like leaking, back pain, or pelvic pressure alongside your diastasis, or if you simply do not know where to start, it’s time for pelvic PT.

A thorough evaluation looks at how your entire core system is functioning, identifies what is limiting your progress, and builds a plan specific to your body and your goals. Not a generic protocol or a YouTube program, but a plan that actually accounts for where you are and where you want to go.

You were made to heal. Your core is not broken. It just needs the right support to finish the job.

Ready to find out where your core actually stands? Book a consultation and let's build a clear path forward together.

Fortis Physical Therapy and Pelvic Health serves women in Greenville and the surrounding Upstate South Carolina area.

References:

1. Chen B, Zhao X, Hu Y. Rehabilitations for maternal diastasis recti abdominis: An update on therapeutic directions. Heliyon. 2023.

2. Skoura A, Christakou A, Douka S, Skordilis E. Diastasis recti abdominis rehabilitation in the postpartum period: A scoping review of current clinical practice. International Urogynecology Journal. 2024;35(3):491-520.

3. Gluppe S, Engh ME, Bo K. What is the evidence for abdominal and pelvic floor muscle training to treat diastasis recti abdominis postpartum? A systematic review with meta-analysis. Brazilian Journal of Physical Therapy. 2021;25(6):664-675.