Diastasis Recti: Signs, the 3 cm Rule and When Surgery Is Considered

Diastasis recti, also called abdominal separation or divarication, is a gap between the two long muscles that run down the front of your tummy. Some separation is a normal part of pregnancy, and for many women the gap closes in the weeks after birth.

This guide explains the signs, how to check yourself safely, why physiotherapy is the first step, and when surgery may be worth discussing. It is written by The Swan Clinic, where specialist plastic surgeon Dr Reema Hadi sees women who still have a gap and symptoms after physiotherapy.

What is diastasis recti?

Your rectus abdominis muscles are the two long, flat muscles that run from your ribs to your pelvis. In the middle they are joined by a band of connective tissue called the linea alba.

During pregnancy, the growing womb pushes the muscles apart and makes them longer and weaker. The linea alba stretches and thins. After the birth it often recovers, but if it has lost some of its elasticity, the gap can stay.

Diastasis recti is not only a pregnancy condition. Swan's abdominoplasty page notes it can also follow weight changes, ageing or muscle strain.

How common is it?

Very common. It can affect up to 6 in 10 women after childbirth, The separation will usually go back to normal by the time your baby is 8 weeks old.

So a gap in the early weeks after birth is expected. It is not a sign that something has gone wrong.

Signs to look for

Look for

• a bulge just above or below the belly button that remains after any pregnancy weight has gone
• a soft, jelly-like feeling around the belly button
• coning or doming down the middle of your tummy when you sit up or lean back
• difficulty lifting, walking or doing everyday tasks
• low back pain or poor posture

The separation itself is not usually painful. Pain tends to come from its effects, such as a weak core when lifting. With a severe or untreated gap possible complications including an umbilical hernia (a bulge at the belly button), more back pain, leaking urine and pelvic or hip pain.

Who is more likely to have it?

Risk factors may include fewer than 12 months between pregnancies, being over 35, carrying twins or more, a large baby, a very small frame, and pushing during a vaginal birth. The risk also rises with each pregnancy, as the tissue is stretched again.

The finger self-check

You can do a simple check at home. It gives you a rough idea of the gap, not a diagnosis.

1. Lie on your back with your knees bent and your feet flat on the floor.
2. Lift your head and shoulders slightly off the floor and look down at your tummy.
3. With your fingertips, feel between the edges of the muscles, above and below your belly button.
4. Count how many fingers fit into the gap.

Take care with this test:

• Stop if it hurts, and do not strain to lift higher.
• If you had a caesarean or other recent surgery, ask your GP or physiotherapist before you try it.
• Finger widths vary from person to person, so treat the result as a guide only.

How a health professional measures it

A GP, physiotherapist or surgeon will feel along the midline of your tummy to find where the gap is (above, at or below the belly button) and how wide it is.

For Medicare purposes, the gap must be measured by diagnostic imaging from a radiology provider. Your GP or Dr Hadi can explain which scan you need and who arranges it. It needs to be more than 3cm to qualify.

What the 3 cm rule means

You will often see "3 cm" quoted online. It is not the definition of diastasis recti.

The 3 cm figure comes from Medicare. MBS item 30175, for repair of diastasis after pregnancy, requires a gap of at least 3 cm measured by diagnostic imaging. A wide gap alone is not enough: the item also requires documented symptoms and failed non-surgical treatment that included physiotherapy. See Diastasis recti surgery and Medicare item 30175: who qualifies.

Physiotherapy comes first

For almost everyone, the first treatment is exercise guided by a physiotherapist. Your GP can refer you to a physiotherapist for specific exercises, and that regular pelvic floor and deep stomach muscle exercises can help reduce the gap. Good posture matters too.

While the gap is healing:

• avoid sit-ups, crunches and planks, and any exercise that makes your tummy cone or dome
• hold off high-impact exercise to start with
• avoid heavy lifting and straining on the toilet
• roll onto your side and push up with your arms to get out of bed
• stand tall and breathe so your ribs expand, not just your belly

A support band or binder can remind you to use your core, but it cannot heal the gap or strengthen your muscles. A women's health physiotherapist can tailor a programme to you and progress it safely.

When surgery is considered

Surgery is usually discussed only after a fair trial of physiotherapy. It may be worth talking to a specialist plastic surgeon when:

• a wide gap remains after months of guided exercise
• you have pain or discomfort at the gap when you lift, carry or exercise
• you have low back pain or bladder symptoms that your doctors think are linked to the gap
• you have an umbilical hernia
• you have finished having children, or are not planning a pregnancy soon

Diastasis repair stitches the separated muscles back together. It is usually done as part of an abdominoplasty, which also removes loose skin from the lower tummy. Dr Hadi also performs repair as its own operation when that suits the person [CHECK 29]. It is major surgery with real risks, and results vary. Read about diastasis recti surgery and tummy tuck risks.

Diastasis and future pregnancies

A gap that has closed can open again in a later pregnancy. The Australian Society of Plastic Surgeons notes that surgery may be delayed if you plan to get pregnant, as the result may be lost. If you are still growing your family, physiotherapy is usually the focus for now. See Tummy tuck after pregnancy: when to wait.

Talk to us

The abdomen change with pregnancy and age, and that is normal. If you have done physiotherapy and still have a gap and symptoms, you are welcome to see Dr Hadi with a GP referral. She will examine you, review your imaging and physiotherapy history, and talk through every option, including not having surgery. Call 02 9526 6885 or send an enquiry.

Frequently asked questions

Does diastasis recti go away on its own?

Often, yes. The separation usually returns to normal by the time your baby is 8 weeks old. If it does not, physiotherapy can help.

How many fingers is diastasis recti?

Speaking to your healthcare provider if you feel a gap of two or more finger widths. A health professional can measure it properly.

Is a 3 cm gap bad?

Not on its own. 3 cm on imaging is one of the Medicare criteria for surgery, but what matters just as much is whether the gap causes symptoms and whether physiotherapy has helped.

Can I fix diastasis recti with exercise?

Exercise guided by a physiotherapist helps many women and is always the first step. Some gaps remain despite this, and surgery may then be discussed.

What exercises should I avoid?

Avoid sit-ups, crunches, planks and anything that makes your tummy cone or dome, as well as heavy lifting, until a physiotherapist advises otherwise as it can make it worse.

Can diastasis recti cause back pain?

It can be linked to low back pain, poor posture and pelvic or hip pain. A GP or physiotherapist can help work out the cause.

Does Medicare cover diastasis recti surgery?

It can, under item 30175, when every criterion is met, including a gap of at least 3 cm on imaging, documented symptoms, failed physiotherapy and no pregnancy in the last 12 months. It applies once per lifetime.