Mummy Tummy: Treating Abdominal Separation

If you’ve had a baby you might have noticed that when you try and do crunches or even sit up out of bed that your stomach looks a little bit strange. You might see something pushing up through the middle like there’s a gap there now that wasn’t there before. That is your abdominal separation, otherwise known as a rectus diastasis.

When you are pregnant your stomach muscles have to stretch to allow more space for the baby as it grows. It’s not just your 6-pack muscles that get stretched, it’s every muscle in your abdominal wall. The 6-pack muscle (rectus abdominus) gets stretched and separated so you end up with a gap down the middle that runs from the bottom of your rib cage to your pubic bone.

How wide this separation is does not have anything to do with your prenatal weight or weight gain during pregnancy. It happens to make room for the baby.


After you deliver your baby you may have been told that time and reducing your weight would mean your stomach would go back to normal. For the vast majority of women this is simply not true. Even after losing weight and giving your stomach a few months you might have noticed the skin on your stomach is lose and wrinkly, that people are still asking you if you’re pregnant or that your back aches.

After such a significant stretch on your abdominal wall, where one side is often stretched a little more than the other side, your stomach muscles need some help to get reorganised.

The tissue that runs down the middle of your 6-pack muscle is called the linea alba. This tissue is directly linked with one of your core muscles, a deep abdominal muscle called the transversus abdominus. Getting your separation to narrow and the tissue in the middle to feel nice and firm again is vital and will only occur if you can get a coordinated contraction on both sides. If you can’t generate tension along the linea alba this there is a very high risk of back pain, pelvic pain, prolapses and incontinence. There is even a risk of developing hernias if there is a tear in the linea alba.

The transversus not only acts like a natural deep back brace that supports your spine and pelvis without you being aware of it but it also directly attaches to your urethra. If you can’t get a good transversus contraction it is even more important that your pelvic floor is functioning well so you’re not leaking urine.

This applies regardless of what type of delivery you have had BUT if you have had a caesarean, because they cut through the abdominal muscles during the procedure, your stomach muscles might be a little bit more resistant to working properly. If you’ve had a caesarean it is also extremely important to see a physio, not only to help you recover your muscle function but also to help minimize scar tissue.

This all might sound a little scary but, with the help of a quality physiotherapist, you can get your stomach muscles functioning properly, minimize any abdominal separation and significantly reduce the risk of back pain, pelvic floor issues or being asked if you’re still pregnant!

Our physiotherapists will use a Real Time Ultrasound machine to teach you how to best active your transversus on both sides and then how to strengthen your abs properly. They will also be looking at the separation itself and making sure that the transversus contraction pulls the linea alba nice and tight and that you can also see your pelvic floor contract at the same time.

Strengthening the abdominals and restoring the tissue thickness and strength of the linea alba is a progressive process and we may recommend some Pilates so we can challenge you with a variety of exercises while we supervise that you’re able to control them.

It is vital that the transversus and pelvic floor muscles work together and synchronize well with what your diaphragm does as you breathe. This not only helps you stay continent but it also minimizes the risk of a residual belly that you can’t get rid of. You may need a pelvic floor assessment with one of our Women’s Health physios to ensure that all the muscles are working well together.

The best thing you can do to make sure there are no side effects of having a baby is to have a postnatal check like those at Sydney Advanced Physiotherapy in Lindfield. You need to make sure that your alignment is good, that your pelvic floor is functioning well, that there are no prolapse issues AND that you have a complete ultrasound assessment for your stomach muscles.

If you would like more information about how to get your body back after having a baby and to find out more about what types of exercises are safe, Sydney Advanced Physiotherapy is holding a FREE seminar led by one of our expert women’s health physios at 11am October 18th in our Lindfield clinic. Seating is limited so please contact 9416 4410 to reserve a seat.

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