Condition guide
After giving birth, do you notice a dome-like bulge down the middle of your tummy when you get out of bed or cough? During pregnancy, the connective tissue that joins the tummy muscles in the middle softens and stretches to make room for the baby, and a gap forms between the muscles. This is not dangerous and is very common. With the right everyday habits and simple exercises, you can strengthen your tummy wall again.
Don’t sit straight up from lying on your back. Roll onto your side first, then push up with your elbows.
In the early weeks, don’t lift anything heavier than your baby. Gently tighten your tummy muscles before you lift your baby.
From the first few days after the birth, you can start gently working your deep tummy and pelvic floor muscles.
Don’t return to sport or heavy work too early or too quickly. Skipping stages can leave weakness in the deep tummy muscles.
Exercises at home
The exercises should not cause pain or discomfort. If you feel downward pressure in your pelvic floor, the technique is not right; stop and ask a physiotherapist. Don’t hold your breath.
Lie on your back with your knees bent and feet flat. Gently draw in your tummy muscles and flatten the small of your back towards the bed. Hold for 3–5 seconds, then relax. As it becomes comfortable, also try it lying on your side, sitting or standing.
5 repetitions at first, 5–6 times a daySit up straight. Gently draw the tummy muscles below your belly button in towards your spine and slightly upwards; hold for as long as is comfortable. Don’t hold your breath: if you are holding your breath, you are pulling in too hard.
Often during the day; before lifting and carryingLie on your back with your knees bent. Squeeze the muscles around your front and back passages as if stopping wind and urine, and draw them in and up. Keep breathing normally.
Hold for 10 seconds, up to 10 repetitionsSqueeze the same muscles quickly, hold for one second and relax completely. Once you can do this easily lying down, try it sitting and then standing.
10–15 repsLie on your back with your knees bent. Place the fingers of one hand just below your belly button. Draw in your tummy muscles and slowly lift your head and shoulders; you will feel the two bands of muscle tighten towards the middle. Count how many finger widths the gap is.
If the gap is wider than two fingers, it is advised to postpone other tummy exercises until the gap narrows and to focus on the exercises above. Avoid movements that twist or bend the trunk sideways a lot. Returning to sport and strenuous exercise gradually lowers the risk of back and pelvic pain.
The evidence that a specific exercise programme closes the gap is currently very weak: a review of 7 studies with 381 mothers did not find enough evidence to recommend a specific programme. Even so, deep tummy and pelvic floor exercises are safe and a good start for strengthening the muscles.
In a study that followed 300 mothers, those with and without tummy muscle separation reported the same amount of back and pelvic pain 12 months after giving birth.
Firm clothing, a support garment or a tummy binder can give support during recovery. But it does not replace working your muscles.
For the pelvic floor, see the urinary incontinence guide; for pregnancy, see the back pain in pregnancy guide.
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