Diastasis Recti and Pelvic Floor Dysfunction: Why They Often Happen Together?

Many new mothers discover a gap or “separation” in their abdominal muscles after pregnancy and wonder whether it is related to other symptoms they have been experiencing, such as urinary leakage, pelvic heaviness, or a feeling of pressure during daily activities.

These concerns often lead to an important question: is diastasis recti causing my pelvic floor symptoms?

The answer is not always straightforward. From a physiotherapy perspective, diastasis recti and pelvic floor dysfunction are distinct conditions, but they can occur together because both are influenced by the physical changes that happen during pregnancy, childbirth, and postpartum recovery.

Understanding this relationship can help you make sense of your symptoms and guide a more effective recovery plan.

What Is Diastasis Recti?

Diastasis recti abdominis, often shortened to DRA, refers to a separation between the left and right sides of the rectus abdominis muscles. These are the abdominal muscles that run down the front of the abdomen.

During pregnancy, the growing uterus stretches the abdominal wall and the connective tissue between these muscles. Some degree of abdominal separation is common during pregnancy and early postpartum recovery.

While the separation often improves after delivery, some women continue to experience abdominal weakness, doming through the midline, or difficulty generating core support during daily activities such as sitting up, lifting, carrying, or returning to exercise.

What Is Pelvic Floor Dysfunction?

The pelvic floor is a group of muscles located at the base of the pelvis. These muscles help support the bladder, bowel, and reproductive organs, and they also play a role in continence, pelvic stability, and sexual function.

When these muscles are not functioning optimally, symptoms may include:

• Urinary leakage, especially when coughing, sneezing, lifting, or exercising

• Pelvic heaviness or pressure

• Reduced pelvic support

• Difficulty controlling bowel movements

• A feeling of instability through the core and pelvis

• Difficulty relaxing or coordinating the pelvic floor muscles

Pelvic floor dysfunction can occur on its own, but it is commonly seen during the postpartum period, which is also when diastasis recti is often identified.

Why Do They Often Occur Together?

One common misconception is that diastasis recti directly causes pelvic floor dysfunction.

In reality, the relationship is often more complex.

The abdominal wall, diaphragm, pelvic floor, and deep core muscles work together to help manage pressure through the trunk and pelvis. During pregnancy, this system undergoes significant mechanical, hormonal, and postural changes. As tissues stretch and loads increase, both the abdominal wall and pelvic floor may be affected.

Rather than one condition always causing the other, it may be more accurate to think of diastasis recti and pelvic floor dysfunction as conditions that can share similar contributing factors.

These may include:

• Pregnancy-related abdominal wall stretching

• Changes in posture and breathing mechanics

• Increased pressure through the abdomen and pelvis

• Changes in pelvic floor strength, coordination, or relaxation

• Childbirth-related tissue strain

• Return to lifting, carrying, and exercise before the system is ready

This is why a woman may notice both abdominal doming and pelvic floor symptoms during the same stage of recovery.

Can Diastasis Recti Cause Urinary Leakage?

This is one of the most common questions we hear in clinic.

The short answer is: not necessarily.

Diastasis recti does not directly cause urinary leakage in the same way that a bladder condition or urinary tract issue might. However, the abdominal wall plays an important role in managing pressure throughout the trunk and pelvis.

When the abdominal muscles, breathing system, and pelvic floor are not working together effectively, activities such as coughing, lifting, exercising, or carrying a baby may place greater demand on the pelvic floor. In some women, this may contribute to symptoms such as urinary leakage or pelvic heaviness.

This does not mean every woman with diastasis recti will experience urinary leakage. It also does not mean that the size of the separation alone explains the severity of symptoms.

This is why physiotherapists often assess how the whole abdominal-pelvic system is functioning rather than focusing only on the width of the abdominal separation.

What Symptoms Might Suggest Both Are Involved?

If you have diastasis recti, you may also notice symptoms that suggest the pelvic floor and abdominal wall are not coordinating well together.

These may include:

• Urinary leakage when lifting, coughing, laughing, or exercising

• A sensation of pelvic heaviness or pressure after prolonged standing

• Difficulty activating your deep abdominal muscles

• Abdominal doming or bulging when sitting up or lifting

• Weakness during functional tasks such as carrying your baby

• A feeling that your core is not providing adequate support

• Difficulty returning to running, gym training, or higher-impact exercise

For example, a mother may notice a visible abdominal bulge when getting out of bed while also experiencing urine leakage when laughing or sneezing. These symptoms may appear unrelated, but they can reflect challenges in how the abdominal wall, breathing system, and pelvic floor are working together to manage pressure.

This does not necessarily mean the diastasis is severe. In fact, symptoms and function are often more important than separation width alone.

Does a Larger Diastasis Mean Worse Pelvic Floor Symptoms?

Not necessarily.

This is one of the most important points we discuss with patients.

Some women with a relatively large separation have few symptoms, while others with a smaller separation may experience significant challenges with physical activity, pressure management, or continence.

Research on the relationship between diastasis recti and pelvic floor dysfunction is still evolving. Some studies suggest an association between abdominal separation and pelvic floor changes, while others have not found a clear link between the severity of diastasis recti and symptoms such as urinary incontinence or pelvic organ prolapse.

This is why it is important not to judge recovery based only on finger-width measurements.

As physiotherapists, we focus on function rather than simply measuring the distance between the abdominal muscles.

Why Treating One Area Alone Does Not Always Work

Many women are told to focus exclusively on either their abdominal separation or their pelvic floor symptoms.

However, because the abdominal wall and pelvic floor work together to manage pressure, treating one area in isolation may not always address the whole problem.

For example, a woman may improve abdominal strength but continue experiencing urinary leakage. Another may focus heavily on pelvic floor exercises but still struggle with abdominal doming, breath-holding, or feelings of instability during lifting and exercise.

This is why a comprehensive assessment often looks at breathing mechanics, abdominal control, movement patterns, and pelvic floor function together rather than viewing each issue separately.

How Can Physiotherapy Help?

Many women are told to “strengthen your core” without clear guidance on what that means.

Effective rehabilitation often involves assessing how the abdominal wall, breathing mechanics, and pelvic floor are functioning together. The goal is not simply to close the gap. Instead, the focus is improving strength, coordination, pressure management, and confidence in everyday movement.

Depending on your symptoms, physiotherapy may include:

• Assessment of abdominal muscle function

• Evaluation of pressure management strategies

• Pelvic floor muscle assessment

• Breathing and coordination exercises

• Exercise progression tailored to your recovery stage

• Guidance for lifting, carrying, and returning to exercise

• Education on movement patterns that may be contributing to symptoms

• Strategies to manage leakage, doming, heaviness, or pressure during daily tasks

A personalised plan can help you understand what your body is ready for and how to progress without repeatedly triggering symptoms.

Can Exercise Improve Both Conditions?

Current evidence suggests that postpartum exercise may help improve abdominal function and may reduce inter-rectus distance in some women. Pelvic floor muscle training can also help with urinary incontinence and pelvic floor symptoms when it is performed correctly and matched to the individual.

However, there is no single exercise that fixes every case of diastasis recti or pelvic floor dysfunction.

For some women, the first step may be learning how to coordinate breathing, abdominal tension, and pelvic floor activation. For others, the focus may be building strength, improving endurance, or gradually returning to higher-impact exercise.

Recovery is often most successful when exercises are individualised based on symptoms, goals, and physical assessment findings.

When Should You Seek Help?

It may be worth seeking professional advice if:

• The abdominal separation seems unchanged months after delivery

• You experience urinary leakage during daily activities or exercise

• You notice persistent pelvic heaviness or pressure

• You see doming or bulging through the midline during movement

• Core weakness is limiting your ability to exercise or care for your baby

• You are unsure which exercises are appropriate for your recovery stage

• Symptoms worsen when you return to running, lifting, or gym training

Early assessment can help identify whether your symptoms are related primarily to diastasis recti, pelvic floor dysfunction, or a combination of both.

You should also seek medical review if you notice a painful bulge, symptoms of a possible hernia, significant pelvic pressure, difficulty emptying your bladder or bowel, or symptoms that are worsening rather than improving.

Recovery Is About More Than Closing the Gap

Many women focus on the number of finger-widths in their abdominal separation, but recovery is often about much more than that.

How your abdominal wall functions, how you manage pressure during daily activities, and how well your pelvic floor and core work together can all influence your symptoms and confidence.

If you are experiencing diastasis recti alongside urinary leakage, pelvic pressure, or feelings of core weakness, it may be worth looking beyond the separation itself and considering how your whole abdominal-pelvic system is functioning.

At PhysioMatters Singapore, Danielle and Xan assess the bigger picture, helping postpartum women understand the relationship between abdominal separation and pelvic floor symptoms so they can move forward with a personalised, evidence-informed recovery plan.

Quick Summary

Diastasis recti and pelvic floor dysfunction are separate conditions, but they often occur together during postpartum recovery. Diastasis recti does not always directly cause urinary leakage or pelvic pressure, but abdominal wall function, breathing, and pelvic floor coordination can all influence how pressure is managed during daily activities. Recovery should focus on function, symptoms, and confidence, not only on closing the gap.

Contact us today!

References

1. Hagovská M, Švihra J, Buková A, et al. The Relationship of Severity in Diastasis Recti Abdominis and Pelvic Floor Dysfunction Among Postpartum Women. 2021. [springer.com]

2. Li M, Wang N, Wang R, Liang B. Ultrasonographic Evaluation of Diastasis Recti Abdominis and Its Association with Pelvic Floor Dysfunction in Postpartum Women: A Cross-Sectional Study of a Two-Year Retrospective Cohort. 2024. [frontiersin.org]

3. Beamish NF, Davenport MH, Ali MU, et al. Impact of Postpartum Exercise on Pelvic Floor Disorders and Diastasis Recti Abdominis: A Systematic Review and Meta-analysis. 2024.

   [pmc.ncbi.nlm.nih.gov]

4. Liu X, Wang Q, Chen Y, et al. Factors Associated With Stress Urinary Incontinence and Diastasis of Rectus Abdominis in Women at 6–8 Weeks Postpartum. 2023. [ncbi.nlm.nih.gov]

5. Zhu Y, Zhu R, Sun L, et al. Relationships of Diastasis Recti Abdominis with Stress Urinary Incontinence and Pelvic Floor Muscle Dysfunction in Postpartum Women: A Letter to the Editor. 2024. [ejog.org]

Contact Information

Email: hello@physiomatters.com.sg

Tele: +65 9352 9067

Address: 360 Orchard Road #10-07 International Building, 238869