Diastasis Recti (DRAM) in Singapore: Causes, Symptoms, and Treatment Guide (Updated 2026)

Physiotherapist assessing patient for diastasis recti

What Is Diastasis Recti?

Diastasis Recti, also known as Diastasis Rectus Abdominis (DRAM), is a condition where the two sides of the rectus abdominis (commonly known as the “six-pack” muscles) separate along the midline of the abdomen. This separation occurs due to the stretching and weakening of the linea alba, the connective tissue that joins the muscles together.

Although diastasis recti is most commonly associated with pregnancy, it can also affect men, athletes, and non-pregnant individuals, particularly those exposed to repeated or excessive increases in intra-abdominal pressure.

What Causes Diastasis Recti?

In Women (Especially During and After Pregnancy)

• Pregnancy: As the uterus expands, the abdominal wall and connective tissue stretch to accommodate the growing baby. Hormonal changes further reduce tissue stiffness, making separation more likely.

• Breath-holding (Valsalva manoeuvre): Holding the breath during exertion increases intra-abdominal pressure, placing excessive strain on the abdominal wall and pelvic floor.

• Improper lifting techniques: Repeatedly lifting toddlers, car seats, or prams without proper posture or breathing can worsen abdominal separation.

• Older Women: Muscle tone and strength naturally declines, causing the connective tissue between the Rectus Abdominis muscles (the Linea Alba) weakening over time, increasing the risk of separation.

In Men and the General Population

• Poor exercise technique: Performing crunches, sit-ups, or heavy lifts with poor form or breath-holding can overload the abdominal connective tissue.

• Chronic constipation and straining: Frequent straining increases internal pressure on the abdominal wall.

• Obesity: Excess abdominal fat stretches and weakens the abdominal muscles over time.

What Are The Common Signs and Symptoms of Abdominal Separation?

Diastasis recti can present differently from person to person. Common signs and associated symptoms include:

Visible and Structural Changes

• Bulging or doming along the midline, particularly during sit-ups, coughing, or lifting (often described as a “mummy pooch”)

• A palpable gap between the abdominal muscles

• A feeling of flabbiness or lack of tension through the abdomen

Musculoskeletal Symptoms

• Lower back pain due to reduced core stability

• Poor posture and difficulty maintaining upright alignment

• Hip or pelvic discomfort

• Weakness through the midsection, especially during daily activities

Pelvic Floor Dysfunction (PFM)

• Urinary incontinence

• Faecal incontinence

• Constipation

• Painful intercourse

• Vaginal heaviness, pressure, or pain

Digestive Symptoms

• Abdominal bloating, especially in the evening or after exercise

• Excess gas

• Constipation or symptoms similar to Irritable Bowel Syndrome (IBS)

Interested to know more? You can explore our article on “Debunking Myths of Diastasis Recti.”

What Are The Risk Factors for Diastasis Recti?

Several factors increase the likelihood of developing DRAM:

• Pregnancy and postpartum changes (especially third trimester)

• Multiple pregnancies or large babies

• Older maternal age (reduced tissue elasticity)

• Vaginal delivery with prolonged or intense pushing

• Obesity

• Repeated heavy lifting without proper core engagement

• Chronic coughing, constipation, or frequent straining that increases intra-abdominal pressure

How Does Diastasis Recti Feel?

Separated abdominal muscles are often painless, and many individuals may not initially notice symptoms. However, others experience functional difficulties such as:

• Discomfort or instability during movement

• Difficulty performing daily tasks like lifting, rolling in bed, or exercising

• Doming or tenting of the abdomen during effort

• Persistent weakness or lack of support through the core

• Diastasis recti can have a profound emotional and psychological impact too

What Is Considered a “Normal” DRAM Separation?

• A gap of 1–2 finger widths is often considered within normal limits.

• However, gap width alone does not tell the full story.The depth of the separation and tension or integrity of the connective tissue are equally important.

• Real-Time Ultrasound (RTUS) is considered the gold standard for accurately assessing:

  • Width and depth of separation

  • Quality of connective tissue

  • Functional muscle activation

What Are The Possible Complications of Untreated Abdominal Separation?

If left unmanaged, DRAM may contribute to:

• Umbilical hernia: A visible bulge near the belly button due to weakened tissue

• Chronic low back pain: Resulting from poor load transfer and core instability

• Pelvic organ prolapse or dysfunction: Affecting bladder, bowel, and sexual health

How Can Diastasis Recti Be Prevented During Pregnancy?

To reduce the risk of DRAM during pregnancy:

• Breathe rhythmically during exertion

• Avoid breath-holding or bearing down

• Avoid traditional sit-ups and abdominal crunches

• Practise safe lifting techniques with proper posture

• Exhale during effort

• Hum, talk, or sing while lifting to naturally prevent breath-holding

Diagnosis and Assessment Options

If you suspect diastasis recti, consult a physiotherapist trained in women’s and men’s health.

At PhysioMatters Singapore, we provide a comprehensive diastasis recti physical assessment, including Diagnostic Ultrasound, to:

• Measure gap width and depth

• Evaluate tissue quality

• Develop a personalised, evidence-based rehabilitation plan

How Is Diastasis Recti Treated?

Non-Surgical (Conservative) Treatment – First Line of Care

• Physiotherapy-led rehabilitation: Targeted, safe, and progressive core exercises (e.g., physiotherapy pilates)

• Pelvic floor training: Improving continence, organ support, and pressure management

• Postural and breathing re-education: Teaching functional movement strategies that protect the core

With appropriate rehabilitation, most individuals experience significant improvement without surgery.

How Can a Physical Therapist Help?

Diastasis recti physical therapy plays a central role in DRAM recovery and long-term management:

Education

• Identifying movements to modify or avoid

• Teaching safe ways to return to daily activities and exercise

Postural and Breathing Training

Focuses on coordinated activation of:

• Transverse abdominis

• Diaphragm

• Pelvic floor

• Low back muscles

Exercise Rehabilitation

Addresses all four abdominal layers:

• Transverse abdominis

• Internal and external obliques

• Rectus abdominis

Exercises are progressed safely based on individual goals and tissue capacity.

Bracing and Support

• Taping or abdominal support garments may be used short-term

• Provides proprioceptive feedback and pressure management

• Does not weaken muscles when used appropriately

Electrical Muscle Stimulation (When Indicated)

• Can assist in activating the rectus abdominis post-pregnancy

• Shown to improve function and reduce separation in selected cases

Can Abdonimal Separation Be Prevented?

Diastasis recti is a natural and common adaptation to pregnancy, and in many cases resolves on its own. However, research shows that early intervention with core and pelvic floor training:

• Improves function during pregnancy

• Reduces symptom severity postpartum

• Supports recovery in both women and men with non-pregnancy-related DRAM

Early physiotherapy leads to faster and more complete return to activity.

What Kind of Physical Therapist Should You See?

While all physical therapists are trained to assess DRAM, you may benefit from one who:

• Has experience in pelvic or women’s health physiotherapy

• Holds advanced credentials such as:

  • WCS (Women’s Health Clinical Specialist)

  • CAPP-OB certification

  • Residency or fellowship training in pelvic health

When choosing a therapist:

• Ask about their experience with diastasis recti

• Be prepared to describe your symptoms clearly

• Seek recommendations where possible

Surgical Repair (For Severe Cases)

Surgery may be considered when:

• The gap exceeds 2 finger widths

• There is significant connective tissue damage or hernia

• Conservative management has not achieved functional improvement

Key points:

• Typically performed by General or Plastic Surgeons in Singapore

• Physiotherapy should always be tried first

• Pre-surgical core strengthening improves outcomes and recovery

When Should You Seek Help?

Consult a physiotherapist if you experience:

• A persistent abdominal bulge

• Ongoing lower back or pelvic pain

• Incontinence or painful intercourse

• Bloating or gas after light activity or exercise

Let’s Help You Heal at PhysioMatters

At PhysioMatters Singapore, our experienced physiotherapists provide evidence-based, personalised care for diastasis recti—whether you are postpartum, male, or managing long-standing symptoms.

It’s time to speak with a trained physiotherapist and restore confidence in your core.

Client Review

“Danielle is amazing at what she does… She is certified in ultrasound, which gives you incredible insight into what’s happening beneath the skin. If you have questions about diastasis recti or pelvic health, I strongly recommend seeing her.”— Jamielene Fernandez, Google Review

Contact Information

Email: hello@physiomatters.com.sg

Phone: +65 9352 9067

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