Rectus Diastasis Resolution Timeline in the Postpartum Period
Most rectus diastasis resolves substantially by 6 months postpartum, with approximately 60-68% of women achieving resolution by this timepoint, though some degree of separation may persist in 33-39% of women even at 12 months postpartum. 1, 2
Natural Resolution Timeline
The inter-recti distance (IRD) follows a predictable pattern of improvement after delivery:
- At delivery (gestational week 35): Nearly 100% of women have diastasis recti abdominis (DRA) 1
- 6-8 weeks postpartum: Prevalence remains elevated at approximately 45-60% 1, 2
- 6 months postpartum: Prevalence decreases to 32-39% 1, 2
- 12 months postpartum: Approximately 33% of women still have measurable DRA 2
The most significant improvement occurs during the first 6 months postpartum, with the IRD decreasing progressively from immediately post-intervention through the 6-week postpartum period 3, 1.
Clinical Significance and Measurement
DRA is typically defined as an inter-recti distance of ≥16 mm at 2 cm below the umbilicus on ultrasound, or a palpated separation of ≥2 fingerbreadths at various locations along the linea alba 1, 2. The separation is generally greatest above the umbilicus and smallest below the umbilicus 4.
Factors That Do NOT Affect Resolution
Importantly, research has found no statistically significant differences in resolution rates based on:
- Pre-pregnancy body mass index (BMI) 1
- Weight gain during pregnancy 1
- Baby's birth weight 1
- Abdominal circumference 1
Physical Activity Considerations
Women can safely engage in abdominal and pelvic floor muscle exercises during the postpartum period without worsening diastasis. 3 The 2019 Canadian Guideline specifically notes that women with diastasis recti should seek physiotherapy advice and avoid abdominal strengthening exercises like abdominal curls during pregnancy, as this may worsen the condition 5. However, continuing aerobic exercise such as walking is associated with decreased odds of developing diastasis recti 5.
For postpartum recovery, women should gradually resume physical activity, starting slowly and progressively increasing intensity from light to moderate over the first 6-8 weeks 5. Most guidelines recommend waiting until after the 6-8 week postnatal visit before gradually resuming more intensive exercise 5.
Treatment Options
For women with persistent DRA at 6 months postpartum, a comprehensive rehabilitation program including EMG-biofeedback-assisted pelvic floor muscle training combined with neuromuscular electrical stimulation can significantly reduce the inter-recti distance and improve quality of life 6. This intervention showed a mean reduction of 0.4 cm in IRD at 6 weeks compared to electrical stimulation alone 6.
Important Clinical Caveat
DRA at 6-12 months postpartum is not associated with increased lumbopelvic pain, contrary to common clinical assumptions 1, 2. Women with and without DRA report similar levels of lumbopelvic pain, so the presence of diastasis should not be automatically attributed as the cause of back or pelvic pain 2.