When it happens · 4 min read
Your core and pelvic floor after birth
There's a whole category of postpartum body changes that women are quietly expected to absorb as the price of admission: a belly that domes when you sit up, leaking when you sneeze or jump, a heaviness by evening. Common, yes — most of it. Permanent and untreatable, no. Here's the actual picture.
Last updated August 9, 2026
Diastasis recti, in plain terms
The rectus abdominis — the 'six-pack' muscles — run in two halves joined by connective tissue down your midline, and pregnancy stretches that seam so the halves separate. This happens to some degree in most pregnancies and persists early postpartum in well over half of women; estimates commonly run from a third to two-thirds depending on how and when it's measured. Much of it closes substantially on its own over the first months as tissue remodels.
The self-check: lie on your back, knees bent, lift your head slightly, and press your fingers along the midline above and below your navel — a soft gap wider than about two fingers, or a visible doming ridge when you sit up, is the sign. It's worth knowing about less for looks than for function: the core is your lifting, carrying, back-supporting machinery, and you're about to spend years lifting a growing human.
The pelvic floor half
The pelvic floor — the muscle hammock supporting bladder, uterus, and bowel — carried the pregnancy and, in vaginal birth, did the delivering. Weakness afterward shows up as stress incontinence (leaking with sneezes, laughs, jumps), urgency, heaviness or pressure, or pain with sex. All of it is common; none of it is obligatory to live with. Gentle pelvic-floor contractions (Kegels — squeeze as if stopping urine, hold a few seconds, release fully, repeat in short sets) are safe to start early for most women and are the standard first-line strengthening.
What early recovery work looks like
The early sequence favors reconnection over intensity: breathing that lets the ribs and belly move, gentle deep-core engagement (drawing the lower belly in on an exhale), pelvic floor sets, and walking. What to postpone: crunches, sit-ups, front planks, and heavy lifting while a gap is doming — loading a separated midline before it's ready pushes outward on exactly the tissue trying to knit. Progression is individual, which is one of several reasons the blanket 'cleared at six weeks' moment is a starting line for graded return, not a green light for everything at once.
Pelvic floor PT: the specialty nobody tells you about
Pelvic floor physical therapists treat exactly this — persistent leaking, prolapse symptoms, pain with sex, stubborn diastasis — with internal assessment, individualized programs, and strong evidence behind the approach. In much of the world a postpartum pelvic PT course is routine care. If symptoms persist past the early months, ask your OB for a referral in plain words: 'I'm still leaking when I sneeze — I'd like pelvic floor PT.' That sentence, said at the six-week visit or any visit after, is usually all it takes.
Common questions
- Is it too late if my baby is one — or five?
- No. Pelvic floor PT and core rehab work at any distance from delivery; 'years postpartum' is a routine referral, not an expired one.
- Are Kegels always the answer for leaking?
- Usually helpful, but not universally — some pelvic floors are tight rather than weak, and more squeezing worsens those. That's exactly what a pelvic floor PT assessment distinguishes.
- Will the ab gap close completely?
- Most narrow substantially in the first months, especially with graded core work; a functional core matters more than a to-the-millimeter closure. A wide gap that persists and bothers you is worth a PT evaluation before considering anything surgical.
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