Women's Health Physiotherapy - 21/08/2026
C-Section Recovery: Scar, Core and Pelvic Floor
What your caesarean scar does over the first year, when to start scar massage, and why your pelvic floor still needs checking.
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Ab separation is the gap that opens down the middle of your tummy while you are pregnant. Almost everyone gets one. For most women it closes a long way on its own, and for some it does not, which is when the doming, the softness through the middle and the back that aches by mid-afternoon start to make sense. Here is how to check your own, what actually closes it, and when it is worth getting looked at.
Your two columns of six-pack muscle are joined down the middle by a band of connective tissue called the linea alba. As your baby grows, that band stretches and the two sides move apart. That is ab separation, also called abdominal separation, tummy separation, stomach separation, or by its clinical name, diastasis recti (or diastasis of the rectus abdominis muscle, DRAM).
It is not an injury and it is not something you caused. It is what has to happen for a baby to fit. By the end of a pregnancy, close to every woman has one to some degree.
The part that matters is what happens afterwards. Most separations narrow substantially in the first couple of months after birth. Some stay wide, and more importantly some stay soft, which is a different problem and the one that tends to cause symptoms.
You can get a rough answer on your bedroom floor in about a minute.
Lie on your back with your knees bent and your feet flat. Put two or three fingers just above your belly button, pointing down toward your feet. Let your tummy relax completely. Now lift your head and shoulders a little, as though you were starting a very small sit-up, and press gently down.
You are feeling for two things. Width: how many fingers fit in the gap between the two muscle edges. Depth: how far your fingers sink before they meet resistance. Check above the belly button, at it, and below it, because a separation is often wider in one spot than another.
Roughly two finger-widths or less, with a firm springy floor under your fingers, is what most people settle at and is usually not a problem. Wider than that, or a gap you can sink into with very little resistance, is worth having assessed.
The other sign to watch for is doming, sometimes called coning: a ridge that pops up down the middle of your tummy when you sit up, get out of the bath, or lift something heavy. Doming is your abdominal wall telling you the load is more than it can currently spread.
A self-check tells you roughly where you are. It will not tell you how well the tissue is holding tension, whether your pelvic floor is coping with the same loads, or which exercises will help you specifically. That is what an assessment is for.
The honest answer is that a lot of it is outside your control. Carrying more than one baby, a big baby, several pregnancies close together, and your own connective tissue all play a part.
What is inside your control is what happens to the tissue afterwards: whether it gets loaded in a way that helps it rebuild tension, or loaded in a way that keeps pushing it apart.
It also matters that nobody usually checks. Most women are never assessed for this, so a separation that would have responded well to the right exercise at three months is still there at three years, by which point it has been quietly blamed on age, or on never getting the weight off.
The goal is not really to close a gap to a particular number. It is to get the whole abdominal wall generating and holding tension again, so it does the job of supporting your spine and working with your pelvic floor. Plenty of women end up with a measurable gap and no symptoms at all, and they are fine.
What that looks like: retraining the deep abdominal muscles first, then progressively loading them, breathing that works with the effort rather than against it, and the pelvic floor rehabilitated alongside rather than separately, because the two share the same pressure system. Then a staged return to whatever you actually want to do, whether that is lifting a toddler and a pram or getting back to running.
Progression is the part that gets missed. Gentle deep-core work is where you start, not where you stay. Tissue rebuilds in response to load that increases, and the reason a lot of women stall is that they are still doing month-one exercises in month nine.
At All for One this happens as one-on-one postnatal physiotherapy appointments, and then in Clinical Pilates or Mums and Bubs classes when you are ready to build.
The gap matters less than the tension across it.
Anything that repeatedly pushes pressure forward into the weakest part of the wall before it is ready. Traditional sit-ups and crunches are the usual culprits, along with heavy lifting with a held breath, and going back to high-impact exercise before the abdominal wall and pelvic floor can handle it.
None of these are banned forever. Most women get back to all of it. The issue is doing them while your middle cannot yet spread the load, which is exactly what the doming is showing you.
Bracing hard and gripping your stomach in all day is not the answer either. A wall that is permanently clenched is not a wall that is working well.
Ab separation gets talked about as a cosmetic thing, the tummy that still looks pregnant. That is real and it matters to plenty of women. But the abdominal wall is part of how your trunk holds itself up, so a middle that is not carrying its share can show up as low back pain, a body that feels unstable when you lift, and pelvic floor symptoms like leaking or heaviness.
If you have any of those alongside a separation, they are worth assessing together rather than one at a time. They usually share a cause. If you had a caesarean, the scar is part of the same picture and we have written about c-section recovery separately.
For a small number of women a separation stays wide and symptomatic after a proper, progressive rehabilitation program, and surgical repair becomes a reasonable conversation with a surgeon.
It is not the usual path and it is not the first step. Most women have never had structured rehabilitation, so the sensible order is to do that properly first and then see what is left. If surgery does end up being right for you, going in with a stronger abdominal wall and pelvic floor tends to make the recovery afterwards easier anyway.
If you have a referral or a scan report in front of you, you may see DRAM, which stands for diastasis of the rectus abdominis muscle. Clinicians also write diastasis recti, diastasis rectus abdominis, or describe a lax abdominal wall. Online you will see ab separation, abdominal separation, tummy separation and mummy tummy.
They are all describing the same thing. If a health professional has used a term you have not met before and nobody explained it, bring the paperwork to your appointment and we will go through it with you.
A women’s health physiotherapy appointment gives you a real assessment of your abdominal wall and pelvic floor, and a plan that progresses. Six weeks after birth or six years, it is the same starting point.
Lie on your back with your knees bent, place two or three fingers just above your belly button, relax your tummy, then lift your head and shoulders slightly and press gently down. Feel for how many fingers fit between the muscle edges and how far they sink before meeting resistance. Check above, at and below the belly button. Roughly two finger-widths with a firm feel underneath is common and usually fine. Wider than that, or very little resistance, is worth having assessed.
Nothing. Diastasis recti is the clinical name, sometimes written DRAM for diastasis of the rectus abdominis muscle. Ab separation, abdominal separation, tummy separation and mummy tummy are the everyday names for the same thing.
Most separations narrow a long way in the first couple of months after birth without anyone doing anything in particular. Some stay wide, and some stay soft even when the width looks acceptable. If yours has not settled by around eight weeks, or you are getting doming, back pain or pelvic floor symptoms, that is the point to have it assessed rather than wait longer.
No. The abdominal wall responds to appropriate loading at any stage, and a lot of the women we assess have children at school. The program is much the same. What changes is that you have usually built years of habits around avoiding the problem, so part of the work is undoing those.
Early on, avoid anything that makes your tummy dome or cone down the middle, which usually means traditional sit-ups and crunches, heavy lifting while holding your breath, and high-impact exercise before your abdominal wall and pelvic floor are ready. None of it is banned permanently. The point is to rebuild the capacity to handle those loads rather than avoid them forever.
No. You can book a women’s health physiotherapy appointment at All for One directly. Private health extras are claimed on the spot through HICAPS, and if your GP has written you a care plan we can claim the Medicare rebate at the appointment.
Women's Health Physiotherapy - 21/08/2026
Women's Health Physiotherapy - 21/08/2026
What your caesarean scar does over the first year, when to start scar massage, and why your pelvic floor still needs checking.
READ MOREPrefer to talk? Yarraville (03) 8319 9945 · Hampton East (03) 9086 3740 · Kensington (03) 8319 9946
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Senior Women’s Health Physiotherapist
Emily has a deep passion for empowering women to take control of their pelvic health. She creates a warm, judgement-free space where you can talk openly about what’s really going on.
With advanced training in pelvic floor rehabilitation, Emily treats a wide range of conditions including incontinence, prolapse, pelvic pain, and pregnancy-related concerns. She takes the time to really listen, explain what’s happening in your body, and build a treatment plan that fits your life. Whether you’re preparing for birth, recovering postpartum, or navigating menopause — Emily is here to help you feel strong and confident again.
Women’s Health Physiotherapist
Tori is passionate about helping women feel heard and supported through every stage of life. She combines clinical expertise with genuine empathy to deliver care that makes a real difference.
Tori brings a holistic, evidence-based approach to treating pelvic floor dysfunction, pregnancy-related pain, and postnatal recovery. She has a special interest in helping women return to exercise safely after having a baby and supporting those with persistent pelvic pain. Tori believes every woman deserves to understand her body and feel empowered in her recovery — no topic is too awkward, and no concern is too small.