Diastasis Recti
Abdominal muscle separation after pregnancy — what it is, how it is measured, and when surgery is the answer
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- Measured properly at assessment — inter-rectus distance, above and below the navel
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- Consultant plastic surgeons, GMC specialist register
- Physiotherapy first — surgery is not the first answer for everyone
- CQC registered hospital in central Manchester
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Diastasis Recti
Abdominal Muscle Separation — Assessment and Repair in Manchester
The two vertical columns of the rectus abdominis — the “six-pack” muscles — are joined down the midline by a sheet of connective tissue called the linea alba. In pregnancy that sheet stretches to let the abdomen expand. In most women it recoils afterwards. In a substantial minority it does not, and the two muscle bellies stay further apart than they should. That is diastasis recti.
It is the reason a stomach can still look pregnant months or years after delivery in someone who has lost all the weight. It is also why that stomach bulges outward in a distinctive ridge when you sit up from lying down, and why core exercises can make the appearance worse rather than better.
The important thing to say at the outset is that surgery is not the first answer, and for a good number of women it is not the answer at all. Specialist physiotherapy helps a meaningful proportion. What follows is how to tell which group you are in.
How Separation Is Measured
Inter-rectus distance and what the numbers mean
Understanding Your Measurement
Diastasis is measured as the inter-rectus distance — the gap between the inner borders of the two muscle columns — in finger-widths or centimetres, taken at rest and on contraction. It is measured at three points: above the navel, at the navel, and below it, because the gap is rarely uniform and where it sits changes what can be done about it.
Under 2cm. Within normal range. Most women have some separation and it means nothing on its own.
2 to 3cm — mild. Often responds well to specialist physiotherapy. Surgery would not usually be recommended.
3 to 5cm — moderate. Physiotherapy first, always. Where a properly supervised programme has been completed and a functional or cosmetic problem remains, surgical repair becomes a reasonable conversation.
Over 5cm — severe. Unlikely to close with exercise alone. Surgical repair is the realistic option where it is causing symptoms.
The other half of the assessment is the quality of the tissue between the muscles. A 4cm gap with firm tissue across it behaves very differently from a 4cm gap where the midline has thinned to the point of being almost transparent, and the second is far less likely to respond to exercise. That judgement needs an examination; it cannot be made from a measurement alone, and it certainly cannot be made from a photograph.
How to check for it yourself
Lie flat on your back with your knees bent and feet on the floor. Place your fingertips just above your navel, pointing down towards your feet. Lift your head and shoulders slightly off the floor, as if starting a sit-up. Feel for the two firm bands of muscle either side of your midline and note how many finger-widths fit between them. Repeat above and below the navel.
What you are feeling for is not just the width but the depth — whether your fingers sink in, and how far. A gap where the tissue feels firm and springy under your fingers is a different situation from one where they sink through easily.
This is a reasonable screening test and nothing more. It tells you whether it is worth being assessed properly; it does not tell you what to do next.
It Is Not Just How It Looks
Diastasis Recti Assessment in Manchester
Diastasis recti is often written about as a cosmetic concern, and for some women that is exactly what it is. For others it is functional. The abdominal wall is part of how you transfer load between your upper and lower body, and when the midline no longer holds, the symptoms that follow are real: lower back pain, a core that feels like it will not engage however much work you put in, pelvic floor symptoms, and in more marked cases a genuine bulge or hernia at the midline.
It also does not resolve with weight loss. Women frequently arrive having lost all the baby weight and more, and having been told to keep going. The stomach still protrudes because the problem is structural, not fat, and no amount of further weight loss addresses a gap in the abdominal wall.
Deansgate Hospital is a CQC‑registered independent hospital in central Manchester. Assessment is with a consultant plastic surgeon on the GMC specialist register — a proper examination and measurement, with an honest answer about whether physiotherapy or surgery is the right next step.
Physiotherapy or Surgery?
The options, and the order they should be tried in
This is the part most commercial websites skip, because physiotherapy is not something a hospital bills for. It is nevertheless where most women should start. A properly supervised programme with a specialist women’s health physiotherapist produces meaningful improvement in a good proportion of mild and moderate separations, and it costs a fraction of surgery.
1. Specialist Physiotherapy — first, for almost everyone
A women’s health physiotherapist assesses the separation, the pelvic floor and how you load the abdominal wall, then builds a programme around deep core activation rather than crunches — which make a diastasis look and often function worse. Give it three to six months of proper adherence. For mild and many moderate separations this is the whole answer, and where it is not, you arrive at surgery with a better-conditioned abdominal wall.
2. Mini Abdominoplasty with Repair — from £6,500
Where the separation is confined to below the navel and there is modest loose skin, a short-scar operation repairs the lower rectus and removes the excess. The navel is not moved. A smaller operation with a shorter scar and a faster recovery — but it cannot reach separation that extends above the navel, which is where most post-pregnancy diastasis sits.
3. Abdominoplasty with Full Repair — from £8,500
The definitive repair. The skin is lifted to the ribcage, the rectus sheath is plicated along its full length from breastbone to pubis, the navel is brought out through a new opening and surplus skin is removed. This is what is actually needed for most post-pregnancy diastasis, because the separation almost always extends above the navel.
4. Lipoabdominoplasty with Repair — from £10,000
Full repair combined with liposuction of the flanks and upper abdomen, narrowing the waist as well as flattening and closing the front. The usual recommendation where the trunk is thickened rather than simply loose.
To have your separation measured properly and get an honest answer about physiotherapy versus surgery, book an assessment in Manchester on 0161 470 9280 or enquire online.
When is surgical repair appropriate?
Who benefits, and who should wait
Repair is worth considering where the separation is moderate to severe, where a supervised physiotherapy programme has been completed without resolving it, where your family is complete, and where your weight has been stable for at least six months. A further pregnancy will stretch a repair just as it stretched the original midline, so repairing before you have finished having children generally means doing it twice.
You should wait if you are within twelve months of delivery — the tissues continue to recover for longer than most people expect, and a separation measured at six months is often meaningfully better at twelve. You should also wait if you are still breastfeeding, still losing weight, or have not yet given physiotherapy a proper attempt.
Smokers are asked to stop for at least six weeks either side of surgery. Abdominal wound healing is more sensitive to smoking than almost any other site, and we do not operate on someone who is still smoking.
Physiotherapy First
Three to six months with a specialist women’s health physiotherapist, properly adhered to. It resolves a good proportion of mild and moderate separations and it costs a fraction of surgery.
Finish Your Family
A repair is durable but pregnancy will stretch it again. Unless there is a functional problem that cannot wait, repairing before your family is complete usually means repairing twice.
Diastasis, Hernia, or Both?
A distinction that changes the operation
A diastasis is a stretching and thinning of the midline — the muscles have moved apart but the sheet between them is intact. A hernia is a hole in it, through which abdominal contents can push. They look similar from outside and they frequently occur together, most commonly as an umbilical hernia at the navel where the tissue is naturally weakest.
The distinction matters. A diastasis alone is a quality-of-life problem and repairing it is elective. A hernia can obstruct or strangulate, which makes repairing it a different kind of decision, and the repair itself may need mesh where a diastasis repair does not.
Examination usually distinguishes them; where there is doubt, an ultrasound settles it. If a hernia is found, it is repaired at the same time as the diastasis rather than separately — one operation and one recovery. Tell your surgeon if you have noticed a lump at your navel that appears when you cough or strain.
What Repair Costs
From £6,500
If surgical repair is the right answer, prices at Deansgate Hospital start from: £6,500 for mini abdominoplasty with lower repair, £8,500 for abdominoplasty with full-length repair, and £10,000 for lipoabdominoplasty with repair.
The fee covers your surgeon, your anaesthetist, the hospital, dressings and all routine follow-up for twelve months. Compression garments are not included.
Where procedures are combined, the first is charged in full and each additional one at half price. Assessment is a free consultation with a £25 booking deposit, redeemable against treatment. If the assessment concludes that physiotherapy is the better next step, that is what you will be told and there is nothing further to pay.
Assessment and Repair, Step by Step
From first appointment to twelve-month review
A diastasis assessment is a measurement, an examination and a recommendation — which may well be physiotherapy rather than surgery. Where repair is the right answer, here is what it involves.
You are examined lying flat and standing. Your surgeon measures the inter-rectus distance at three levels — above the navel, at the navel and below it — at rest and on contraction, and assesses the quality of the tissue across the midline, which matters as much as the width of the gap. The skin is assessed separately: elasticity, stretch marks, and how much excess there is.
You are checked for a hernia, most often at the navel, and an ultrasound is arranged where there is any doubt. Your weight history and family plans are discussed, because both affect timing.
You are then told your measurement, whether it is mild, moderate or severe, and what the realistic options are — including, frequently, that physiotherapy should come first. Photographs are taken for your record and you leave with a written plan.
For mild and most moderate separations we will ask you to complete a supervised programme with a specialist women’s health physiotherapist before considering surgery, and we would rather refer you than operate on someone who has not tried it.
What that involves: assessment of the pelvic floor alongside the abdominal wall, retraining of the deep core, and load management — learning how to get out of bed, lift a toddler and cough without pushing the midline apart. Crunches and sit-ups are usually stopped, because they increase intra-abdominal pressure and tend to make both the appearance and the function worse.
Give it three to six months of genuine adherence. If it resolves the problem, you have avoided an operation. If it does not, you come to surgery with a better-conditioned abdominal wall, which improves the result.
You are marked standing. Under general anaesthetic a low transverse incision is made, the skin and fat lifted — to the navel for a mini repair, to the ribcage for a full one — and the separated rectus sheath is brought back together with a running row of strong internal sutures, from breastbone to pubis in a full repair. Where a hernia is present it is repaired at the same time.
Surplus skin is then removed, the navel repositioned through a new opening in a full abdominoplasty, and the wound closed in layers over drains.
The operation takes two to three hours. Deansgate Hospital is a day-case facility, so you go home the same day once your surgeon and the recovery team are happy with you.
Days 1 to 3. Tightness rather than sharp pain, and you will walk slightly bent forward — that is expected and it straightens out. Compression garment day and night, and short regular walks around the house to protect against clots.
Days 4 to 14. Swelling peaks around day three to five then settles. Seen in clinic at about a week. No lifting anything heavier than a kettle — which is the hard part if you have small children, and worth planning for before surgery. Most desk-based workers return at two weeks.
Weeks 3 to 6. Light walking only — nothing strenuous, nothing that raises your heart rate or blood pressure. Compression garment throughout. No abdominal work of any kind.
Six weeks onwards. Exercise resumes. Core and abdominal training restarts gradually from around eight weeks, ideally guided by a physiotherapist — the repair holds better if you rebuild the muscle properly rather than returning straight to crunches.
Abdominal repair is major surgery. The commonest complication is a seroma — fluid collecting under the skin flap — which typically appears in week two or three and is drained in clinic with a needle, sometimes more than once. Inconvenient rather than dangerous.
Other recognised risks are bleeding, infection, delayed wound healing at the centre of the scar, altered or reduced sensation below the navel (very common, usually temporary), fat necrosis, asymmetry, dog-ears at the ends of the scar, and a scar that heals thicker or wider than hoped.
The serious risk is venous thromboembolism — clot in the leg or lung. Every patient is formally risk-assessed, given compression stockings and calf pumps in theatre, mobilised the same day and prescribed anticoagulant injections where indicated. Repairing the muscle raises intra-abdominal pressure, which is why early mobilisation matters more here than in a skin-only operation.
Recurrence of the separation is possible, particularly after a further pregnancy or significant weight gain.
Deansgate Hospital is a registered independent hospital in central Manchester with its own theatres and its own team. Your consultant plastic surgeon is on the GMC specialist register, you meet them at assessment, and they perform the operation themselves.
For this condition the thing that matters most is being told the truth about physiotherapy. A meaningful proportion of the women who come to us for a tummy tuck because of diastasis should try a supervised programme first, and we will say so. Aftercare, follow-up, seroma drainage and any revision required for a surgical complication are included in the quoted fee.
Diastasis Recti
Frequently Asked Questions
What is diastasis recti?
The two vertical columns of the rectus abdominis muscles are joined down the midline by a sheet of connective tissue called the linea alba. In pregnancy that sheet stretches; in most women it recoils afterwards, but in a substantial minority it does not and the muscles stay further apart than they should. That gap is diastasis recti. It is why a stomach can still protrude long after the weight has gone.
How do I check for it at home?
Lie on your back with knees bent. Place your fingertips just above your navel pointing towards your feet, then lift your head and shoulders slightly as if starting a sit-up. Feel for the firm bands of muscle either side of the midline and note how many finger-widths fit between them, and how far your fingers sink. Repeat above and below the navel. It is a screening test only — it tells you whether to get assessed, not what to do.
How much separation is normal?
Under 2cm is within normal range; most women have some separation. 2–3cm is mild and often responds to physiotherapy. 3–5cm is moderate — physiotherapy first, with surgery a reasonable conversation if a supervised programme has not resolved it. Over 5cm is severe and unlikely to close with exercise alone. The quality of the tissue across the gap matters as much as the width.
Will exercise close the gap?
Sometimes, and it should be tried first. A supervised programme with a specialist women’s health physiotherapist produces meaningful improvement in a good proportion of mild and moderate separations. What does not help is crunches and sit-ups — they increase intra-abdominal pressure and tend to make both the appearance and the function worse. Give a proper programme three to six months.
Will losing weight fix it?
No. The problem is structural, not fat. Women frequently arrive having lost all the baby weight and more, with the stomach still protruding, having been told to keep going. Further weight loss does not close a gap in the abdominal wall, though being at a stable weight does make surgery safer and the result better.
Is a tummy tuck the only surgical option?
Repair of the separation is done as part of an abdominoplasty — there is no separate keyhole operation that does it reliably. Which abdominoplasty depends on where the separation sits: a mini repairs below the navel only and cannot reach above it, which is where most post-pregnancy diastasis extends. Most women need a full-length repair.
Can I have it repaired before having more children?
You can, but a further pregnancy will stretch the repair just as it stretched the original midline, so you would likely be doing it twice. Unless there is a functional problem that cannot wait, we would usually advise completing your family first.
How soon after giving birth can I be assessed?
Assessment any time is reasonable, but do not make decisions before twelve months. The tissues continue to recover for longer than most people expect and a separation measured at six months is often meaningfully better at twelve. We would also want you to have finished breastfeeding and to be at a stable weight.
Is diastasis recti the same as a hernia?
No. A diastasis is a stretching and thinning of the midline with the sheet between the muscles intact; a hernia is a hole in it. They look similar from outside and often occur together, most commonly at the navel. The distinction matters because a hernia can obstruct or strangulate. Where a hernia is found it is repaired at the same time as the diastasis.
Can diastasis cause back pain?
It can contribute. The abdominal wall is part of how load transfers between your upper and lower body, and when the midline no longer holds, lower back pain, a core that will not engage and pelvic floor symptoms are all commonly reported. Whether repair resolves them varies between individuals and should not be promised.
Is repair available on the NHS?
Rarely. NHS funding for abdominoplasty is limited to specific circumstances — usually recurrent skin infections beneath an overhanging apron after major weight loss, or a true hernia — and thresholds vary between commissioning areas. Repair of a diastasis for contour or core function is not generally funded. A genuine hernia is a different matter and should be discussed with your GP.
How much does repair cost in Manchester?
At Deansgate Hospital, mini abdominoplasty with lower repair starts from £6,500, abdominoplasty with full-length repair from £8,500, and lipoabdominoplasty with repair from £10,000. The fee covers your surgeon, anaesthetist, the hospital, dressings and twelve months of follow-up. Compression garments are not included.
Still looking pregnant months later?
Diastasis Recti Assessment, Manchester
A stomach that still protrudes long after the weight has gone is usually structural rather than fat, and no amount of further dieting addresses it. Equally, not every separation needs an operation — a good proportion respond to proper physiotherapy, and that should be tried first.
Book an assessment with one of our consultant plastic surgeons in Manchester. Your separation will be measured properly at three levels, you will be examined for a hernia, and you will be told honestly whether physiotherapy or surgery is the right next step. Call 0161 470 9280 or enquire online.