Does Diastasis Recti Cause Pelvic Floor Problems?

No — diastasis recti does not cause pelvic floor dysfunction. Three separate research studies (Siff et al. 2020, Hagovska et al. 2024, Tian et al. 2021) have found no correlation between abdominal separation and pelvic floor problems like prolapse, incontinence, or levator hiatus enlargement. However, both conditions commonly occur together after pregnancy because they share the same cause — pregnancy itself — not because one causes the other.

This is one of the most common questions I get from postpartum women. And I understand the fear — if your abs separated, it feels logical that everything underneath must be affected too. But the research tells a different story, and understanding it changes how we approach treatment.

The Myth: Diastasis Recti Damages Your Pelvic Floor

For years, the clinical assumption was straightforward: if the abdominal wall separates, it weakens the support structure above the pelvic floor, leading to increased pressure downward and eventually prolapse or incontinence.

It sounds reasonable. And it scared a lot of women into avoiding exercise, avoiding their core entirely, and living in fear that their body was falling apart from the inside.

But when researchers actually measured what happens to the pelvic floor in women with diastasis recti, the results were clear:

• Siff et al. (2020) found that exercise does not enlarge the levator hiatus — the opening in your pelvic floor. The fear that ab exercises push everything down? Not supported.
• Hagovska et al. (2024) found no correlation between diastasis recti and levator hiatus size. Women with separation did not have wider pelvic floor openings.
• Tian et al. (2021) found no difference in levator hiatus area between women with diastasis recti and those without.

Three studies. Three different research teams. Same conclusion: DRAM does not increase the risk of pelvic floor dysfunction or prolapse.

Why Both Conditions Show Up Together

If diastasis recti doesn’t cause pelvic floor problems, why do so many women have both?

Because pregnancy causes both independently.

During pregnancy, your body produces relaxin, your uterus expands, your abdominal wall stretches, and the weight and pressure on your pelvic floor increases. These are parallel processes, not a chain reaction. The ab separation doesn’t cause the pelvic floor changes — pregnancy causes both.

This distinction matters because it changes how we treat you. If we assumed DRAM caused your leaking, we’d focus only on closing the gap. But that’s not the right approach. Your pelvic floor needs its own assessment and its own treatment plan. Understanding whether your pelvic floor is tight or weak is a completely separate question from your abdominal separation.

What Diastasis Recti Actually Does

This doesn’t mean diastasis recti is nothing to worry about. When the separation is significant (— 3cm or greater, based on updated diagnostic criteria from Wang & Wang 2023), it is associated with:

• Weakened abdominal muscles — which affects core stability, posture, and daily function
• Increased low back pain — Wang et al. (2024) found IRD greater than 3cm associated with decreased quality of life and persistent back pain
• Decreased quality of life — difficulty lifting, exercising, and returning to activity

But notice what’s NOT on that list: pelvic floor dysfunction, prolapse, or incontinence.

And here’s another important update: the diagnostic cutoff has changed. The old standard was 2-2.2cm. Current research supports 3cm as the appropriate threshold for when diastasis recti becomes clinically meaningful. That means many women who were told they have a “significant” separation are actually within normal postpartum range. Here’s how to check your own separation at home.

The Doming Myth

While we’re challenging outdated thinking: doming or bulging along your midline during exercise is not associated with dysfunction.

Vesting et al. (2023) studied this specifically and found that linea alba bulging is simply a visible sign that the tissue is stretching under load — not a sign of damage or worsening separation. It’s a signal to modify your technique or reduce load, not a reason to stop exercising entirely.

I see women terrified of any visible movement along their midline. That fear keeps them sedentary, which actually makes both their core and pelvic floor weaker over time. Crunches and other ab exercises are actually safe and beneficial when done appropriately.

You Can Train Both at the Same Time

One of the most important findings from recent research: you do not need to “fix” your diastasis before working on your pelvic floor, or vice versa.

Gluppe et al. (2023) conducted a randomized controlled trial showing that curl-ups improve abdominal muscle strength and thickness without worsening pelvic floor disorders. This was a 12-week home-based program — real women, real results, no adverse effects on the pelvic floor.

Your core and your pelvic floor are part of the same system. They work together when you breathe, when you lift, when you move. Treating them together — not in sequence — produces better outcomes.

This is exactly how I approach treatment. When someone comes to me with diastasis recti, I don’t just look at the gap. I assess the whole picture: how your core is functioning, how your pelvic floor is coordinating, how your hips and back are contributing. Because the symptom you notice (the gap) may not be the thing that’s actually limiting you.

How I Assess Both in One Visit

When you come in for your first visit, we start with a whole-body assessment. I’m looking at:

• Your abdominal wall — measuring the separation both at rest and during a curl-up (the active measurement is more clinically relevant, per Starzec-Proserpio et al. 2022)
• Your pelvic floor — assessing whether muscles are contracting and relaxing when they should
• Your core coordination — how your diaphragm, deep core, pelvic floor, and abdominals work together during movement
• Your hips, back, and posture — because everything connects

Then we build a plan that addresses everything together — not one piece at a time. Most clients invest between a few sessions to several months depending on their goals. And at least half of every session is education, because I want you to understand your body well enough that you don’t need me forever.

This is what board-certified pelvic rehabilitation looks like. It’s not guessing from a YouTube video or a generic “no crunches” protocol. It’s an individualized assessment based on current research and thousands of hours of specialized training.

When to Actually Be Concerned

Not all diastasis recti needs treatment. Most postpartum separation under 3cm resolves on its own or with general return to activity. But you should seek assessment if:

• Your separation is 3cm or greater and not improving
• You have persistent back pain that started after pregnancy
• You feel core weakness that limits your daily life or exercise
• You have pelvic floor symptoms (leaking, pressure, pain) alongside your separation
• You’ve been avoiding exercise because you’re afraid of making things worse

The last one is important. Fear of exercise is one of the biggest barriers to postpartum recovery. Research consistently shows that appropriate exercise — including abdominal exercises — is beneficial, not harmful. Avoidance makes things worse.

The Bottom Line

Diastasis recti and pelvic floor dysfunction are separate conditions that commonly coexist after pregnancy. One does not cause the other. Both are treatable. And the most effective approach addresses both simultaneously with a whole-body assessment.

If you’ve been told your ab separation is causing your leaking, or that you can’t do core exercises until your gap closes, or that doming means damage — those ideas are not supported by current research. And they may be keeping you from the recovery you deserve.

Schedule a free consultation and let’s figure out exactly what’s going on — no guessing, no outdated protocols, just evidence-based answers.

By Dr. Danaya Kauwe, PT, DPT, PRPC, Cert-DN — Board-Certified Pelvic Rehabilitation Practitioner serving Utah Valley with in-home pelvic floor physical therapy.