The postpartum period is when the body reverses nine months of change, and it does not complete itself unaided. Separation of the abdominal muscles, pelvic floor weakness and back pain are the most common complaints — all of which improve with a structured programme.
Diastasis recti: what it is and how to check
Diastasis recti is thinning and widening of the connective tissue (linea alba) between the two columns of abdominal muscle. Almost every woman has some degree of it at the end of pregnancy; the real question is how much it closes afterwards.
Checking at home: Lie on your back, knees bent, feet flat. Place your fingers on the midline just above the navel. Lift your head and shoulders slightly. Note how many finger-widths the gap is and, more importantly, how much tension the tissue underneath produces.
Wider than two fingers with a soft, sinking feel underneath warrants assessment. Tension under load matters more than the width itself.
What to avoid early on: Classic sit-ups, double leg lowering, full plank — anything that drives pressure into the midline. If you see a cone-shaped bulge down the centre of the abdomen (doming), that exercise is too early.
The pelvic floor: the problem nobody mentions
Leaking after birth is common but not normal, and should not be brushed off with "you've had a baby, that happens". Leaking when you sneeze, laugh or run means the pelvic floor is not producing enough support under load.
Signs:
- Leaking with coughing, sneezing or jumping
- Frequency, urgency
- A feeling of heaviness or pressure in the vagina (prolapse sign)
- Pain during intercourse
- Difficulty controlling wind
All of these have the potential to improve with physiotherapy.
A week-by-week return
Weeks 0–2: breathing and circulation
- Diaphragmatic breathing: the abdomen and ribs expand on the in-breath, the pelvic floor lifts gently on the out-breath
- Ankle pumps, safe technique for getting out of bed
- Hinging at the hips rather than the back when lifting the baby
Weeks 2–6: activation
- Pelvic floor contract-and-release work coordinated with breathing
- Deep abdominal (transversus) activation
- Bridge, bird dog, side-lying hip abduction
- Walking distance increased gradually
Weeks 6–12: strength
- Loaded exercise begins after the six-week check
- Squat and bridge progressions, single-leg work
- Upper body strengthening — a genuine need when you are carrying a baby
- Modified plank variations, watching for doming
Week 12 onward: return to higher intensity
- Running, jumping and high-intensity training are assessed at this point
- Return-to-running checklist below
When can I run again?
Time alone is not the criterion. These tests should be possible without pain and without leaking:
- 30 minutes of brisk walking
- Single-leg stand for 10 seconds
- Single-leg bridge — 20 repetitions each side
- 20 jumps on the spot
- Single-leg hopping — 10 each side
- No leaking, heaviness or pain throughout
If you leak on any of them, running is early. That does not mean running is forbidden — it means the preparation is not finished.
After a caesarean
- No direct abdominal loading for the first six weeks
- Once the scar has healed (usually 6–8 weeks), scar mobilisation begins — it reduces adhesion and improves altered sensation
- Breathing and pelvic floor work start as early as after a vaginal birth; a caesarean does not protect the pelvic floor, since pregnancy itself loads it
Back and neck pain
Most postpartum pain comes from baby-care positions: hunching to feed, carrying the baby on one hip, lifting from a cot with a bent back.
- Bring the baby up to you with a pillow when feeding rather than leaning down
- Alternate which hip you carry on
- Hinge at the hips when lifting from the cot
- Push a pram with your hands at elbow height
Frequently asked questions
When will my stomach look like it did before? Recovery of the abdominal wall takes months and is gradual. Early on, function — managing pressure under load — comes before appearance.
Should I use a support band? It can be used for short-term support, but prolonged use reduces the work done by the deep abdominal muscles.
When should I see a physiotherapist? If you have leaking, heaviness, persistent back pain or a gap that is not closing, assessment after six weeks is advised. In countries such as France, postnatal pelvic floor assessment is routine.
Can I exercise while breastfeeding? Yes, with attention to fluid and calorie intake.
This article is general information and does not replace an examination. For a postnatal assessment, book an appointment at our clinic in Muratpaşa, Antalya.