Can you still repair post-pregnancy belly changes 10 years later?

I never had a flat stomach before having kids. But I’m fairly certain my twin pregnancy was responsible for the lower belly “pooch” that hasn’t gone away, even though my boy and girl are now teens. While I maintain a healthy weight, exercise regularly, eat a healthy diet, get my steps in, drink plenty of water, and get adequate sleep, it still feels like that part of my tummy is here to stay.

And while I can’t say I’m a fan of the “shelf” that sits over my C-section scar, I’ve accepted that it’s part of what I got along with two wonderful kids—at least, that’s what I thought until I found myself lying on an exam table in the office of a pelvic floor therapist.

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What is diastatis recti?

I’d heard about diastasis recti—a common postpartum condition where the abdominal muscles separate, leading to a pooch above or below your belly button—and often wondered if I had it since it’s more common in pregnancies with multiples. Because I work out regularly (Orangetheory classes are a favorite), I started to worry about some of the advice I’d seen on social media: that certain ab exercises can actually make diastasis recti worse. Were the bicycle crunches and the planks I dutifully held at the end of class actually making my belly more pronounced?

Curiosity spurred a visit to Ashley Newton, DPT, a pelvic floor physical therapist at Activcore, who explained that certain ab moves can worsen symptoms, especially when performed with poor form or without proper core support—potentially contributing to issues like low back pain, poor posture, and difficulty walking or lifting things. And since I was largely doing these exercises without one-on-one guidance, there was a good chance I wasn’t doing them correctly.

Dr. Newton explained that diastasis recti is not just an ab muscle problem but a pressure problem, and that everything from the diaphragm (your breathing) all the way down to the pelvic floor is interconnected. If the core isn’t doing the work, the body will compensate in other ways. Most women only discover they have diastasis recti because of pain elsewhere in the body. And it’s not just women—diastasis recti can affect men as well, including those who lift heavy weights.

Did I have diastasis recti?

Diastasis recti can be diagnosed by a pelvic floor therapist, ob-gyn, or primary cary doctor, who can assess both the separation and how well your core is functioning. While some personal trainers are taught to recognize the signs, they cannot make a formal diagnosis.

After an anatomy lesson by Dr. Newton and some tests to assess my alignment and balance, it was time for the moment of truth. While I was lying on the table, Dr. Newton pressed her fingers into my abdominal area. Measuring with her fingers, she told me I had a six-centimeter separation with a depth of about four centimeters. “This indicates a separation through the abdominal wall, along with reduced tension in the tissue,” she said.

At rest, a typical separation is about one to two centimeters (or one to two finger widths). Mine measured closer to three finger widths—something Newton said she wasn’t surprised by, given that I had twins. When she touched my scar, I was surprised to feel myself welling up. Dr. Newton notes this can be a common reaction, especially when a part of the body has been through trauma and then largely ignored. She was right—no one, myself included, had really touched that scar since I gave birth, and it had become a part of my body I’d essentially stopped thinking about.

My disastis recti treatment plan

Now that I knew for sure I had diastasis recti, I wanted to know what exercises I should be doing—and how often—to get my stomach back into shape. While Dr. Newton assured me it’s possible to improve it—even after all these years—I was surprised to learn that the first thing she wanted me to try was dry brushing my abdomen after the shower. Dry brushing is a body massage technique using a stiff-bristled brush that may help increase circulation to specific areas of the body.

A typical treatment plan also includes exercises that engage deep abdominal muscles. Dr. Newton explained that, over the course of six weeks, I’d do exercises both in her office and at home, including shoulder extensions and standing balance work on different surfaces to help my body relearn how to use those deep stabilizing muscles.

And while she isn’t against any type of movement, she noted that certain exercises can exaggerate diastasis recti—especially when performed incorrectly. She asks clients to avoid moves like crunches and planks at first, because they often lead people to crane their necks or bear down, increasing pressure on the connective tissue that runs down the center of the abdomen, which can make the separation appear more pronounced and contribute to that outward “pooching” effect.

All this sounded great, but what I really wanted to know was whether following the plan would actually change the appearance of my belly.

“Absolutely,” says Dr. Newton, explaining that with treatment there would be less downward pouching of the abdomen, especially around my C-section scar. “The abdomen gets a more ‘toned’ appearance as it lifts upward and toward the center. This can change the waistline as well as the appearance of the tissue.”

How a trainer approaches diasatis recti

One of the biggest misconceptions about this condition is that there’s a one-size-fits-all approach to rebuilding your core, Anna Hammond, DPT, a strength and conditioning specialist who works with postpartum clients, tells SELF. In reality, some people overload their exercises, straining the abdominal wall, while others don’t challenge it enough to build strength.

If you suspect you have diastasis recti, Dr. Hammond recommends starting with a pelvic floor physical therapist, who can perform a thorough assessment and evaluate how your core and pelvic floor are functioning together. From there, consider working with a specialized trainer, or do a combination of both depending on your needs.

When it comes to exercise, Dr. Hammond emphasizes that it’s less about specific moves and more about how they’re performed, but there are some common starting points. She often begins with breathing and mobility work, like rib cage drills to improve pressure management, followed by gentle movements such as segmental cat-cow to help restore coordination through the core and hips. From there, more targeted core work can be introduced, like a lower ab brace with a leg slide or a modified side plank.

In the early stages, she recommends avoiding high-load or overly demanding core exercises until you can maintain proper breathing and control. Signs like doming in the abdomen (a visible bulge), especially if it’s firm, can indicate that an exercise is too advanced and should be modified.

“Just because you can do something doesn’t mean you should,” she says.

When to consider surgery

Exercise can help, but it doesn’t always fix the underlying issue, Karolynn Echols, MD, section chief of urogynecology at Thomas Jefferson University Hospital, tells SELF. “Surgery is usually considered when the patient’s quality of life is affected, there is structural damage that is causing issues with other connected parts of the body, and conservative treatments have not helped,” she says.

“Exercise is powerful, but it is not magic,” she adds. It can improve strength, balance, and stability, and help with posture and confidence—but it cannot always fully close a large diastasis or repair structural issues.

“Remember your body did not fail you,” she says. “It adapted to the change and now we can decide how to support it moving forward.”

Those are words that will stick with me as I take my next steps—starting a structured program with Dr. Newton and rethinking how I view and use my body. Before I can rebuild my core, I first need to get reacquainted with it.

Original article appeared on SELF