You’ve done the gut work: eliminated trigger foods, rebalanced your microbiome, taken the supplements, maybe even treated Small Intestinal Bacterial Overgrowth (SIBO) or medically-diagnosed parasites, and yet the bloating, sluggish digestion, and stubborn belly shape linger.
If you’re in your 40s or 50s and had children years (or even decades) ago, there’s one structural issue that could still be quietly sabotaging your digestion: diastasis rectus abdominis (DRA), or abdominal muscle separation.
It’s rarely spoken about outside the early postpartum period, but this condition can persist for years, and may be an overlooked driver of IBS-like symptoms.
What Is Diastasis Rectus Abdominis?
Diastasis recti is a thinning and widening of the midline fascia between your rectus abdominis muscles, what we commonly think of as the “six-pack.” It’s most often triggered by pregnancy, but poor posture, heavy lifting, core weakness, and even genetics can also contribute to it.
For many women, this separation never fully heals after birth. And because it’s usually painless, it often goes undetected.
Left unaddressed, it can create:
- A bulging or distended belly that isn’t fixed by weight loss or exercise
- A feeling of core weakness, instability, or “disconnect”
- Back pain, pelvic heaviness, or urinary leakage
- And yes, persistent bloating and digestive discomfort
How Could This Affect Digestion?
While formal research is still emerging, the clinical observations are compelling.
A weakened abdominal wall reduces intra-abdominal pressure, which can compromise the function of your digestive organs, particularly:
- Peristalsis: the muscular wave-like contractions that help move food and waste along
- The migrating motor complex (MMC): a key “housekeeping” process that clears bacteria and debris from the small intestine between meals
Disruption of these functions can contribute to bloating, constipation, and bacterial overgrowth (SIBO), which is increasingly recognised as a major driver of IBS symptoms (Pimentel et al., 2020).
In short: if your gut has been treated but not stabilised, symptoms often return.
Still Have a Diastasis? You Might Never Know
You don’t have to be freshly postpartum to have diastasis recti. In fact, one study found that nearly a third of women still had a diastasis 12 months after birth (Sperstad et al., 2016). If that wasn’t addressed through rehab at the time, it’s likely still present.
And because it often doesn’t hurt, many women go years—even decades—without knowing.
And yes, men can develop diastasis too, particularly those with chronic core strain from improper weightlifting technique, abdominal obesity, or chronic constipation. It’s often missed in men because it’s wrongly assumed to be a postpartum-only condition.
Signs it could be lingering:
- Your belly domes or bulges when you sit up or lift your head off the floor
- You have a “pooch” or fullness in the lower belly that doesn’t change with weight loss
- Ongoing core weakness, instability, or lower back pain
- A sense that your body’s “centre” doesn’t feel coordinated or strong anymore
- You can feel a soft gap between your abdominal muscles when lying on your back and lifting your head
Why It Matters in Midlife
During perimenopause and menopause, changes in collagen, muscle mass, and connective tissue can worsen the effects of an unresolved diastasis, leading to more bloating, pelvic floor issues, and postural instability.
If your digestion, core strength, or pelvic health have been subtly deteriorating, this could be the hidden thread tying them together. Unfortunately, traditional abdominal muscle exercises such as crunches, planks, or ab machines won’t help. They may actually make things worse by increasing pressure on an already compromised midline.
What to Do About It
Thankfully, it’s never too late to restore your core.
The first step is a proper physical assessment.
If you suspect you have diastasis recti, speak with a women’s health physiotherapist or gynaecologist trained in core and pelvic floor rehabilitation. They’ll assess the width and depth of the separation (generally, anything greater than 2 cm is considered clinically significant) and determine whether there’s also associated core weakness, herniation, or pelvic floor dysfunction.
From there, you can follow a personalised rehabilitation plan that may include the following:
Targeted Core Rehab
Rehabilitation programs often include:
- Deep core activation (especially the transversus abdominis)
- Breath training and posture work
- Modifications to everyday movements to reduce intra-abdominal pressure
These programs are highly individualised and typically avoid standard crunches, sit-ups, or planks in the early stages.
Abdominal Binders and the Tupler Technique®
Support garments, such as abdominal binders or splints, may be recommended as part of recovery.
The Tupler Technique® involves an 18-week program using an abdominal splint alongside a progressive exercise protocol that begins at 6 weeks. While widely used clinically and often beneficial, the technique still has limited published data on long-term effectiveness.
Electrical Muscle Stimulation
Some practitioners also incorporate neuromuscular electrical stimulation (NMES) to help retrain deep core muscles, especially in cases of significant muscle weakening. While research is limited, early-stage studies suggest it may be a supportive adjunct to rehab in selected cases.
Surgical Repair (When Conservative Options Aren’t Enough)
For women with a large separation that hasn’t improved, especially after multiple pregnancies, surgical repair may be considered. This is typically offered when:
- There are significant symptoms (e.g., functional limitations, hernia, or back pain)
- The separation is unlikely to improve with rehab alone
- There is loss of abdominal wall integrity or poor fascial tension
The Takeaway
If you’ve tried everything to heal your gut but still feel bloated, distended, or disconnected in your core, don’t overlook your abdominal structure.
A diastasis may not show up on a blood test or stool panel but it could still be affecting your digestion, your posture, and your performance.
Healing your gut might require reconnecting to your centre, literally.
References
- Pimentel, M., Saad, R. J., Long, M. D., & Rao, S. S. (2020). ACG clinical guideline: Small intestinal bacterial overgrowth. American Journal of Gastroenterology, 115(2), 165–178. https://doi.org/10.14309/ajg.
0000000000000501 - Sperstad, J. B., Tennfjord, M. K., Hilde, G., Ellström-Engh, M., & Bø, K. (2016). Diastasis recti abdominis during pregnancy and 12 months after childbirth: Prevalence, risk factors and report of lumbopelvic pain. British Journal of Sports Medicine, 50(17), 1092–1096. https://doi.org/10.1136/
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