Diastasis Recti After Pregnancy: Latest Australian Evidence and Medicare Coverage

Last Updated May 2025

Pregnancy brings numerous changes to a woman’s body, with one common challenge being abdominal separation, also known as diastasis recti. This condition affects 30-60% of women who may continue to experience symptoms 12 months after childbirth. Studies have observed diastasis recti in up to 45% of women at six months postpartum and in 33% at one year after childbirth. For many women, this separation doesn’t heal naturally, leaving them searching for effective solutions that address both functional and aesthetic concerns.

In this comprehensive guide, Dr Scott Turner, a Specialist Plastic Surgeon in Sydney who specialises in abdominoplasty surgery, explains what diastasis recti is, the latest Australian research supporting surgical intervention, Medicare coverage requirements, and treatment options available.

Understanding Diastasis Recti: More Than Just a Cosmetic Concern

Diastasis recti abdominis occurs when the rectus abdominis muscles (your “six-pack” muscles) separate due to stretching of the linea alba, the connective tissue that runs down the midline of the abdomen. This happens primarily during pregnancy as the expanding uterus exerts considerable pressure on the abdominal wall, causing the linea alba to stretch, thin, and widen.

During pregnancy, the body releases hormones such as relaxin that make muscles and ligaments more flexible. This is a natural physiological adaptation to accommodate the growing fetus. These hormonal changes, combined with the physical stretching of the abdomen, can sometimes leave the abdominal muscles stretched beyond their natural elasticity, resulting in diastasis recti that persists after childbirth.

Abdominal separation is more common in women who:

• Have had multiple pregnancies, particularly with short intervals (less than 12 months) between them
• Have a weaker abdominal wall muscle structure
• Are carrying twins or triplets (or more)
• Are aged over 35 years
• Have gained significant weight during pregnancy
• Have a small frame or petite body type
• Experienced prolonged pushing during delivery or had a caesarean section
• Have a genetic predisposition to connective tissue laxity

Symptoms and Functional Implications

While the visible bulge in the midsection is often what prompts women to seek help, Australian research has documented that diastasis recti is associated with numerous functional issues that significantly impact quality of life:

• Chronic lower back pain and postural changes: The weakened abdominal muscles affect posture and place additional strain on the lower spine
• Core instability and abdominal wall weakness: Difficulty engaging core muscles during daily activities
• Urinary incontinence and pelvic floor dysfunction: Often coexists with diastasis recti due to shared musculature
• Reduced ability to perform routine activities: Some women report having to modify work responsibilities or being unable to return to their careers
• Psychological impacts: Effects on body image and self-confidence that can affect relationships and mental wellbeing
• Pelvic girdle and hip pain: Discomfort in the pelvic region due to altered biomechanics

How to Check if You Have Diastasis Recti

Self-Assessment

To check for diastasis recti at home, follow these steps:

1. Lie down on your back with your knees bent and feet flat on the floor
2. Place one hand on your abdomen, positioning your fingertips above your belly button
3. Gently lift your head and shoulders off the floor slightly, engaging your abdominal muscles
4. Feel for a gap between the muscles with your fingertips. A gap of two fingers’ width or more may indicate diastasis recti

Professional Diagnosis

While self-assessment can provide an indication, a professional evaluation by a healthcare provider is necessary for an accurate diagnosis. Formal assessment with ultrasound is considered the best option to diagnose and classify the severity of diastasis recti, which is especially important for Medicare eligibility.

Ultrasound can precisely measure:

• The width of separation between the rectus muscles (the key measurement for Medicare eligibility)
• The length of the separation
• The condition of the linea alba connective tissue

Treatment Options for Diastasis Recti

Conservative Management: Physiotherapy

For mild to moderate cases, physiotherapy may help improve symptoms:

• Targeted exercises: Gentle core strengthening exercises that avoid increasing intra-abdominal pressure
• Pelvic tilts and modified planks: Exercises that engage the core without straining the muscles
• Abdominal bracing: Learning to engage the core by drawing the belly button toward the spine
• Postural training: Improving overall posture to reduce strain on the back
• Diaphragmatic breathing: Techniques to optimize breathing patterns and manage intra-abdominal pressure effectively
• Clinical Pilates: Modified Pilates exercises under the guidance of a physiotherapist
• Manual therapy: Soft tissue techniques such as massage and myofascial release

Recent research provides insights into the effectiveness of these approaches. A 2024 systematic review and meta-analysis found “low” certainty evidence indicating that abdominal muscle training resulted in a greater reduction in inter-rectus distance compared to no exercise in women during the first year postpartum, particularly for separation below the umbilicus (mean difference = -0.31 cm, 95% CI: -0.53 to -0.10).

While research supporting specific exercise protocols is still developing, most studies suggest that implementing interventions within the first 6-8 weeks postpartum may help accelerate the natural recovery of inter-rectus distance.

It’s recommended to work with a physiotherapist who specializes in postpartum recovery to ensure exercises are performed correctly and safely. Women’s health physiotherapists possess specialized knowledge to assess the extent of abdominal separation and design individualized rehabilitation programs.

Exercises and Activities to Approach with Caution

When managing diastasis recti, it’s important to understand which movements might exacerbate the condition. Exercises and activities to avoid or modify include:

• Traditional abdominal crunches and sit-ups: These movements typically increase intra-abdominal pressure and can cause the abdomen to bulge outwards
• Full planks and standard push-ups: Unless appropriately modified, these can be too strenuous for a weakened abdominal wall
• Certain yoga poses: Poses that involve significant spinal extension or place direct strain on the abdominal wall (e.g., full wheel backbends, full cobra pose, boat pose)
• Double leg lifts, scissor kicks, and reverse crunches: These exercises often generate high levels of intra-abdominal pressure
• High-impact cardiovascular exercise: Activities like running, jumping, or high-intensity interval training may need to be delayed until sufficient core strength is re-established

Other Conservative Measures

In addition to targeted exercises, other non-surgical approaches may help manage diastasis recti:

• Supportive garments: Abdominal binders or compression garments can provide external support to the abdomen and lower back, potentially improving comfort during daily activities. While these garments do not actively heal the diastasis, they can serve as a helpful proprioceptive cue and temporary support. Research suggests that abdominal exercise is actually more effective than binding alone in reducing inter-rectus distance below the umbilicus.
• Kinesio taping: Application of kinesio tapes using the corrective technique has shown promising results in reducing rectus abdominis diastasis in women up to 12 months after delivery. Studies have found statistically significant reductions in diastasis at measured sites after kinesio taping compared to sham taping. This approach can be effectively used as an adjunct to other interventions.
• Neuromuscular electrical stimulation (NMES): This involves applying electrical current to stimulate muscle contractions in the abdominal area. Some studies examining NMES in combination with abdominal exercises have shown significant improvement in outcomes compared to abdominal exercises alone.

Australian Research Supporting Abdominoplasty for Diastasis Recti

Australia has contributed significantly to research supporting surgical intervention for diastasis recti. The Taylor et al. (2018) Australian prospective cohort study of 214 postpartum women found statistically significant improvements in back pain and urinary incontinence following abdominoplasty.

Key findings from Australian research include:

• Significant pain reduction: Patients experienced mean improvements of -9.32 for back pain (95% CI: -10.40 to -8.40) following abdominoplasty
• Improvement in urinary symptoms: Mean improvements of -4.62 for urinary incontinence (95% CI: -5.43 to -3.81) at six months post-surgery
• Long-term benefits: The Medical Services Advisory Committee (MSAC) in Australia found that benefits of abdominoplasty with repair of rectus diastasis persisted for up to 5 years
• Mechanical explanation: Studies have demonstrated that the procedure leads to significant improvements in ODI (Oswestry Disability Index) and SF-36 scores relating to physical function and pain, attributed to spinal stabilization that occurs after plication of the separated abdominal muscles

MSAC concluded that “abdominoplasty had inferior but acceptable safety, superior effectiveness that was sustained over five years, and acceptable cost-effectiveness compared with no treatment.”

Medicare Coverage for Abdominoplasty in Australia

Introduction of MBS Item 30175

A significant development occurred on July 1, 2022, when the Australian government introduced Medicare Benefits Schedule (MBS) item 30175 specifically for post-pregnancy abdominoplasty with repair of rectus diastasis.

The item covers “radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus” for patients whose abdominal wall defect is a consequence of pregnancy. Under this item, eligible patients receive a Medicare rebate of 75% of the scheduled fee of $1,105.15, amounting to $828.90.

For more detailed information about Medicare coverage for plastic surgery procedures, please visit our Medicare and Plastic Surgery page.

Specific Eligibility Criteria

To qualify for Medicare coverage under item 30175, patients must meet ALL of the following stringent criteria:

1. Measurable diastasis of at least 3cm: Have a documented diastasis of at least 3cm measured by diagnostic imaging (such as ultrasound) prior to the service
2. Symptomatic impact: Experience at least moderate severity of pain or discomfort at the site of the diastasis during functional use and/or low back pain or urinary symptoms likely due to the rectus diastasis
3. Failed conservative treatment: Have not responded to non-surgical conservative treatment, which must include physiotherapy
4. Post-pregnancy recovery period: Have not been pregnant in the last 12 months

Additionally, the procedure must be deemed medically necessary rather than purely cosmetic, with proper documentation of symptoms in the patient’s medical records by the specialist plastic surgeon providing the service.

It’s important to note that MBS item 30175 is applicable only once per lifetime. This limitation has significant implications, as recurrence of diastasis recti can occur with subsequent pregnancies, but would not be eligible for Medicare coverage if surgical repair had been previously performed under this item number.

Documentation Requirements

The Medicare coverage process requires comprehensive documentation, including:

• Diagnostic imaging (typically ultrasound) confirming at least 3cm separation between the rectus muscles
• Medical records documenting symptoms and their severity
• Evidence of attempted conservative treatments and their failure
• GP referral detailing the patient’s clinical history

Surgical Intervention: Abdominoplasty

When conservative management fails to resolve symptoms, abdominoplasty (tummy tuck surgery) offers a comprehensive solution for correcting diastasis recti. You can learn more about this procedure on our Abdominoplasty & Tummy Surgery page.

The Procedure

During abdominoplasty, Dr Turner:

• Makes an incision in the lower abdomen (often along the bikini line)
• Lifts the skin and fat to expose the abdominal muscles
• Sutures the separated rectus abdominis muscles back together along the midline (plication)
• Removes excess skin and fat if needed
• Repositions the navel for a natural appearance
• Closes the incision with fine sutures

The procedure is typically performed under general anesthesia in an accredited hospital setting. If an umbilical hernia is present, it can be repaired during the same operation.

Benefits Beyond Aesthetics

While abdominoplasty improves the appearance of the abdomen, Australian research highlights significant functional improvements:

• Reduced back pain: Due to restored core stability and improved posture
• Improved core function: Enhanced ability to engage abdominal muscles during daily activities
• Reduced urinary symptoms: Improvement in symptoms of stress urinary incontinence
• Enhanced quality of life: Greater ability to participate in work, childcare, and recreational activities

It’s important to note that while non-surgical treatments can be effective for many women, they may have limitations in cases of severe diastasis recti. As one review noted: “The success rate [of physiotherapy] is questionable and not possible to state, as no identified studies report on the long-term effects of physiotherapy.” For women with persistent functional limitations after trying conservative approaches, surgical intervention may be the most effective solution.

Considering Surgery With Dr Turner

Dr Scott Turner is a Specialist Plastic Surgeon in Sydney with extensive experience in post-pregnancy abdominoplasty at his Manly and Double Bay clinics.

During your consultation, Dr Turner will assess your condition, discuss your goals, explain the procedure, and determine Medicare eligibility. He’ll create a personalized treatment plan addressing your specific needs and provide comprehensive care from pre-surgery planning through recovery.

As a Specialist Plastic Surgeon, Dr Turner uses advanced techniques in accredited facilities and provides thorough aftercare support throughout your recovery journey.

Conclusion

Diastasis recti is a significant post-pregnancy condition that affects many Australian women both physically and emotionally. With the introduction of Medicare item 30175, abdominoplasty has become more accessible for those with significant separation who meet the stringent criteria.

The requirement for ultrasound confirmation of at least 3cm separation is not arbitrary but based on clinical evidence indicating that this threshold corresponds with significant functional impairment and likelihood of response to surgical intervention. While Medicare coverage has improved accessibility, patients should be aware of potential out-of-pocket expenses and should thoroughly discuss both benefits and risks with their healthcare provider.

When considering treatment options, it’s important to begin with conservative approaches like targeted exercise and physiotherapy. While the evidence supporting specific non-surgical protocols is still developing, many women experience improvement with proper rehabilitation exercises. For those with severe or persistent diastasis that doesn’t respond adequately to conservative measures, surgical consultation may ultimately be warranted.

Dr Scott Turner, a Specialist Plastic Surgeon in Sydney, offers expert assessment and treatment for women experiencing diastasis recti at his Manly and Double Bay clinics. By combining the latest evidence-based approaches with personalized care, Dr Turner helps women restore both function and confidence.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult with a qualified healthcare professional to determine the best treatment options for your individual needs.