Diastasis Recti (DR) is the separation of the rectus abdominis muscles, the two vertical bands of muscle that meet at the midline of the abdomen. This condition commonly results from pregnancy, where the growing uterus stretches the connective tissue (linea alba). Finding a comfortable position to rest is challenging, as improper posture increases pressure on the weakened abdominal wall. The primary goal is to minimize intra-abdominal pressure (IAP) during all activities, including sleep, to promote healing.
Understanding Safe Sleeping Positions
The best position for minimizing strain on the abdominal wall is side-lying. Resting on your side directs gravity away from the weakened midline tissue. This posture allows deep core muscles to relax without the gravitational drag that stretches the linea alba. Either side is acceptable for abdominal comfort, though the left side is often suggested to improve circulation.
To maintain optimal spinal alignment in the side-lying position, place a pillow between the knees. This keeps the hips stacked and prevents the top leg from rotating inward, which can twist the pelvis and strain the lower back. Hugging a pillow can also achieve a slight forward tilt of the upper body, further reducing tension on the abdominal muscles.
A modified back-lying position is a viable option for those who cannot tolerate side-sleeping. Lying flat on the back without support causes the lower back to arch, increasing abdominal pressure. To counteract this, place a pillow under the knees to create a gentle bend. This flattens the lower back and places the pelvis in a neutral position, distributing IAP evenly.
Positions and Practices to Avoid
Sleeping flat on the back without lower body support should be avoided. In this supine position, gravity pulls the abdominal contents forward if the core muscles are not engaged. This stretches the separated connective tissue and can lead to “doming” or coning, increasing IAP and potentially worsening the separation.
Sleeping on the stomach is discouraged. This posture compresses the abdomen against the mattress and forces the lower back into an excessive arch. This arching motion can splay the ribcage and overstretch the linea alba, creating stress on the abdominal wall. The intense pressure and twisting make stomach-sleeping counterproductive for core recovery.
Sudden or uncontrolled movements during the night can be damaging. Abrupt actions that force the body to sit straight up, often called “jackknifing,” intensely flex the rectus abdominis. This explosive movement stresses the midline connective tissue, so deliberate, slow transitions are necessary to protect the core.
Techniques for Entering and Exiting Bed
Safely moving into and out of bed requires the “log roll” technique. This practice prevents the direct engagement of the rectus abdominis, which pulls the separated muscles apart. The goal is to move the entire body as a single, rigid unit, ensuring shoulders, hips, and knees remain aligned.
To exit the bed, lie on your back with your knees bent and feet flat on the mattress. Roll your entire body—head, shoulders, torso, and legs—to one side simultaneously, keeping abdominal muscles gently engaged. Once fully on your side, swing your legs off the edge of the bed. Use the arm closest to the mattress and your elbow for leverage, pushing your upper body up to a seated position without bending forward at the waist.
The process is reversed when getting into bed: sit on the edge of the mattress and gently lower your body onto your side, using your arms for support. As your upper body descends, bring your knees up onto the bed, keeping your trunk straight. This single-unit movement prevents twisting or direct abdominal flexion.
Utilizing Supportive Tools and Garments
External aids play a supportive role in maintaining safe positions and minimizing core strain while sleeping. Body pillows are effective when side-sleeping, providing structure that supports the weight of the abdomen. They can be tucked between the knees and under the top arm to maintain neutral spinal alignment.
Wedge pillows offer support, particularly in the modified back-lying position. They are placed under the upper back to create a semi-reclined angle, which helps offload pressure from the abdomen. Proper placement avoids postural collapse that would put drag on the linea alba.
While postpartum binders and compression garments provide daytime support, caution is necessary regarding their use during sleep. These garments offer external compression, but overly restrictive garments could cause discomfort or interfere with natural breathing. Any decision to wear a supportive garment overnight should be made in consultation with a physical therapist specializing in pelvic floor health.