Postpartum: “Still have a belly pooch years after baby? Here’s what might be causing it”
You've done the crunches. You've cut back on snacks. You've added another workout. And that little area below your belly button still won't budge.
If that's you, you are far from alone. And it's not just new moms. Plenty of women whose "baby" is now in middle school feel the same way.
Here's what I want you to know first: not every belly pooch has the same cause. And not every belly pooch needs to be "fixed."
Five things that can cause a lower belly pooch & 4 of which Pelvic Floor PT can help!
1. Where your body stores fat. Genetics, age, and hormones all affect where your body holds onto fat. For a lot of women, the lower belly is one of those spots. Exercise and good food can change your overall body, but you can't choose which spot loses fat first.
2. Diastasis recti (abdominal separation). During pregnancy, the tissue down the middle of your belly stretches to make room for baby. Sometimes it stays stretched, or has a hard time getting firm again. You might notice a bulge, or a ridge that pops up down the middle when you sit up. This is more common than most women think. In one study of first-time moms, about 1 in 3 still had some separation a full year after birth. And yes, it can still be there years later.
3. How your core handles pressure. Your diaphragm (your main breathing muscle), your belly muscles, and your pelvic floor are a team. When they don't work together, like when you hold your breath or brace hard every time you lift, pressure pushes outward. That can show up as your belly bulging when you lift, bend, or get up off the floor.
4. Bloating and constipation. Sometimes the pooch isn't muscle or fat at all. Gas, bloating, and backed-up bowels can make your belly look bigger, especially by the end of the day. Your bowels and pelvic floor work closely together, so a pelvic floor that has trouble relaxing can add to constipation too.
5. C-section scar tissue. If you've had a C-section, you may notice a little "shelf" just above your scar. As the scar heals, it can stick to the tissue around it and create a tug or fold.
So how do you get rid of it?
It depends on the cause. That's why more crunches usually don't work. They're one answer to five different questions.
Diastasis recti or pressure problems: the right core strengthening and breathing can help your belly work better and bulge less when you move.
Bloating or constipation: working on bowel habits and pelvic floor relaxation can make a real difference.
C-section shelf: gentle scar work and core strengthening can help the tissue move better and feel less tight. It may not erase the shelf completely, but many women notice a real change in how it feels and moves, even years later.
Natural fat storage: no special ab exercise or Kegel will spot-reduce it. And that's okay.
A flat stomach isn't the goal
Here's the part I care about most. A flatter stomach doesn't automatically mean a stronger core.
As a pelvic floor PT, I care about what your body can do. Can you lift your kids, carry groceries, laugh, cough, and work out without leaking, pain, or pressure? That's what a strong core looks like.
Your goal doesn't have to be a perfectly flat stomach. It can be a core that supports you in real life.
Try this today: stop sucking it in
Are you holding your stomach in right now? A lot of us do it all day without noticing.
Your belly muscles aren't meant to stay clenched. You wouldn't walk around flexing your biceps all day, right?
Sit or stand comfortably and notice if you're gripping your stomach.
Let your belly muscles soften.
Breathe in slowly and let your ribs widen.
Breathe out without pulling your belly button in hard.
Repeat for a few breaths.
A healthy core tightens when you need it and relaxes when you don't.
When it's worth getting checked
If you notice your belly bulging or doming when you move, heaviness in your pelvis, leaking, or pain that hangs around, those are good reasons to have your core and pelvic floor looked at. It doesn't matter if your baby is 6 months old or 16 years old.
After three babies and three very different recoveries, I know how frustrating it is to feel like you're doing everything right and still not feel like yourself.
If this sounds familiar, let's talk. Email me at emily@essentialmovementpt.com or request an appointment here.
— Dr. Emily, Essential Movement Physical Therapy
This post is for education only and isn't a diagnosis. If you have new or changing symptoms, talk with your healthcare provider.
Sources
Sperstad JB, et al. "Diastasis recti abdominis during pregnancy and 12 months after childbirth." British Journal of Sports Medicine, 2016: https://pmc.ncbi.nlm.nih.gov/articles/PMC5013086/
Olszewska K, et al. "Changes in the scar tissue structure after cesarean section as a result of manual therapy." Advances in Clinical and Experimental Medicine, 2024: https://advances.umw.edu.pl/en/article/2024/33/4/387/
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