What is the recommended treatment for diastasis recti?

Treatment of Diastasis Recti

Physiotherapy is the first-line treatment for diastasis recti, with surgery only considered for patients with functional impairment who have failed a standardized 6-month abdominal core training program. 1

Diagnosis and Assessment

• Diastasis recti is diagnosed through clinical examination using a caliper or ruler for measurement
• Diagnostic imaging (ultrasound or other modality) should be performed when concurrent umbilical/epigastric hernia or other causes of symptoms cannot be excluded
• Normal inter-rectus distance is less than 2 cm; diastasis is diagnosed when this distance exceeds 2 cm

Treatment Algorithm

First-Line Treatment: Physiotherapy

• All patients with diastasis recti should begin with a structured physiotherapy program targeting the core muscles
• Specific exercises should focus on strengthening the transverse abdominis and deep core muscles
• Avoid traditional abdominal exercises like crunches or sit-ups as these may worsen the condition 2
• For pregnant women who develop diastasis recti, continuing aerobic exercise such as walking is associated with decreased odds of developing worsening diastasis 2

Second-Line Treatment: Surgical Intervention

Surgery should only be considered when ALL of the following criteria are met:

1. Patient has completed a standardized 6-month abdominal core training program without adequate improvement
2. Patient demonstrates functional impairment (not just cosmetic concerns)
3. The width of the diastasis is at least 5 cm at its largest point
4. At least 2 years have elapsed since last childbirth (if applicable)
5. No future pregnancies are planned

Surgical Techniques

• Plication of the linea alba is the first-line surgical approach 1
• Other techniques including laparoscopic approaches with mesh placement may be considered in specific cases 3
• Minimally invasive techniques show promising results but require longer follow-up for definitive assessment 3

Special Considerations

For Pregnant and Postpartum Women

• Women experiencing diastasis recti during pregnancy should be counseled to seek physiotherapy advice
• Avoid abdominal strengthening exercises (e.g., abdominal curls) as these may worsen the condition 2
• Postpartum women may benefit from abdominal binding in combination with exercise therapy, which shows positive effects on body image and trunk flexion strength 4

For Patients with Severe Diastasis

• In cases with pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered even with a diastasis smaller than 5 cm 1
• Patients should be evaluated for associated symptoms such as lower back pain and urogenital symptoms which may improve with treatment

Monitoring and Follow-up

• Regular reassessment of inter-rectus distance during physiotherapy treatment
• Post-surgical follow-up should begin two months after surgery to assess for complications or recurrence
• Monitor for potential complications including infection, recurrence, and mesh-related issues if mesh was used

The evidence strongly supports a conservative approach first, with surgical intervention reserved for cases that fail to respond to physiotherapy and meet specific criteria for surgery.