Initial Management of Diastasis Recti
For patients presenting with diastasis recti, physiotherapy with targeted abdominal/core strengthening exercises is the recommended first-line treatment. 1, 2
Understanding Diastasis Recti
Diastasis recti abdominis (DRA) is a condition where the abdominal muscles are separated by an abnormal distance due to widening of the linea alba, causing the abdominal content to bulge. It is commonly acquired during pregnancy and with significant weight gain.
Common Symptoms
- Abdominal pain and discomfort
- Musculoskeletal problems (including low back pain)
- Urogynecological issues (including urinary incontinence)
- Negative body image
- Impaired quality of life
Management Algorithm
Step 1: Physiotherapy (First-line Treatment)
- Core Strengthening Exercises: Focus on targeted abdominal/core strengthening exercises 1, 2
- Evidence suggests that exercise during the antenatal period can reduce the presence of DRA by 35% 2
- Exercise may also help reduce DRAM width during both ante- and postnatal periods 2
Step 2: Abdominal Binding
- Can be considered as an adjunct to exercise therapy
- Preliminary evidence shows positive effects on body image when used alone or in combination with exercise 3
- Combination therapy (binding + exercises) has shown positive effects on trunk flexion strength 3
Step 3: Surgical Management (When Conservative Treatment Fails)
- Consider surgical options when physiotherapy fails to provide adequate relief
- Both open and laparoscopic surgical approaches have high success rates 1, 4
- Surgical repair can improve associated symptoms including low back pain and urinary incontinence 1
Important Considerations
Contraindications for Exercise
During pregnancy, women with diastasis recti should avoid abdominal strengthening exercises (e.g., abdominal curls) as these may worsen the condition 5. However, aerobic exercises like walking are associated with decreased odds of developing diastasis recti.
Special Considerations During Pregnancy
For pregnant women with diastasis recti, the Canadian Guideline for Physical Activity throughout Pregnancy (2018) recommends:
- Seeking physiotherapy advice
- Avoiding abdominal strengthening exercises
- Continuing aerobic exercise such as walking 5
Monitoring Progress
- Regular assessment of inter-rectus distance using ultrasound
- Evaluation of functional improvement
- Assessment of symptom relief
Caveats and Pitfalls
- Limited Evidence: There is sparse high-quality evidence on the optimal physiotherapy regimen for DRA 1, 2
- Individualized Assessment: The severity of DRA varies, requiring tailored approaches
- Pregnancy Considerations: Different management approaches are needed during pregnancy versus postpartum
- Surgical Timing: Surgery should only be considered after adequate trial of conservative management
Despite limited high-quality evidence, physiotherapy remains the cornerstone of initial management for diastasis recti, with surgical options reserved for cases that fail to respond to conservative measures.