What is the treatment for diastasis recti?

Treatment for Diastasis Recti Abdominis

Physiotherapy is the first-line treatment for diastasis recti abdominis, with core stabilization exercises showing the most effectiveness for reducing inter-rectus distance, particularly below the umbilicus. 1, 2

Diagnosis and Assessment

• Diagnosis is made through clinical examination using a caliper or ruler for measurement
• Diagnostic imaging (ultrasound) should be performed when concurrent umbilical/epigastric hernia cannot be excluded
• Inter-rectus distance (IRD) should be measured both above and below the umbilicus

Treatment Algorithm

First-Line Treatment: Conservative Management

1. Core Stabilization Exercises (6-month standardized program)

   • Most effective for reducing IRD below the umbilicus 2
   • Improves trunk flexion strength and endurance 3
   • Avoid abdominal curls/crunches in patients with significant diastasis as these may worsen the condition 4
   • Focus on exercises that decrease inter-rectus distance

2. Combination Therapy

   • Core stabilization exercises combined with abdominal binding shows superior results for:
     • Trunk flexion strength
     • Trunk flexor endurance
     • Balance
     • Overall function 3

3. Abdominal Binding/Corset

   • Less effective than exercises alone for IRD reduction 2
   • May provide symptomatic relief and improve body image 5
   • Can be used as adjunctive therapy

Second-Line Treatment: Surgical Intervention

Surgery should only be considered when:

• Patient has completed a 6-month standardized abdominal core training program
• Functional impairment persists despite conservative management
• The largest width of diastasis is at least 5 cm
• At least 2 years have elapsed since last childbirth
• No future pregnancies are planned 1

Surgical technique:

• Plication of the linea alba is the first-line surgical approach 1

Effectiveness of Interventions

Intervention	Effect on IRD Below Umbilicus	Effect on IRD Above Umbilicus	Other Benefits
Core exercises	Significant reduction	Limited evidence	Improved trunk strength, reduced pain
Abdominal binding	Moderate reduction	Limited effect	Improved body image
Combination therapy	Greatest overall reduction	Moderate effect	Best for functional outcomes

Important Considerations

• During pregnancy, continuing aerobic exercise such as walking is associated with decreased odds of developing diastasis recti 4
• Women with visible separation of abdominal muscles should seek physiotherapy advice and avoid abdominal strengthening exercises like abdominal curls as these may worsen the condition 4
• The optimal duration for conservative management is 6 months before considering surgical options 1

Common Pitfalls to Avoid

1. Initiating aggressive abdominal exercises too early postpartum
2. Focusing solely on abdominal binding without proper exercise therapy
3. Performing exercises that increase intra-abdominal pressure (heavy lifting, traditional sit-ups) which may worsen diastasis
4. Neglecting to assess for concurrent conditions like umbilical hernia
5. Considering surgery before completing an adequate trial of conservative management

By following this evidence-based approach, most patients with diastasis recti can achieve significant improvement in both anatomical correction and functional outcomes.