What is the treatment for diastasis recti?

Treatment of Diastasis Recti

Physiotherapy should be the first-line treatment for diastasis recti, with surgery only considered after a 6-month standardized abdominal core training program and when the diastasis width is at least 5 cm. 1

Diagnosis and Assessment

• Diastasis recti is a separation of the rectus abdominis muscles along the midline of the abdomen
• Diagnosis is made through:
  • Clinical examination using a caliper or ruler for measurement
  • Diagnostic imaging (ultrasound) when concurrent umbilical/epigastric hernia cannot be excluded 1

Treatment Algorithm

Step 1: Conservative Management (First-Line)

1. Physiotherapy/Exercise Therapy

   • Targeted abdominal/core strengthening exercises 1, 2
   • Evidence shows exercise during pregnancy can reduce the presence of diastasis by 35% 2
   • Continuing aerobic exercise such as walking is associated with decreased odds of developing diastasis recti 3

2. Avoid Aggravating Activities

   • Women with diastasis recti should avoid abdominal strengthening exercises like abdominal curls as these may worsen the condition 3
   • Seek physiotherapy advice for appropriate exercises 3

Step 2: Supportive Interventions

• Abdominal Binding
  • Can be used as an adjunct to exercise therapy
  • Shows positive effects on body image (Cohen's d = 0.2-0.5) 4
  • Combination of binding and exercise therapy shows positive effect on trunk flexion strength (Cohen's d = 0.7) 4

Step 3: Surgical Management

Surgery should only be considered when:

• Patient has completed a standardized 6-month abdominal core training program 1
• Functional impairment persists despite conservative management 1
• The width of diastasis is at least 5 cm (or smaller if pronounced abdominal bulging or concomitant ventral hernia exists) 1
• At least 2 years have elapsed since last childbirth 1
• No future pregnancies are planned 1

Surgical options:

1. Plication of the linea alba - first-line surgical technique 1
2. Onlay mesh reinforcement - for severe diastasis cases 5

Special Considerations

• Timing: Conservative management should be tried for at least 6 months before considering surgery 1
• Pregnancy: Wait at least 2 years after childbirth before surgical intervention 1
• Comorbidities: Surgery may be considered with smaller diastasis if there is pronounced abdominal bulging or concomitant ventral hernia 1

Monitoring and Follow-up

• Regular assessment of diastasis width using calipers or ultrasound
• Evaluation of functional improvement and symptom relief
• Assessment of trunk strength and endurance using clinical tests 4

Potential Complications

• Surgical complications may include infections, seromas, and delayed healing 5
• Inadequate treatment may lead to persistent functional impairment and body image concerns 4

The evidence for diastasis recti treatment is still developing, with most studies being of moderate to low quality. However, the current consensus strongly supports starting with physiotherapy and only proceeding to surgery in cases that meet specific criteria and have failed conservative management.