What is the best treatment approach for rectus diastasis (abdominal muscle separation)?

Treatment Approaches for Rectus Diastasis

Surgical intervention is the most effective treatment for rectus diastasis, with both open and laparoscopic approaches showing high success rates and low complication rates, particularly when conservative measures fail to provide adequate relief. 1

Understanding Rectus Diastasis

Rectus diastasis (also called diastasis recti abdominis or DRA) is characterized by:

• Abnormal widening of the linea alba causing separation of the rectus abdominis muscles 1
• Common occurrence during pregnancy and postpartum periods 2
• Associated with symptoms including abdominal pain, musculoskeletal issues, urogynecological problems, and impaired quality of life 1

Treatment Algorithm

First-Line Approach: Conservative Management

1. Physiotherapy/Exercise Therapy

   • Focused abdominal/core strengthening exercises are the cornerstone of conservative treatment 3
   • Evidence shows only modest effectiveness with a small reduction in inter-recti distance (mean difference -0.43 cm) compared to usual care 4
   • Exercise during pregnancy may reduce the presence of DRAM by 35% 2

2. Adjunctive Conservative Therapies

   • Electrical stimulation combined with exercise shows preliminary promising results 3
   • Abdominal kinesiotaping can be used as a complementary intervention 3
   • Abdominal binding may provide symptomatic relief 4

Second-Line Approach: Surgical Management

When conservative measures fail to provide adequate symptom relief, surgical intervention should be considered:

1. Open Surgical Approach

   • Classic low abdominoplasty is the most common technique 5
   • Involves plication (folding and suturing) of the rectus fascia 5
   • Can be performed with single or double layer plication, typically using permanent sutures 5
   • High success rates with low recurrence and complication rates 1

2. Laparoscopic Approach

   • Minimally invasive alternative to open surgery 5
   • Various plication techniques can be employed 5
   • Shows positive outcomes similar to open approaches 1
   • May be preferred for patients seeking minimal scarring 1

Outcomes and Benefits of Treatment

Successful treatment of rectus diastasis can lead to:

• Improvement in low back pain 1
• Reduction in urinary incontinence 1
• Enhanced quality of life 1
• Improved body image 1

Important Considerations and Caveats

• Measurement Challenges: Different measurement methods (palpation, calipers, ultrasound) and sites make it difficult to standardize assessment and compare treatment outcomes 3
• Timing of Intervention: Optimal timing for both conservative and surgical interventions remains unclear, particularly in the postpartum period 4
• Evidence Quality: There is a lack of high-quality evidence regarding the optimal exercise regimen for conservative management 1
• Surgical Technique Selection: No single surgical technique has been proven superior to others; choice should be based on individual patient factors and surgeon expertise 5

Special Considerations for Pregnant and Postpartum Women

• During pregnancy, exercise may help prevent DRAM development 2
• Women experiencing diastasis recti during pregnancy should avoid abdominal strengthening exercises that may worsen the condition (e.g., abdominal curls) 6
• Walking and other appropriate aerobic exercise during pregnancy is associated with decreased odds of developing diastasis recti 6
• Postpartum women with diastasis recti should seek physiotherapy advice before resuming abdominal strengthening exercises 6