What are the treatment options for Diastasis Recti (separation of abdominal muscles)?

Treatment Options for Diastasis Recti

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

Conservative Management Approaches

Physical Therapy

• Core stabilization exercises are effective in reducing inter-rectus distance, improving trunk flexion strength and endurance, and enhancing balance in patients with diastasis recti 2
• Women experiencing diastasis recti during pregnancy should avoid exercises that may worsen the condition, such as abdominal curls 3
• Walking and appropriate aerobic exercise during pregnancy is associated with decreased odds of developing diastasis recti 3
• Postpartum women should seek physiotherapy advice before resuming abdominal strengthening exercises 3

Abdominal Binding/Corsets

• Abdominal binding alone shows positive effects on body image (Cohen's d = 0.2-0.5) 4
• The combination of core stabilization exercises and abdominal corset use has been found more effective than either intervention alone in the postpartum period 2
• Abdominal corsets can positively impact inter-rectus distance, trunk flexion muscle strength, and disability in diastasis recti management 2

Surgical Management

Indications for Surgery

• Surgery should only be considered after failure of a standardized 6-month abdominal core training program 1
• The patient should have functional impairment related to the diastasis 1
• The largest width of the diastasis should be at least 5 cm before surgical treatment is considered 1
• In cases of pronounced abdominal bulging or concomitant ventral hernia, surgery may be considered with smaller diastasis 1
• At least 2 years should have elapsed since last childbirth and future pregnancy should not be planned 1

Surgical Techniques

• Plication of the linea alba is the first-line surgical technique 1
• Diastasis repair with concomitant ventral hernia repair is feasible and safe when indicated 5
• Surgical approaches may include:
  • Laparoscopic diastasis recti repair with ventral hernia repair 5
  • Open diastasis recti repair with ventral hernia repair and abdominoplasty 5

Clinical Considerations and Caveats

• Diagnostic imaging by ultrasound should be performed when concurrent umbilical or epigastric hernia cannot be excluded 1
• Potential complications of surgery include seroma formation (reported in 30% of cases in one study) 5
• Diastasis recti is not a hernia per se, but may result in herniation of abdominal viscera if left untreated 6
• The combination of exercise therapy and abdominal binding shows the most promising results for improving trunk flexion strength (Cohen's d = 0.7) 4

Treatment Algorithm

1. Confirm diagnosis through clinical examination using caliper or ruler measurement 1
2. Begin with conservative management through physiotherapy (core stabilization exercises) for at least 6 months 1, 2
3. Consider adding abdominal binding/corset for enhanced outcomes 2
4. Evaluate for surgical candidacy only if:
   • Conservative management fails after 6 months 1
   • Functional impairment persists 1
   • Diastasis width is ≥5 cm (or smaller with pronounced bulging or concomitant hernia) 1
   • At least 2 years post-childbirth with no future pregnancy plans 1
5. If surgery is indicated, plication of the linea alba is the preferred technique 1