What is the treatment for diastasis recti?

Treatment of Diastasis Recti

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

Initial Conservative Management

Start with structured exercise therapy as the primary intervention:

• A 6-month standardized abdominal core training program must be completed before considering surgical options 1
• Exercise programs targeting trunk muscles show positive effects on trunk flexion strength (Cohen's d = 0.7) when combined with other interventions 2
• Continuing aerobic exercise such as walking during pregnancy is associated with decreased odds of developing diastasis recti 3
• Women with visible diastasis recti should seek physiotherapy advice and avoid abdominal strengthening exercises like abdominal curls, as these may worsen the condition 3

Abdominal binding may provide additional benefit:

• Abdominal binding combined with exercise therapy shows positive effects on body image (Cohen's d = 0.2-0.5) 2
• Elastic compression techniques can be used as an adjunctive measure 2

Important caveat: While physiotherapy is recommended first-line, the evidence on which specific conservative regimen to use is sparse, and success rates are not well-established in the literature 4

Diagnostic Criteria Before Treatment

Clinical diagnosis should be confirmed with objective measurement:

• Diastasis should be diagnosed at clinical examination using a caliper or ruler for measurement 1
• Diagnostic imaging by ultrasound or other imaging modality should be performed when concurrent umbilical or epigastric hernia or other causes of symptoms cannot be excluded 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 a smaller diastasis 1

Surgical Indications and Timing

Surgery is reserved for specific circumstances after failed conservative therapy:

• Surgery should only be considered in patients with functional impairment who have completed a 6-month standardized abdominal core training program 1
• At least 2 years should have elapsed since last childbirth and future pregnancy should not be planned 1
• Both open and laparoscopic surgical approaches have high success rates with low recurrence and complication rates 4

Surgical Technique

Plication of the linea alba is the preferred surgical approach:

• Suture plication of the linea alba is the first-hand surgical technique 1
• Other techniques may be used but have not been found superior 1
• Endoscopic preaponeurotic repair with recti plication using barbed suture and polypropylene mesh reinforcement shows excellent results with 96% patient satisfaction and no recurrences at 3-year follow-up 5
• Surgical repair provides long-term improvement in abdominal core function, quality of life, and urinary incontinence symptoms that persists for at least 3 years 6

Expected Outcomes

Surgical repair demonstrates sustained functional improvement:

• All disability rating parameters improve significantly (p < 0.001) at 3-year follow-up compared to preoperative values 6
• Core muscle strength and stability, back muscle strength, and abdominal muscle strength all show significant improvement 6
• Urinary incontinence symptoms and quality of life measures improve and remain stable through long-term follow-up 6
• Average hospital stay is 1.3 days with pain level 3/10, and patients return to usual activities after approximately 16.5 days 5

Common Pitfalls to Avoid

• Do not proceed to surgery without first completing an adequate trial of conservative therapy, specifically a 6-month structured abdominal core training program 1
• Do not perform surgery if the patient plans future pregnancies or if less than 2 years have elapsed since last childbirth 1
• Avoid abdominal strengthening exercises (like abdominal curls) during pregnancy or early postpartum period as these may worsen the condition 3
• Do not consider surgery if the diastasis width is less than 5 cm unless there is pronounced abdominal bulging or concomitant ventral hernia 1