Treatment for Diastasis Recti
Physiotherapy with structured abdominal core training is the first-line treatment for diastasis recti and should be attempted for at least 6 months before considering surgical intervention. 1
Initial Conservative Management
All patients with diastasis recti must begin with physiotherapy as the primary treatment approach. 2, 1 The evidence shows that exercise during the antenatal period can reduce the presence of diastasis recti by 35% (RR 0.65,95% CI 0.46 to 0.92). 3
- Implement a standardized 6-month abdominal core training program focusing on targeted abdominal and core strengthening exercises before considering any surgical options. 1
- Exercise interventions may reduce diastasis width during both ante- and postnatal periods, though the quality of evidence is limited. 3
- The specific physiotherapy regimen remains poorly defined in the literature, with success rates not consistently reported across studies. 2
Diagnostic Criteria Before Treatment
Measure the inter-recti distance using a caliper or ruler during clinical examination. 1
- Obtain diagnostic imaging with ultrasound when concurrent umbilical or epigastric hernia cannot be excluded or when other causes of symptoms need evaluation. 1
- The largest width of diastasis should be documented to guide treatment decisions. 1
Surgical Indications
Surgery should only be considered when patients have functional impairment AND have completed a 6-month standardized physiotherapy program without adequate improvement. 1
Specific Surgical Criteria:
- The diastasis width must be at least 5 cm at its largest measurement before surgical treatment is appropriate. 1
- Surgery may be considered with smaller diastasis if there is pronounced abdominal bulging or concomitant ventral hernia. 1
- At least 2 years must have elapsed since last childbirth and future pregnancy should not be planned. 1
Surgical Approach Selection
Plication of the linea alba is the first-line surgical technique for diastasis recti repair. 1
Open vs. Laparoscopic Surgery:
Both approaches demonstrate equivalent outcomes with no significant differences in recurrence or complication rates. 4
- Recurrence rates are similarly low for both open (0.89%) and laparoscopic (0%) repairs in patients without concurrent herniorrhaphy (p > 0.05). 4
- Total complication rates are comparable between open (11.8%) and laparoscopic (16.2%) approaches in patients without herniorrhaphy (p > 0.05). 4
- The most common complications include seroma, skin dehiscence, hematoma/post-operative bleeding, and infection. 4
- Both surgical approaches demonstrate high success rates with low recurrence and minor complications. 2
Surgical Outcomes:
- Surgical repair improves low back pain, urinary incontinence, and quality of life in addition to correcting the anatomical defect. 2
- Other plication techniques may be used but have not been found superior to standard linea alba plication. 1
- Robotic-assisted surgery remains investigational with insufficient data to recommend routinely. 2
Common Pitfalls and Caveats
Do not proceed to surgery without documenting completion of a full 6-month physiotherapy program unless there are exceptional circumstances with severe functional impairment. 1 Many patients are referred for surgery prematurely without adequate conservative management trials. 2
Avoid surgical intervention in women planning future pregnancies as this significantly increases recurrence risk and negates surgical benefits. 1
Ensure accurate measurement and documentation of diastasis width using objective tools (caliper or ruler) rather than subjective assessment alone, as the 5 cm threshold is critical for surgical decision-making. 1