What are the treatment options for Diastasis Recti?

Treatment of Diastasis Recti

Physiotherapy with structured abdominal core training is the first-line treatment for diastasis recti, and surgery should only be considered after a standardized 6-month exercise program has failed in patients with functional impairment and a diastasis width of at least 5 cm. 1

Initial Conservative Management

Physiotherapy as Primary Treatment

• Start with physiotherapy-based abdominal core strengthening exercises as the initial treatment approach. 2, 1
• During pregnancy, women with visible diastasis recti should seek physiotherapy advice and avoid abdominal curls or crunches, as these may worsen the condition and increase the likelihood of requiring postnatal repair. 3
• Continuing aerobic exercise such as walking during pregnancy is associated with decreased odds of developing diastasis recti. 3
• Exercise during the antenatal period reduces the presence of diastasis recti by 35% (RR 0.65,95% CI 0.46 to 0.92). 4

Diagnostic Criteria

• Diagnose diastasis recti at clinical examination using a caliper or ruler for measurement. 1
• Diastasis recti is diagnosed when the inter-rectus distance is greater than 2 cm. 5
• Perform diagnostic imaging by ultrasound or other modality when concurrent umbilical or epigastric hernia or other causes of symptoms cannot be excluded. 1

Surgical Intervention Criteria

When to Consider Surgery

• Surgery should only be considered in patients with functional impairment who have completed a standardized 6-month abdominal core training program without adequate improvement. 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 width. 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
• Both open and laparoscopic approaches have high success rates with low recurrence and complication rates. 2
• Laparoscopic techniques include modifications using endostaplers to plicate the posterior rectus sheaths with mesh placement in the retromuscular space. 5
• Abdominoplasty with plication of the anterior rectus sheath is commonly used but requires a wide skin incision. 5

Expected Outcomes

Benefits of Surgical Repair

• Surgical repair improves low back pain, urinary incontinence, and quality of life. 2
• Complications are typically minor with low recurrence rates. 2
• In one series of 74 patients using minimally invasive repair, there were no major complications, no postoperative infections, and only two recurrences at six months. 5

Common Pitfalls to Avoid

• Do not proceed directly to surgery without attempting a structured 6-month physiotherapy program first. 1
• Avoid abdominal curls and similar exercises during pregnancy in women with visible diastasis, as these worsen the separation. 3
• Do not consider surgery until at least 2 years postpartum if the patient has given birth. 1
• Evidence on specific physiotherapy regimens is limited, but targeted abdominal/core strengthening appears most beneficial. 2, 4