Management of Diastasis Recti Without Strangulation or Incarceration
For diastasis recti without signs of strangulation or incarceration on CT, conservative management with observation and elective surgical planning is appropriate, as this represents an uncomplicated abdominal wall defect rather than an acute surgical emergency. 1
Initial Clinical Assessment
Diastasis recti is not a true hernia but rather a separation of the rectus abdominis muscles with extension of the linea alba tissue. 2 When CT imaging confirms absence of bowel compromise, the management approach differs fundamentally from complicated rectal prolapse or incarcerated hernias:
- No emergency surgical intervention is required when there are no signs of ischemia, perforation, or hemodynamic instability 1
- Assess for symptoms including lower back pain, uro-gynecological symptoms, and abdominal discomfort at the defect site 3
- Measure the inter-rectus distance, as diastasis recti is diagnosed when this distance exceeds 2 cm 3
- Document the location and severity of the defect using classification schemes based on inter-rectus distance and anatomical location 4
Conservative Management Strategy
Exercise therapy should be the first-line treatment for symptomatic diastasis recti without complications:
- Initiate therapeutic exercises focusing on recruitment of abdominal muscles 5
- These exercises have been shown to improve functional impairments associated with diastasis recti 5
- Consider ultrasound imaging and electromyography to assess abdominal muscle function and guide exercise therapy 5
Surgical Planning for Elective Repair
When conservative management fails or symptoms are severe, plan elective surgical repair at 6-12 months to allow for physiologic optimization: 1
Surgical Options Include:
- Simple plication of the midline defect for mild cases 6
- Extensive plication of the anterior abdominal wall for more severe deformity 6
- Minimally invasive laparoscopic repair using posterior sheath plication with mesh placement in the retromuscular space, which has shown promising results with low complication rates 3
- Abdominoplasty with anterior rectus sheath plication remains the most commonly used technique, though it requires a wide skin incision 3
Patient Selection Considerations:
- Multiparous women, obese patients, and those with multiple previous operations are at highest risk and may benefit most from surgical intervention 6
- Mesh reinforcement (resorbable or nonresorbable) may be considered based on the degree of myofascial deformity 6
Critical Pitfalls to Avoid
Never confuse uncomplicated diastasis recti with incarcerated or strangulated hernias requiring emergency intervention - the absence of bowel compromise on CT fundamentally changes the management timeline from urgent to elective 1
Do not proceed with immediate surgical repair in stable patients without attempting conservative management first, as exercise therapy can effectively resolve functional impairments in many cases 5