What is the treatment for diastasis recti?

Treatment for Diastasis Recti

Conservative management with targeted exercise therapy is the first-line treatment for diastasis recti, with surgical repair reserved for cases that fail conservative management or have significant functional impairment.

Initial Conservative Approach

Exercise Modifications During Pregnancy and Early Postpartum

• Avoid abdominal strengthening exercises (such as abdominal curls and crunches) during pregnancy and early postpartum, as these may worsen the condition and increase the likelihood of requiring postnatal repair 1
• Continue aerobic exercise such as walking, which is associated with decreased odds of developing diastasis recti 1
• Antenatal exercise programs can reduce the presence of diastasis recti by 35% (RR 0.65,95% CI 0.46 to 0.92) 2

Therapeutic Exercise Programs

• Targeted abdominal/core strengthening exercises are the mainstay of conservative treatment, though the evidence quality is limited 2
• Hypopressive exercises combined with targeted abdominal muscle strengthening show promise in reducing inter-rectus distance 3
• Exercise therapy during both ante- and postnatal periods may reduce diastasis width, though high-quality evidence is lacking 2
• Combination therapy (exercise plus abdominal binding) shows positive effects on trunk flexion strength (Cohen's d = 0.7) after 6 months 4

Adjunctive Conservative Therapies

• Abdominal binding can positively impact body image (Cohen's d = 0.2-0.5) when used alone or in combination with exercise 4
• Transcutaneous radiofrequency diathermy (TRD) combined with therapeutic exercise may significantly reduce inter-rectus distance, with one case report showing reduction from 6.5 cm to 2.1 cm (-47.5%) at rest 3
• Conservative management should be attempted for at least 6 months before considering surgical options 4

Surgical Management

Indications for Surgery

• Failure of conservative management after adequate trial (typically 6+ months) 5
• Persistent symptoms including lower back pain, uro-gynecological symptoms, and discomfort at the defect level 5
• Inter-rectus distance > 2 cm with functional impairment 5
• Patient preference after informed discussion of risks and benefits 6

Surgical Techniques

• Minimally invasive laparoscopic repair is increasingly preferred over traditional open abdominoplasty, avoiding wide skin incisions 5
• The modified Costa technique combines Rives-Stoppa principles with laparoscopic access, using surgical staplers to plicate the posterior rectus sheaths 5
• Mesh placement in the retromuscular space without fixation can be performed laparoscopically 5
• Traditional abdominoplasty with plication of the anterior rectus sheath remains an option but requires extensive incisions 5

Surgical Outcomes

• Minimally invasive techniques show promising results with low complication rates and no major postoperative infections in pilot studies 5
• Recurrence rates appear low (2/74 patients at 6 months in one series), though longer follow-up is needed 5
• Significant symptom reduction is achieved with surgical repair 5

Clinical Pitfalls to Avoid

• Do not recommend traditional abdominal exercises (crunches, sit-ups) during pregnancy or early postpartum, as these can worsen the separation 1
• Do not rush to surgery without adequate trial of conservative management (minimum 6 months) 4
• Recognize that diastasis recti is not a true hernia, though it may result in herniation of abdominal viscera 6
• Be aware that evidence quality for most conservative interventions is poor, requiring shared decision-making with patients 2