Does Rectus Diastasis Improve After Pregnancy?
Yes, rectus diastasis typically improves spontaneously after pregnancy in most women, but conservative management with physiotherapy-guided exercise should be the first-line treatment for persistent cases, with surgery reserved only for severe symptomatic cases that fail conservative therapy. 1, 2, 3
Natural History and Spontaneous Resolution
- Most women develop some degree of rectus diastasis during pregnancy, and the majority experience spontaneous improvement in the postpartum period without intervention 2, 4
- The condition commonly occurs during pregnancy due to hormonal changes (relaxin, progesterone, estrogen) that reduce ligament rigidity and the mechanical stretching from the growing uterus 5
- However, severe diastasis may persist postpartum and require active management to prevent complications including abdominal herniation, strangulation, or incarceration 4
Conservative Management: First-Line Treatment
Physiotherapy with targeted exercise should be the initial treatment approach for all women with persistent postpartum rectus diastasis. 1, 3
During Pregnancy:
- Avoid abdominal strengthening exercises that worsen the condition, particularly abdominal curls 1
- Walking and appropriate aerobic exercise during pregnancy is associated with decreased odds of developing diastasis recti 1
- Antenatal exercise programs reduce the presence of diastasis by 35% (RR 0.65,95% CI 0.46 to 0.92) 2
Postpartum Period:
- Women should seek physiotherapy advice before resuming abdominal strengthening exercises 1
- Abdominal exercise leads to a small but statistically significant reduction in inter-recti distance (mean difference -0.43 cm, 95% CI -0.82 to -0.05) compared to usual care 6
- While the reduction may not be clinically dramatic, abdominal exercises provide other important physical and psychosocial benefits 6
Important Caveat:
The evidence for specific physiotherapy regimens is limited, with success rates poorly documented and no standardized protocols established 3, 6. Despite moderate-quality evidence showing some benefit, the clinical significance of the improvements remains modest 6.
Surgical Management: Reserved for Severe Cases
Surgery should only be considered for severe, symptomatic diastasis that fails conservative management and significantly impacts quality of life. 3, 4
Indications for Surgery:
- Severe irreversible diastasis with concurrent abdominal hernia 4
- Persistent symptoms including pain, discomfort, musculoskeletal problems, or urinary incontinence despite physiotherapy 3
- Significant negative impact on quality of life and body image 3
Surgical Outcomes:
- Both open and laparoscopic approaches have high success rates with low recurrence and complication rates 3
- Surgery improves low back pain, urinary incontinence, and quality of life 3
- Standard abdominoplasty with multiple wide longitudinal plications is an efficient management option for severe cases 4
- Complications are typically minor when they occur 3
Clinical Algorithm
Prevention during pregnancy: Encourage walking and aerobic exercise; avoid abdominal curls 1, 2
Immediate postpartum: Allow spontaneous improvement; most cases resolve without intervention 2, 4
Persistent diastasis (>6-12 months postpartum): Refer to physiotherapy for guided abdominal strengthening exercises 1, 3
Failed conservative management with severe symptoms: Consider surgical consultation for abdominoplasty with plication 3, 4
Key Pitfalls to Avoid
- Do not recommend abdominal curls or crunches during pregnancy - these worsen the condition 1
- Do not rush to surgery - physiotherapy should always be attempted first, as evidence for conservative management exists even if modest 3, 6
- Do not ignore severe cases - untreated severe diastasis can lead to abdominal hernia with risk of strangulation 4
- Do not assume all postpartum abdominal bulging is benign - evaluate for concurrent herniation with imaging if severe 4