Treatment of Diastasis Recti in Postpartum Women
Conservative exercise therapy should be the first-line treatment for diastasis recti, with surgical repair reserved for patients who fail conservative management or have severe functional impairment.
Initial Conservative Management
Exercise Therapy as Primary Treatment
- Targeted abdominal and core strengthening exercises during the antenatal period reduce the presence of diastasis recti by 35% (RR 0.65,95% CI 0.46 to 0.92) 1
- Exercise programs should focus on deep and superficial abdominal muscles, pelvic floor muscles, respiratory maneuvers, and functional exercises 2
- Alternative interventions including yoga, suspension training, and hypopressive exercises have shown promising results in reducing inter-recti distance 2
- A minimum trial of 3-6 months of conservative therapy is recommended before considering surgical options 3
Diagnostic Criteria
- Diastasis recti is diagnosed when the inter-rectus distance exceeds 2 cm 4
- Assessment should include evaluation of associated symptoms: lower back pain, uro-gynecological symptoms, abdominal discomfort, and quality of life impairment 4, 3
Surgical Management
Indications for Surgery
- Surgery should be considered only after failure of conservative physiotherapy, or in cases of severe functional impairment with significant musculoskeletal or urogynecological problems 3
- Both open and laparoscopic approaches have high success rates with low recurrence and complication rates 3
Surgical Technique Options
Minimally Invasive Laparoscopic Approach
- The modified laparoscopic technique using endo-stapler plication of the posterior rectus sheaths with mesh placement in the retromuscular space has shown promising results with minimal complications 4
- This approach involves dissecting the posterior rectus sheath from the rectus muscle, plicating the posterior sheets using an endo-stapler, and placing mesh in the retromuscular space without fixation 4
- In a series of 74 patients, there were no major complications, no postoperative infections, only 2 recurrences at 6 months, and significant symptom reduction 4
Open Surgical Approach
- Abdominoplasty with plication of the anterior rectus sheath is the most commonly used open technique, though it requires a wide skin incision 4
- Both open and laparoscopic approaches demonstrate positive results with minor complications 3
Surgical Outcomes
- Surgical repair improves lower back pain, urinary incontinence, and quality of life 3
- Recurrence rates are low across both surgical approaches 3
- Most complications are minor when they occur 3
Treatment Algorithm
First-line (0-6 months postpartum): Initiate targeted exercise therapy focusing on core strengthening, pelvic floor exercises, and respiratory maneuvers 1, 2
Second-line (after 3-6 months of failed conservative therapy): Consider surgical consultation if persistent symptoms significantly impair quality of life, cause ongoing musculoskeletal pain, or result in uro-gynecological dysfunction 3
Surgical decision: Choose between laparoscopic (preferred for reduced complications and shorter recovery) versus open approach based on severity and patient factors 4, 3
Important Caveats
- Evidence for specific exercise regimens remains limited, with significant variability in diagnostic criteria, program design, and outcome measures across studies 2
- Success rates for physiotherapy are not well-established in the literature, making it difficult to predict which patients will respond to conservative management 3
- Robotic-assisted surgery may become an option in the future, but current data are insufficient to recommend this approach 3