What is the treatment for divarication of recti muscle (diastasis recti)?

Treatment of Diastasis Recti (Divarication of Recti Muscle)

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

Initial Conservative Management

Women with diastasis recti during pregnancy should avoid abdominal strengthening exercises that worsen the condition, particularly abdominal curls and crunches. 2, 3

• Aerobic exercise, particularly walking, during pregnancy is associated with decreased odds of developing diastasis recti. 2, 3
• Postpartum women with diastasis recti should seek physiotherapy advice before resuming abdominal strengthening exercises. 2
• Physiotherapy is the mandatory first treatment step, though specific regimens and success rates remain poorly defined in the literature. 4

Criteria for Surgical Consideration

Surgery should only be considered when specific criteria are met to ensure appropriate patient selection and optimize outcomes:

• The diastasis width must be at least 5 cm at its largest measurement. 1
• Patients must have functional impairment (such as pain, musculoskeletal problems, or urinary incontinence) rather than purely cosmetic concerns. 4, 1
• A standardized 6-month abdominal core training program must have been completed without adequate improvement. 1
• At least 2 years should have elapsed since the last childbirth, and no future pregnancies should be planned. 1
• Exception: Surgery may be considered with smaller diastasis if there is pronounced abdominal bulging or concomitant ventral hernia. 1

Surgical Approaches

Plication of the linea alba is the first-line surgical technique when surgery is indicated. 1

Open Surgical Repair

• Standard abdominoplasty with plication of the anterior rectus sheath is the most commonly used approach, with high success rates and low recurrence rates. 4, 5
• Multiple wide longitudinal plications of the abdominal wall can be performed for severe cases. 5
• The major limitation is the requirement for a wide skin incision. 6

Laparoscopic/Minimally Invasive Repair

• Laparoscopic approaches have shown high success rates with low complication rates. 4
• Modified techniques using endo-staplers to plicate the posterior rectus sheaths in the retromuscular space (Rives-Stoppa principles) have shown promising results. 6
• Mesh placement in the retromuscular space may be used without fixation in minimally invasive approaches. 6

Expected Outcomes

Both open and laparoscopic surgical approaches demonstrate:

• High success rates with low recurrence and complication rates. 4
• Improvement in low back pain, urinary incontinence, and quality of life. 4
• Minor complications when they occur, with no major readmissions typically required. 6

Diagnostic Approach

Diastasis recti should be diagnosed at clinical examination using a caliper or ruler for measurement. 1

• Diagnostic imaging by ultrasound or other modality should be performed when concurrent umbilical or epigastric hernia or other causes of symptoms cannot be excluded. 1
• The condition is defined as separation between the rectus abdominis muscles with widening of the linea alba, typically diagnosed when the inter-rectus distance exceeds 2 cm. 6

Common Pitfalls to Avoid

Do not proceed directly to surgery without attempting conservative management first, as this violates evidence-based treatment algorithms. 1

Do not operate on patients who plan future pregnancies, as this significantly increases recurrence risk. 1

Avoid recommending abdominal curls or crunches during pregnancy in women with visible diastasis, as these exercises worsen the separation. 2, 3