Specialist Referral for Diastasis Recti
For patients with diastasis recti, refer to a general surgeon or colorectal surgeon with experience in abdominal wall reconstruction, not to a gastroenterologist or obstetrician-gynecologist. 1, 2, 3
Rationale for Surgical Referral
Diastasis recti is fundamentally an abdominal wall structural defect requiring surgical expertise in myofascial repair and mesh placement when indicated. 2, 3, 4 The condition involves separation of the rectus abdominis muscles with thinning and widening of the linea alba, which falls squarely within the domain of surgical management rather than medical gastroenterology or obstetric care. 5, 6
Why Not Gastroenterology
- Gastroenterologists manage luminal gastrointestinal diseases, inflammatory bowel conditions, and functional GI disorders—not structural abdominal wall defects 7
- The evidence for GI specialist involvement is limited to complex inflammatory bowel disease requiring multidisciplinary teams with colorectal surgeons, not isolated diastasis recti 7
Why Not OB-GYN Alone
- While diastasis recti commonly occurs postpartum in multiparous women, the definitive surgical repair requires techniques beyond typical obstetric training 5, 6
- OB-GYN involvement may be appropriate for concurrent pelvic floor disorders (such as severe rectocele), where a collaborative approach between gynecologists and colorectal surgeons is ideal 8
- However, for isolated diastasis recti, surgical expertise in abdominal wall reconstruction is paramount 2, 3
Optimal Surgical Specialist
The ideal referral is to a general surgeon or colorectal surgeon with specific experience in abdominal wall reconstruction. 2, 3, 4 Key considerations include:
- Surgeon experience matters significantly: High-volume centers and surgeons with subspecialty training in abdominal wall surgery demonstrate better outcomes with lower complication rates 7
- Technical options require surgical expertise: Available approaches include laparoscopic/endoscopic techniques, laparoabdominoplasty, and minimally invasive repairs with mesh placement—all requiring advanced surgical skills 2, 3, 4
- Functional restoration is the goal: Beyond cosmetic improvement, proper repair restores abdominal wall integrity and core function, which requires understanding of myofascial anatomy and repair principles 3, 4
Clinical Decision Algorithm
Initial Conservative Management
- Implement moderate-intensity aerobic and resistance exercise for physical fitness and body composition improvement 1
- Reserve surgical referral for symptomatic patients who fail conservative management or have concurrent midline hernias 1, 4
Surgical Referral Indications
- Inter-rectus distance >50 mm with functional impairment (lower back pain, core weakness, uro-gynecological symptoms) 3, 5
- Coexisting midline hernia of any size, which significantly increases recurrence risk without proper repair 4
- Failed conservative management after 3-6 months of structured exercise rehabilitation 1
Critical Pitfalls
Counsel patients that anatomic correction does not guarantee symptom resolution, as the correlation between inter-rectus distance reduction and functional improvement can be weak 1. This expectation management is crucial before surgical referral.
Avoid referring to gastroenterology unless there are concurrent gastrointestinal pathologies requiring medical management separate from the diastasis recti 7.