What is the best approach to manage diastasis recti in a postpartum woman?

Management of Diastasis Recti in Postpartum Women

Women with diastasis recti should begin with conservative management focused on physiotherapy and specific abdominal exercises, avoiding traditional crunches and curls which can worsen the condition. 1

Prevention During Pregnancy

Pregnant women who develop visible diastasis recti should immediately avoid abdominal curls or crunches, as these exercises worsen the separation and increase the likelihood of requiring postnatal surgical repair. 1

• Continue aerobic exercise such as walking throughout pregnancy, which is associated with decreased odds of developing diastasis recti 1
• Seek physiotherapy consultation as soon as visible separation is noted during pregnancy 1

Initial Conservative Treatment (First-Line)

Abdominal exercise programs are the cornerstone of treatment and are generally effective at various postpartum periods. 2

The exercise program should include:

• Activation of the transversus abdominis muscle - this is the key therapeutic target for reducing diastasis 3
• Pelvic floor muscle activation and training 3
• Postural adjustment and correction 3
• Modification of breathing patterns to support proper abdominal wall mechanics 3
• Training in correct ergonomics for daily activities 3

Dosing schedule based on evidence: 3

• Week 1: 15 minutes daily
• Weeks 2-4: 20 minutes daily
• Weeks 5-12: 30 minutes daily
• Frequency: 5 days per week for minimum 12 weeks

Adjunctive Conservative Therapies

Electrical stimulation combined with exercise shows preliminary but promising efficacy and can be added if exercise alone provides insufficient improvement. 2

Abdominal kinesiotaping can be used in conjunction with exercise programs as a supportive measure. 2

Assessment and Monitoring

Objective measurement should be performed using:

• 2D ultrasound with linear probe (preferred method) 3
• Measurements at three locations: 4.5 cm above umbilicus, at umbilicus, and 4.5 cm below umbilicus 3
• Assessment both at rest and during stress tests (such as lower limb elevation) 3
• Alternative methods include caliper measurement or palpation, though ultrasound provides superior objectification 3

When to Consider Surgical Management

Surgical intervention should be reserved for patients who fail conservative management after an adequate trial (minimum 12 weeks) or have severe anatomical deformity causing functional impairment. 4

Surgical options include:

• Simple plication of the midline defect for mild cases 4
• Extensive plication of the anterior abdominal wall for moderate to severe cases 4
• Use of resorbable or nonresorbable mesh in select cases 4

Important Clinical Pitfalls

The most critical error is prescribing traditional abdominal crunches or curls - these exercises recruit the rectus abdominis in a way that increases intra-abdominal pressure and worsens the separation rather than improving it. 1

Lack of focus on transversus abdominis activation - many exercise programs fail because they don't specifically target this deep abdominal muscle, which is essential for reducing the inter-recti distance. 3

Inadequate treatment duration - improvement requires consistent exercise for at least 12 weeks; shorter trials often lead to premature surgical referral. 3

Risk Factors to Document

High-risk patients include: 4

• Multiparous women
• Obese patients
• Those with multiple previous abdominal operations

These patients may require more intensive conservative management or earlier consideration of surgical options.