Management of Diastasis Recti Abdominis in Adults
Begin with physiotherapy as first-line treatment for all patients with diastasis recti abdominis, and reserve surgical repair for those who fail conservative management or present with concurrent abdominal herniation. 1
Initial Conservative Management
Physiotherapy should be the initial treatment approach for diastasis recti abdominis, focusing on exercises that recruit and strengthen the abdominal muscles. 1, 2
Exercise Therapy Components:
- Core stabilization exercises targeting the rectus abdominis and transverse abdominis muscles should be prescribed. 2
- Electromyography and ultrasound imaging can be employed to assess abdominal muscle recruitment and monitor treatment effectiveness. 2
- Duration of conservative therapy should be adequate before declaring failure, though specific timeframes are not well-established in the literature. 1
Important Caveat:
The evidence for physiotherapy protocols is limited—success rates are not clearly defined in the literature, and there is no consensus on which specific exercise regimen is most effective. 1 Despite this limitation, conservative management should still be attempted first given the low risk profile.
Indications for Surgical Intervention
Surgery is indicated when:
- Conservative management fails to improve symptoms (abdominal pain, discomfort, musculoskeletal problems, or impaired quality of life). 1
- Concurrent abdominal hernia is present, which requires correction to prevent strangulation or incarceration. 3
- Severe diastasis with significant functional impairment or negative body image persists. 1
Surgical Approach Options
Both open and laparoscopic approaches demonstrate high success rates with low recurrence and complication rates. 1
Open Surgical Repair:
- Standard abdominoplasty with multiple wide longitudinal plications of the abdominal wall is effective for severe cases with concurrent hernia. 3
- Plication techniques vary based on the degree of separation and myofascial deformity. 4
- Mesh reinforcement (resorbable or nonresorbable) may be used in select cases with extensive defects. 4
Laparoscopic Repair:
- Minimally invasive plication offers comparable success rates to open surgery. 1
- Lower wound complication rates compared to open approaches. 1
Surgical Benefits:
- Repair improves low back pain, urinary incontinence, and quality of life in addition to correcting the anatomical defect. 1
- Complications are typically minor when they occur. 1
Classification-Based Treatment Algorithm
Severity assessment guides treatment intensity:
- Mild diastasis (minimal separation, no functional impairment): Conservative management with targeted exercises. 4
- Moderate diastasis (noticeable separation with symptoms): Intensive physiotherapy trial, followed by simple midline plication if unsuccessful. 4
- Severe diastasis (wide separation, functional impairment, or hernia): Extensive plication of anterior abdominal wall, potentially with mesh reinforcement. 4
High-Risk Populations Requiring Vigilance
Patients at increased risk for diastasis recti include:
- Multiparous women (multiple pregnancies). 4
- Obese patients. 4
- Those with multiple previous abdominal operations. 4
These populations warrant closer monitoring and earlier intervention if symptoms develop.
Critical Clinical Pitfall
Do not delay surgical correction in postpartum women with severe diastasis and concurrent abdominal hernia, as this can lead to strangulation or incarceration. 3 While most postpartum diastasis improves spontaneously, persistent severe cases require active management.