Management of Diastasis Recti Abdominis
First-Line Treatment: Physiotherapy with Structured Exercise Program
Physiotherapy with targeted abdominal core strengthening is the first-line treatment for diastasis recti abdominis, and surgery should only be considered after a standardized 6-month exercise program has failed in patients with functional impairment. 1
Initial Conservative Management Approach
- Begin with a 6-month structured abdominal core training program that includes targeted abdominal muscle strengthening and hypopressive exercises before considering any surgical intervention 1
- Exercise programs during the postpartum period have been shown to reduce the presence of diastasis recti by 35% (RR 0.65,95% CI 0.46 to 0.92) 2
- Abdominal exercise programs are generally effective in treating diastasis recti at various postpartum periods, with evidence showing significant reductions in inter-rectus distance 3
Diagnostic Criteria
- Diagnose diastasis recti at clinical examination using a caliper or ruler for measurement of the inter-rectus distance 1
- Perform diagnostic imaging by ultrasound when concurrent umbilical or epigastric hernia cannot be excluded clinically 1
- The measurement should be taken at the widest point of separation, typically at the supraumbilical, umbilical, or infraumbilical level 1
Adjunctive Conservative Therapies
- Electrical stimulation combined with exercise shows promising preliminary evidence for enhanced effectiveness compared to exercise alone 3
- Abdominal kinesiotaping can be used as an adjunct to other interventions, though it should not be the sole treatment 3
- Transcutaneous radiofrequency diathermy combined with therapeutic exercise may reduce inter-rectus distance by up to 47.5% in severe cases, though this requires further validation 4
Indications for Surgical Repair
Surgery should only be considered when ALL of the following criteria are met:
Mandatory Criteria Before Surgery
- The patient must have completed a standardized 6-month abdominal core training program without adequate improvement 1
- The patient must demonstrate functional impairment (not cosmetic concerns alone) that persists despite conservative management 1
- The largest width of the diastasis must be at least 5 cm measured at clinical examination 1
- At least 2 years must have elapsed since the last childbirth 1
- No future pregnancy should be planned, as pregnancy would likely cause recurrence 1
Exceptions to the 5 cm Rule
- Surgery may be considered with diastasis width less than 5 cm if there is pronounced abdominal bulging causing significant functional impairment 1
- Surgery may be considered with smaller diastasis if there is a concomitant ventral hernia requiring repair 1
Surgical Technique When Indicated
- Plication of the linea alba is the first-line surgical technique when surgery is undertaken 1
- Other surgical techniques may be used but have not been found superior to linea alba plication 1
- The goal is to restore the anatomical integrity of the abdominal wall and improve functional capacity 1
Critical Clinical Pitfalls to Avoid
- Do not proceed to surgery without documenting completion of a full 6-month conservative exercise program - the vast majority of patients improve with physiotherapy alone 1
- Do not operate based on cosmetic concerns alone - functional impairment must be documented 1
- Do not operate if the patient plans future pregnancies - this will likely result in recurrence and wasted intervention 1
- Avoid using inconsistent measurement techniques (palpation vs. calipers vs. ultrasound) across follow-up visits, as this makes it difficult to assess treatment response 3