postpartuum diastasis recti abdominis

Postpartum Rectus Abdominis Diastasis

• rectus abdominis diastasis (RAD) occurs in 30 to 70% during pregnancy (1)
  • incidence rates reported to range from approximately 21% to nearly 30% in postpartum women, especially among those diagnosed with gestational diabetes mellitus (GDM) (2)
• anatomically, it is characterized by the pathological separation of the two rectus abdominis muscle along the linea alba, a condition that often results in a significant impairment of women’s health-related quality of life (1)
  • according to the 2021 European Hernia Society (EHS) guidelines, RAD is clinically defined as a widening and thinning of the Linea alba exc
    • this separation is typically assessed via clinical palpation, ultrasound, or caliper measurement, standardized at 3 cm above the umbilicus
• during pregnancy, hormonal changes lead to increased laxity of the connective tissue within the abdominal wall, which, when combined with the continuous mechanical stretching caused by the expanding uterus, facilitates the separation of the abdominal muscle

Management

• is aimed at reducing the inter-rectus distance (IRD) and restoring the structural integrity of the abdominal wall
• a review notes that debates continue regarding optimal treatment indications and the long-term efficacy of various approaches (2)
• structured exercise programs
  • a systematic review showed that structured exercise programs significantly reduce IRD in women with RAD (1)
    • however, this anatomical improvement does not translate into superior functional recovery, as measured by the ODI score, within the observed periods
    • study suggests that "the sooner, the better" applies to starting a recovery program:
      • early Intervention: Exercises started within 3 months postpartum showed the greatest reduction in gap size (approximately 10.2 mm).
      • delayed Intervention: While still effective, programs started after 6 months postpartum showed a lower reduction (approximately 5.9 mm)
• surgical options range from open plication to minimally invasive procedures involving mesh reinforcement (1)

Reference:

1. Capoccia Giovannini S et al. Non operative management of postpartum Diastasis Recti: a systematic review and metanalysis of randomized controlled trials. Hernia. 2026 Apr 17;30(1):164.
2. Du Y, Huang M, Wang S, Yang L, Lin Y, Yu W, Pan Z, Ye Z. Diastasis recti abdominis: A comprehensive review. Hernia. 2025 Jul 7;29(1):222.