Indications for Surgery for a Rectus Diastasis

One of the questions I am most frequently asked by patients experiencing a Diastasis Rectus Abdominis is, "Do I need surgery for this?" With a diastasis, once it is diagnosed correctly, many patients and providers are unsure about how long to treat conservatively and when to move forward with surgery.

Only in the last several years has better information concerning rectus diastasis been established by the medical community and the expert leading this charge is Canadian physiotherapist, and researcher Diane Lee. When evaluating a patient to see if they will benefit from surgical intervention she suggests the following approach:

A patient is a candidate for surgical correction if she is greater than 1 year postpartum and has a diastasis (inter-recti distance measured on ultrasound that is greater than 2cm) and fails to:

1. progress in her core exercise program.

2. regain pain-free function.

3. regain urinary continence.

Postpartum women in this group most often have significant damage and stretching of the inter-recti connective tissue making the linea alba very thin, and unable to regain tension despite TA strengthening as noted on ultrasound evaluation. This type of damage is most often seen in a longstanding diastasis which is tubular - as shown in the diagram and example below.

Even with the presentation of a tubular-type diastasis, patients are still initially placed in a restorative exercise program to reactivate the transverse abdominis, pelvic floor and paraspinal muscles. After the patient demonstrates the ability to engage these muscles but has a diastasis that persists with an inability to create tension across the midline fascia and without a loss of articular integrity of the low back and pelvis is surgical repair of the diastasis recommended.

Learn more in our blog article: 5 tests to evaluate if your patient has regained optimal function of the core system.

The type of surgery Diane Lee recommends to correct the diastasis and restore improved function of the core system is called a recti plication with an abdominoplasty to correct the skin. Diane described this procedure in an interview with Pilates Bridge describing the correct technique for best surgical outcome. Once the diastasis is corrected, the patient should restore the function of the core system through exercise.

Using real-time ultrasound is the most accurate way to determine the ability of a patient to properly tension the anterior abdominal fascia. Learn more about our certification programs for medical providers on this type of musculoskeletal ultrasound at

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