Patients with diastasis recti abdominis (DRA) after childbirth often wonder whether conservative or surgical treatment of this dysfunction will be better. In this case, conservative treatment, i.e. physiotherapy, should always be applied first.

In most women, DRA resolves spontaneously in the postpartum period. Full recovery usually takes place a year after delivery. Today, research does not answer why some women still have this problem a year after giving birth. . If the increased distance between the parts of the rectus abdominis (IRD) is maintained, conservative treatment, i.e. physiotherapy, is used.

Does every patient with diastasis rectus need physiotherapy after childbirth? No. Even if the distance between the parts of the rectus abdominis muscle is increased, but the linea alba is strong, elastic, and the patient has a normal breathing pattern, correct posture and does not report any ailments, she does not require therapy. If the linea alba is weak, flaccid, and the patient has an abnormal breathing rhythm, discomfort and other ailments (e.g. pain in the lumbar-pelvic area, abdominal muscle weakness, pelvic floor muscle dysfunction and weakness, or presence of a hernia), then treatment is necessary.

The most commonly used exercises in DRA therapy are abdominal muscle exercises (transversus abdominis and rectus abdominis muscles), posture training, education and training in appropriate movement and lifting, Pilates, Tupler technique, pelvic floor muscle exercises as activation of the transversus abdominis muscle, manual therapy (soft tissue mobilisation, muscle and fascial techniques), osteopathic techniques, kinesiotaping, external bracing.

If conservative treatment is ineffective, surgical intervention is often used in patients with high aesthetic and/or functional discomfort or the presence of a hernia. Surgical treatment of DRA is controversial. Some authors recommend surgery in patients with an IRD distance greater than 3 cm. According to others, the indication for surgery is determined by the presence of a hernia or the assessment of protrusion, and not only by the presence of a diastasis. However, sometimes relapses are observed after surgical treatment.

Antonina Kaczorowska

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