Prolotherapy has long been used as a treatment for pain and joint laxity or instability. The name – prolotherapy, is short for proliferative therapy due via stimulation of healing and growth factors by injecting an irritant solution to an area of injury. Through this mechanism of action, it is possible to extrapolate the use of prolotherapy for other areas of tissue damage and laxity, such as Diastasis Recti.
A diastasis recti is a condition seen particularly in post-partum women where there is separation of the linea alba along the rectus abdominis. While the condition can self resolve, for some it does not and not only presents a cosmetic concern but can result in a midline or paraumbilical hernia. Currently the main treatment strategy for a diastasis recti is surgery, as well as physiotherapy and core exercises (1). Given that the linea alba is a connective tissue, there are now a couple case reports of using prolotherapy to help repair the separation. One of the first such reports was in the 2016 case report by Strauchman and Morningstar listed in the Case Reports in Clinical Medicine (2).
In my practice I had one case where prolotherapy was used to successfully address a diastasis recti abdominis. This case was unique in that the diastasis recti was present in a nulliparous, vegan 39 year old female. The diastasis recti was diagnosed following a successful treatment of SIBO, where her primary concern was bloating. The current theory as to why she experienced the diastasis was a combination of the long standing SIBO as well as her activity as a ultramarathoner which may have caused extra strain through her core. She was diagnosed through her MD and the area of primary concern was around her umbilicus, with a very slight herniation. Consequently, she was not a surgical candidate. Because of the concern of a larger hernia and the look of it, she asked for additional alternatives. We discussed both the risks and benefits the limited data for a trial of prolotherapy as well as access to physiotherapy. After obtaining informed consent we began a treatment starting with a trial of three treatments to assess progress. Since starting we have done 14 sessions to date, the latter sessions were ordered to ensure that tensile strength of the abdominus recti was maintained during higher intensity training.
We started with 3 sessions 5 weeks apart to assess if she was receiving benefits. At the start of treatment, the area of concern was measured to extend 1.5 cm above the umbilicus and 0.75 cm below and fanning out at the level of the umbilicus 0.75 cm along the upper aspect and 1.0 cm the lower edge. We used a 9% dextrose solution along with adenosine-5-monophosphate, sterile water, 2% procaine and methylcobalamine, injecting a total of 4.3 cc into the area with a 27G ½ ” needle, injected to a depth just to the underlying muscle as the patient would engage her core during the treatment to reduce risk of deeper injections and bowel perforation. The area was first cleaned with a Chlorhexidine solution and allowed to dry. The patient would note the diastasis most in a standing or “crunch” position and following injection and bandaging she would assess the area to ensure that we had been thorough in our injections. She felt a difference in tissue feel immediately and was discharged alert and oriented with appropriate after care information given. At her 5 week follow up session there was no change in the extension of the diastasis above and below but there was a reduction in the width to 0.5 cm along the upper and 0.75 cm along the lower. The patient was very pleased with the results and the firmer tissue feel. We repeated a similar injection this time using a total of 4.7 cc. At her third follow up session there was a reduction in length noted from her original 1.5 cm above to 0.4 cm and 0.75 cm below to 0.5 cm. This time there was no change in the width. Unfortunately, the patient had been experiencing a return of her bloating due to a recent bout of acute gastroenteritis and the flu which also affected her digestion. At this session we injected another 4.75 cc of the same formula listed above and repeated some support that we had used in the past for digestion including bitters, some antimicrobial herbs, N-Acetyl Cysteine and a reduction of certain higher fermentable foods.
The patient chose to follow up again in 2 months because of the results she was seeing. She would experience a fullness of the area for a few days then a gradual return of the diastasis. She was also noting that she would not experience it “popping” out after a run, as long as she was not bloated and wearing compression shorts. She has continued with the prolotherapy more intermittently to continue to address the area and to get the most resolution possible. Her most recent treatment was in March of this year and there was no separation above the umbilicus, no discernable herniation and the lower aspect measured 2 mm in length and 3 mm in width. This time only 1.5 cc of the solution was used, and again the patient was discharged without concern after the area was bandaged and aftercare was reviewed. At her most recent follow up she was pleased with the results she had achieved. Currently, she is hoping that she will no longer require further injections..
- Michalska, Rokita, Wolder, Pogorzelska & Kaczmarczkyk (2018) Diastasis recti abdominis – a review of treatment methods. Ginekologia Polska, 89, 2, 97-101 https://journals.viamedica.pl/ginekologia_polska/article/view/GP.a2018.0016/43304
- Strauchman, M. and Morningstar, M. (2016) Prolotherapy Injections for Diastasis Recti: A Case Report. Case Reports in Clinical Medicine, 5, 342-346. doi: 10.4236/crcm.2016.59052.