There is really no shortage of information floating around about diastasis recti (DR).
A recent study found that 100% of women experience diastasis recti (DR) by 35 weeks of pregnancy. Some women spontaneously heal by several weeks of postpartum and many do not, requiring a more focused approach to address the DR. Research has also not been able to find a direct link between postpartum DR and any of the following factors: maternal weight gain, baby’s birth weight, pre-pregnancy body mass index (BMI) or BMI at 6 months postpartum (Lee, 2017).
A google search of the term diastasis recti (or more formerly called diastasis rectus abdominis (DRA)) will result in an abundant amount of resources that do anything from explain the condition to offer exercises and advice on how to “close the gap.” Though awareness of DR has seemed to increase, talk to any woman who has been pregnant in the last 10 years and you will still find many who do not know what DR is and have never had anyone discuss it with them.
The current challenge seems to be working through the various resources, some of which seem contradicting, and knowing what information to apply and what resources to trust. That is the most frustrating thing. Like much information available to us on the internet, information found when googling DR can be very informative and factual or it can be confusing or lack correct detail and scope of what influences healing. So, what are a few things you MUST know about diastasis recti?
1. DR is NOT just about a gap or separation.
Diastasis recti is a significant separation of the space between the two columns of the rectus abdominis muscle. The area of separation occurs at the linea alba, which lies between the columns of the rectus. The rectus abdominis muscle also has a sheath covering it that endures stress and stretch during pregnancy, resulting in separation as well. DR that does not heal spontaneously after birth likely does not due to abdominal wall dysfunction. So, the continued DR is merely a symptom of what is going on at a deeper level. To place exclusive focus on the separation itself is missing out on what needs to be addressed to heal it. And, that leads me to #2.
2. DR healing and treatment is multi-faceted
Diastasis recti, as mentioned, is a symptom of a deeper problem. For many, DR that is assessed and treated thoroughly leads to great healing and functional gains. To heal DR thoroughly, a program must include assessing all abdominal muscles and addressing any weaknesses that are found. This is by far one of the most heavily emphasized pieces of any online or in-clinic program. However, if a program relies on this solely, it is lacking other very significant influencers of DR. Our bodies function as a large unit comprised of many systems and parts that influence the whole. A treatment plan to heal DR must include consideration of this and include assessment of the breath (breathing mechanisms), abdominal strength, alignment, body mechanics (how do you move?) and consideration of individualized healing. Another important part of healing, especially postpartum, is the influence of hormones and our diet (what are you fueling your body with?). Don’t forget that everyone may heal differently, so your connective tissue may not “bounce back” the same as someone else’s tissue. That reminder brings me to #3.
3. There are NO quick fixes; healing takes time.
That is just the honest truth based on science and my professional experience, but it doesn’t and shouldn’t take away the fact that healing is possible. If you come across an article or program that promises amazing results of fixing DR with one exercise or an “easy-to-do plan” you should be very cautious. And notice that I mentioned “fixing.” What I focus on with patients is healing, and healing is more about just the gap, is multi-faceted in treatment and takes time. With all of that in mind, rest assured that with the right help, you can work to heal DR.
Reference: Lee, Diane. Diastasis Rectus Abdominis. A Clinical Guide For Those who are Split Down the Middle. 2017.
Dr. Robyn Wilhelm, PT, DPT, Private Practice Owner in Mesa, Arizona specializes in pelvic floor and women's health physical therapy. Connect with Dr. Wilhelm on her practice website http://www.wilhelmpt.com.
If you have followed my practice at all, whether it be on Facebook, Instagram or Twitter, you have likely read about the care French women receive after childbirth. I am specifically referring to the model of postpartum care for moms (or mums) focusing on pelvic floor health. In France, women are seen by a pelvic physio (pelvic Physical Therapist) approximately 6 weeks following delivery and receive 10-12 sessions with the physio for "perineal re-education." Sound a bit odd? Well, it may, but it may not once you know the affects of pregnancy and labor/delivery on the pelvic floor. According to a study by researchers at the California HMO Kaiser Permanente, approximately 1 in 3 women suffer from a pelvic floor disorder (this includes urinary incontinence, fecal incontinence, and prolapse), and roughly 80 percent of those women are mothers.
It doesn't seem out of place to expect some type of typical care following a vaginal delivery or cesarean delivery (a major surgical operation), right? I mean, we don't expect our athletes to incur an injury, wait 6 weeks to heal and then return to previous level of function with no skilled or specialized professional rehabilitation. "Well, professional athletes are training for a very specific sport with high physical demands and it is their job..." one may rebuttal. And my response...Well, moms are returning to (let's be honest...often continuing with) everyday functions that stress the core and pelvic floor and require good function to prevent compensations or overuse that could cause additional injuries. And..some women, in the US, don't even get a full 6 weeks to assist with some of that recovery before it is back to "life pre-delivery."
So...when the 6 weeks is up, what rehab do women get to make sure that the pelvic floor is healthy and ready to take on current or future demands? Holding up (and in) vital organs, toileting, lifting/carrying, sex, return to exercise.... Most are left to research on their own navigating through loads of online information, advise from family and friends and exercise programs that may or may not be helping them with an effective recovery. This can be daunting for many women. I have had women tell me it is daunting, confusing and frustrating. There is a plethora of click-bait links to postpartum advice and programs, some of which lack a strong foundation of the multiple facets of core and pelvic floor rehab following childbirth. It does not have to be daunting and impossible, but there is also no a quick fix.
Every woman in the US should be seen by a pelvic Physical Therapist after childbirth. The more this is discussed, and the more those who have benefited from pelvic PT speak about it, the more awareness there will be. So what can a pelvic PT help you with? Here are just a few things.
- pain management during pregnancy
- labor positioning
- prevention or treatment of adhesions of c-section scars and perineal tears
- diastasis recti
- pelvic floor tightness or laxity
- pelvic floor dysfunction
- urinary (pee) or fecal (poo) incontinence
- tailbone (coccyx) pain
- pubic symphysis pain and dysfunction
- sacroiliac (SI) joing pain and dysfunction
- stretching to relieve muscle discomfort during postpartum
- painful intercourse
So you have your birth plan, but what about after baby comes? Have you thought of a postpartum plan?
No need to worry if you have not. Take a bit of time to sit down and think about what you may want things to look like postpartum. If this is your first baby, it may be hard to imagine. Ask a couple of close friends who will give you the "real deal" opinions on what they wish they would have thought of in prep for after baby arrived. If this is not your first postpartum experience, think back to what you would like to do a little differently, if anything. Here are a few things to consider.
🌸 Postpartum Doula- a postpartum doula can come to your home after baby to help with light household tasks, allow you to get a bit of self-care, and assist in meal prep, etc. In speaking with women who have had a postpartum doula, many have reported that they benefited emotionally as well as physically by having a trained doula visiting after returning home with baby.
🌸 Visitors- what is your preference on when visitors can come? Family, friends...?? Having your personal request in place and agreed upon with your spouse and other children can help to avoid stressful moments of too many visitors or visitors that interrupt schedule of mom and baby. Don't be afraid to set boundaries. Maybe there is a person or persons who you expect you will feel most comfortable talking to in the case that you feel emotionally off balance. Feelings of overwhelm, depression, anxiety, loneliness, panic, sadness and fear are common for many after delivery. There are also some women who report that they did not experience any of those feelings. It can be different for everyone. The important thing to know is that any struggle you feel emotionally or physically after having baby should not be kept secret out of embarrassment or fear of judgement. Many women have reported that once they discussed it with their spouse, their psychologist or counselor or a trusted family member or friend, they received assistance they needed. This is so important!!
🌸 Breastfeeding- Create a list of names and phone numbers of at least 3 lactation consultants who you can call if you need to. Collecting trusted suggestions and looking at client reviews prior to making your list will help you to feel comfortable in calling one in the midst of breastfeeding questions or problems. You can search your area for an IBCLC (board certified lactation consultant.)
🌸Provider List- Have a list of your providers names and contact information (phone, email, website, etc.) for easy access. Individuals to remember include: Midwife, OB, Doula, Pelvic Physical Therapist, Lactation Consultant, Psychologist/Counselor, Pediatrician.
🌸 Household Set-up- Will baby be in a bassinet with you in your bedroom? In their crib? Their own room? Might you have to transition to a couch or spare bedroom to allow for better position and movement for you? Now is not the time to be too worried about what your house looks like. Don't be afraid to place baskets of extra supplies in areas of the house that you might need them. Extra diapers and wipes in the living room...maybe two breastfeeding support pillows to have spread throughout the house...a basket of burp clothes in multiple rooms....a bassinet, pack and play, etc. in more than one room of the house..... Don't let it overwhelm you. Simply walk around to each room of the house and see how it is set-up for when you get back. Enough room to move around with baby in your arms? Resources within your reach?
🌸 Physical Healing- Birth is a major event. Your body will be healing as you now take on caring for baby. Typically, 6-8 weeks of healing time is expected for vaginal or cesarean delivery. Please know that this is the basic healing time from the birth itself (vaginal area or cesarean incision site). Your body as a whole takes much longer to begin to feel "normal." Your midwife or OB will see you at around 6 weeks post-delivery. If you are then cleared, make an appointment to see a pelvic Physical Therapist for core and pelvic evaluation.
👉Pain (abdominal pain, pelvic pain, pain with intercourse)
👉Difficulty with bladder or bowel (urine or fecal incontinence, constipation)
👉Back pain, tailbone pain, pubic symphysis pain
👉A cesarean incision site that needs scar massage and instruction on self-message
👉Optimal breastfeeding positions to prevent aches and pains
👉Guidance on postpartum exercise progression based on YOUR core and pelvic strength
This is a small list of what a pelvic PT can help you with. In many cases, seeing a pelvic PT during pregnancy can help with pain you are already experiencing and can provide you with valuable information to have for the postpartum time period. Include a pelvic PT in your pregnancy and postpartum plan. Check out my website for additional information and convenient online scheduling.
Relax....Is that even possible? Yes, yes it is. Is it harder in some moments than others? Oh yes! Here are 3 ways to find a little relaxation today or whatever day you need it.
1) ASK FOR IT- It may seem frustrating to feel like you need to "ask" for rest, but it might be just what you need to do. As a mom, we are often pulled in different directions while we also have a laundry list of to-do items in our head or detailed out on a sticky note by our computer. Our spouses, children and family see us juggle this and that everyday so it becomes the normal. Announcing that you are taking 15 minutes, an hour, or whatever to rest allows you to express what you need. And if you feel guilty about doing so or feel that your children will be disappointed, think about the positive example you are setting for your children. We live in a run, run world for the most part and kids are experiencing it as well. Show your children that taking a rest and listening to your body is a good thing, NOT something that should be viewed as weakness.
2) GET IN OR OUT OF YOUR HEAD- Try a technique that allows you to get completely out of your thoughts or one that challenges your mind to acknowledge and release. This can be thoughts about what is stressing you, physical or emotional pain, gratitude....there is really a whole list of things people can process through. The meditation app Headspace offers an awesome FREE 10 min meditation. Deep breathing exercises, body scans and gentle stretching can also be techniques used to give your brain a break.
3) DO ONE THING AT A TIME- Even if you are not the type to completely unplug (though I would encourage you to try), you still have ways to relax your body and mind. Lose yourself in one simple act, one mindful moment. You want to watch a movie? Awesome, put the phone down, go into a room out of sight of typical to-dos (laundry, dishes, bills, messes, etc.) and get taken in by the movie. Want to connect with your kids over board games or crafts or just plain open discussion? Great, put down the phone, don't plan on jumping up to finish something and ignore any other thing you would try to multi-task.
Relaxation is different for everyone. I just wrote this short piece in a quiet room, no kids, no dog wanting something, nothing else on my mind...it was an awesome feeling! Happy Mother's Day. Now off to watch that movie.......
#momlife #momtribe #mothersday2017 #mindfulness #brainbreak
Dr. Robyn Wilhelm, PT, DPT is a women's health and pelvic Physical Therapist and private practice owner in Mesa, AZ. She is passionate about working with women to alleviate pain and dysfunction experienced from core and pelvic health conditions, as well as health and wellness of women during pregnancy and postpartum. Dr. Robyn can be contacted at firstname.lastname@example.org
April is Cesarean Awareness Month. Today, approximately 1 in 3 women in the US have a cesarean delivery. In recognition of all of you mamas who had a cesarean birth, I wanted to address a topic that I help women with quite often.
The noted healing time following a cesarean delivery is 6-8 weeks. During this time, scar tissue develops and takes the place of the tissue injured during cesarean surgery. It is distributed along the abdomen and uterus. The scar tissue is not as strong as the original tissue, though similar in structure. This healing process and laying down of scar tissue is influenced by many factors specific to each woman. Keep in mind that even once the incision site has healed superficially, the scar tissue underneath can span beyond the superficial scar and negatively impact the area, forming adhesions that tightly bond structures together. This can bring on various symptoms, some of which include
Scar tissue can be treated. I have had many women tell me that they have received little to no instruction on what to expect with their scar or how to take care of it. Once it remained painful or seemed to be causing other problems, they just were not sure what to do about it. Some have avoided it all together. The good news...
The scar tissue can be treated with pelvic floor physical therapy. Manual therapy and massage are used to treat not only the incision site specifically, but also the surrounding structures that are being influenced by the scar tissue. External and internal tissue mobilization loosens up the tissue and lessens restrictions to alleviate problems associated with the scarring and any adhesions present that may be binding tissue tightly together. As a PT, I also educate and instruct women on what they can do at home to assist in getting relief from c-section scarring in conjunction with the treatment they receive from me. Scar tissue can be addressed at any point in attempts to bring about change and decrease painful conditions. It is best to begin scar tissue work and treatment around the 6-8 week mark following the c-section, when the tissue is most easily influenced.
If you have any questions about c-section scarring, please drop a comment below or email me at email@example.com
You have probably done it yourself.... or seen it in the workplace or during an outing with friends. You know, the delaying of urination (peeing) until you can barely walk correctly to get to the bathroom. Is this "holding" harmful? It definitely could be.
Although each person's body is different, there is a common consensus and knowledge about the risks of frequently holding urination.
Increased Risk of Bladder Infection- The capacity of an average bladder allows for 15 ounces of urine retention. Holding urine in the bladder for long amounts of time increases the chance that bacteria may attach to the bladder lining and potentially multiply, resulting in a bladder infection. That infection could also make its way to the kidneys and cause other problems.
Decreasing the brain-body connection- When the bladder is full, it sends signals to the brain; the brain then signals to the body it is time to get to the bathroom. Holding urine and delaying those signals can lead to an alteration in the brain-bladder connection. This could result in decreasing the effectiveness of that connection and result in the body not knowing when it is time to go.
So What Do You Do? The issue with "holding it" is real. Many are limited by his/her work environment; teachers, for example, often delay bathroom breaks the most out of many professionals. The problems that can occur from the delay is real though also. Keep these suggestions in mind next time you cross your legs to hold it for "just a little longer...."
1) Void (pee) Regularly- Pretty straight forward advice, right? But, many people just don't do it or don't plan ahead for the day to allow for regular bathroom breaks, especially during times of travel and work. On average, voiding should occur every 3-4 hours. Don't force yourself to urinate; just go when you sense that you need to. Plan ahead and advocate for your ability to use the restroom in reasonable intervals.
2) Drink Water Regularly- Limiting consumption of water in hopes to decrease the need to use the restroom is not the best approach. Our bodies are designed to consume water and flush out regularly. You should drink when you are thirsty and your urine color should be a light yellow-clear. If your urine is a medium to dark yellow, that is your sign that you are not drinking enough.
The Better Bladder Book by Wendy Cohan, RN
Holding Your Pee: Health Risks from Ignoring Nature's Call. The Huffington Post Canada. 02/27/2012
Robyn Wilhelm, PT, DPT Private Practice Owner in Mesa, Arizona specializing in pelvic floor and women's health physical therapy. Connect with Dr. Wilhelm on her practice website http://www.wilhelmpt.com.
In my quest to spread the word about my pelvic floor physical therapy practice, my website, facebook page, twitter account.... I have heard "Do you have a blog?" My response: "Well, not quite yet, but I am working on it!" Anyone that knows me personally knows that I typically have no trouble talking about things I like and sharing my thoughts and opinions, but a blog? A blog that will be out for anyone to read... What can I share...? Will people want to read it...? After thinking about it for weeks, I started to ask myself "Why is it any different from a conversation you might have with a patient or a friend?" Well, there are some differences, but more commonalities I believe. So here I go..... I have a blog...a blog "in progress." That seems safe to say.
In my excitement and nervousness about opening my own practice to help women with conditions that I feel are still left in silence and not always well understood, I have had some convincing to do. Most people know what a Physical Therapist does, but a pelvic floor Physical Therapist? As I have heard "Hmm...that is weird. What do you do exactly?" I began to realize very quickly that my passion and excitement may not be shared with everyone. And...that is ok. On the contrary, I had a close friend tell me that she had problems with painful intercourse a few years back and was basically told by her OBGYN to "relax and lube up." As you may imagine, it wasn't that easy of a fix and left her questioning herself and what was going on in her body and her head. This happens too often for women! She proceeded to share with me: "I commend you for opening a practice for women who NEED the care you provide.....I pray the women who need you, find you." With that, I smiled inside and knew that with some education, what I do would be more clear.
So, like any great blogger, I am going to reference my readers to a great post I read written by someone else! Check out these common misconceptions about pelvic physical therapy provided by Jessica Powley, PT, DPT, WCS from Proaxis Therapy Pelvic PT.
Dr. Robyn Wilhelm, PT, DPT specializes in women's health and pelvic PT. An Ohio native, she enjoys Buckeye football and misses the Fall season. Dr. Robyn enjoys her life in Arizona and spending time with her husband, two kids and Chocolate Lab George.