Part 11: Postpartum Complications (Part 2): In-depth Management of Diastasis Recti and Pelvic Floor Injuries

Diastasis recti (abdominal muscles)

During pregnancy, the abdominal muscles are stretched significantly, and relaxin makes this stretching easier.

The two rectus abdominis muscles, which were originally parallel, separate from the midline of the abdomen to accommodate the gradually enlarging uterus.

According to reports, 66% of women in late pregnancy experience the above symptoms.

The degree of separation varies, ranging from minute separations of 2–3 cm (0.75–1.25 inches) wide and 12–15 cm (4.75–6 inches) long to larger separations of 12–20 cm (4.75–8 inches) wide, almost as wide as the rectus muscle.

The point of maximum lateral separation is usually near the umbilicus, while this separation can extend along the entire length of the linea alba.

The reason for the huge separation

Women with narrow pelvises give birth "at the front of the pelvis," which is just like multiparous women who have had multiple pregnancies, making it very dangerous.

Pregnant women who cannot avoid physical labor during pregnancy, especially those who cannot avoid stretching their abdominal muscles, are also at risk.

Activities such as surfing and high-intensity abdominal exercises, especially oblique muscle training, are not suitable.

A sedentary lifestyle is also unsuitable because the weakened abdominal muscles do not have enough strength to reconnect.

The separation of the abdominal muscles occurs during the second stage of labor, when intra-abdominal pressure increases, pushing the uterus outward and resisting the force of the abdominal muscles.

A short interval between pregnancies is a contributing factor to large separations because there is not enough time and/or exercise for the muscles to recover and reconnect before the next pregnancy.

Postpartum, if you don't pay attention to your abdomen when sitting up or lying down, it will increase the pressure on it, especially when the abdomen protrudes in the middle of the rectus abdominis muscle, which can lead to a larger separation (see protruding abdomen).

How to check for diastasis recti in the abdominal muscles?

Perform an abdominal muscle examination (rectus muscle examination) to determine the width of the separation.

If the width between two rectus muscles is greater than two fingers, it is called muscle separation (rectus detachment).

The width of the separation varies from 2 to 3 centimeters, and it occurs a few centimeters above or below the navel, sometimes exactly below the navel.

In many cases, the separation extends through the linea alba, from the sternum to the pubis.

When can we begin practicing separation techniques?

For most women, the separation of the rectus muscles can be reduced to two fingers or less during a postpartum checkup at 6 weeks.

If the separation is still greater than two fingers at this point, it does not necessarily mean that it is irreversible.

Proper exercise can cause the abdominal muscles to shorten and reconnect.

Excessive separation can lead to sagging and relaxation of the abdominal muscles, requiring surgical correction.

At this time, the lack of abdominal muscle support will increase the pressure on the intervertebral discs when lifting, which may also cause back pain or injury.

The repair method involves suturing the two ends of the rectus muscle together.

What can I do to help with recovery?

At this time, reshaping the abdominal posture is crucial, and every new mother should constantly remind herself of this in her daily life.

Contracting your abdominal muscles and keeping them engaged is a simple practice that can be incorporated into your daily activities.

These exercises help reduce the lateral tension on the deep transverse abdominis muscles, which are responsible for reinforcing the linea alba.

The reduction in abdominal muscle length and the increase in strength are very beneficial for the restoration of abdominal stability.

The rectus muscles will also retract to reduce the vertical stretching force, and proper pelvic tilt exercises will promote this process.

Be careful with your abdomen during daily activities, especially when sitting up from a supine position.

You should first sit up from one side of your body, and then reverse the process when lying down.

The upright sitting posture in this position places too much strain on the abdominal muscles and can exacerbate the separation.

When bending over to change diapers, keep your abdominal muscles taut to prevent them from sagging, and always be mindful of using your muscles for support.

Slimming exercises and diastasis recti

Tighten your abdominal muscles, shorten the transverse abdominis muscle, and strengthen it. This exercise can be performed in any posture.

Practicing the prone position has many benefits, although this position is not suitable for breastfeeding.

Knee exercises while prone are more suitable, but caution is needed if the abdomen is severely sagging, as this position will put extra pressure on the abdominal muscles.

Exercises that involve tilting the pelvis while lying flat can help shorten and strengthen the rectus abdominis muscles, making them ideal for further specialized training.

During this stage, it is permissible to lift the head and shoulders, but initially a pillow should be placed under the head to reduce the range of motion.

When performing this exercise, the movements must be correct, and the height to which the shoulders and head are raised depends on the contraction ability of the abdominal muscles.

If you raise your head and shoulders too high, beyond what your abdominal muscles can handle, it will cause your belly to protrude.

This should be avoided under any circumstances.

Once your head and shoulders are raised to their highest point-raising them any higher will result in a "protruding belly" position-hold this position for 2-3 seconds to strengthen the contraction of your abdominal muscles.

Once you have mastered this movement, you can remove the pillow to increase the range of motion.

All exercises should be performed slowly and with attention to controlling the movements.

If abdominal muscle separation exceeds 3 cm (1.25 inches), then tuck exercises targeting the obliques should be avoided.

Pelvic floor injury

The pelvic floor is composed of muscles and connective tissue; damage to either can affect the function of the pelvic floor.

Damage to the pelvic floor muscles and sphincter may be caused by stretching, cutting, or tearing during childbirth, or by instrumental damage during delivery.

Damaged muscles are replaced by fibrous tissue, which reduces muscle strength and increases the risk of stress incontinence.

perineal pain

Perineal pain is common in the weeks following childbirth.

Most new mothers will feel much better after one month, but some may not feel better until two months later.

Poor healing after an episiotomy or tear can also cause discomfort. This poor healing may be due to poor suturing leading to scar hyperplasia at the wound site, or it may be due to infection.

What can I do to help relieve pain?

Pelvic floor exercises are very effective in promoting wound healing, and many people can understand why they should do these exercises even when experiencing perineal pain.

The pain will be severe during the first training session, but it will lessen as the swelling decreases and the number of repetitions increases.

Increased blood circulation in damaged tissue will accelerate its healing process, remove waste products, and promote the healing of wound edges.

When coughing, sneezing, or lifting heavy objects, the pelvic floor contracts to resist the increased intra-abdominal pressure, which is very dangerous.

Stress incontinence

If the pelvic floor muscles are weak and unable to withstand a sudden increase in intra-abdominal pressure, it can lead to stress incontinence.

This usually occurs when coughing, sneezing, laughing, or exerting force such as lifting, jumping, or running, resulting in minor urinary incontinence.

It occurs very frequently-in about one-quarter of women-and usually after the child is born.

What can be done to improve this situation?

Regular pelvic floor muscle training is essential.

Slow practice can be helpful, but fast practice will be more effective in improving this condition.

Timely and regular postpartum training will help restore the support of the pelvic floor muscles and prevent urinary incontinence.

In fast contraction training, each movement should not be repeated more than 10 times, because fast-twitch muscle fibers will fatigue quickly.

In more serious cases, a small cone-shaped object can be used to strengthen the pelvic floor muscles; it can be inserted into the vagina and left in place for a period of time --- further details should be discussed with an obstetrician.

Weight loss exercise and stress incontinence

Avoid exercises that put excessive stress on the pelvic floor, such as jumping, horseback riding, trampolines, and running (although these exercises require a certain level of skill), as these can worsen incontinence.

Prolonged endurance training and high-intensity abdominal exercises should also be approached with caution, as increased intra-abdominal pressure can also affect the pelvic floor.

Pelvic floor training is an integral part of the entire exercise routine and should be performed as a set of repetitive exercises, just like other muscle group exercises.

prolapse

Prolapse is the protrusion of the bladder or rectum into the vaginal wall, or the downward movement of the uterus into the vagina.

These pelvic organs are fixed by ligaments and fascia (connective tissue) and supported by pelvic floor muscles.

These tissues are already vulnerable during pregnancy and/or childbirth, and relaxin further affects them.

To some extent, while rectal prolapse is not uncommon, bladder prolapse into the vagina is the most common postpartum prolapse.

Uterine prolapse is more common during menopause, when the decrease in estrogen levels reduces the elasticity of the vaginal walls.

Prolapse can also be secondary to weightlifting (such as strength training), chronic constipation, or chronic cough.

What are the symptoms of prolapse?

The symptom of prolapse is a feeling of heaviness or pressure in the vaginal area.

Stress urinary incontinence often occurs because the bladder cannot be completely emptied.

How can I prevent prolapse?

Pelvic floor muscle training can postpone or even eliminate the need for surgery to repair prolapse.

Because if the pelvic floor muscles are strong enough, they can fully support the pelvic organs.

Slimming exercises and prolapse

Just like stress urinary incontinence, high-impact exercise can also damage already loose ligaments and muscle tissue, so if prolapse is suspected, such movements should be avoided.

Minimize the intensity of endurance training, and keep abdominal exercises gentle.

Performing these exercises tightens the pelvic floor in the opposite direction.