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separation of abdominal muscles

separation of abdominal muscles

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Here is a story of a Hobart woman who had a separation of abdominal muscles following her pregnancy.  I have changed her name to protect her identity (lets call her Louise) but I felt her story was particularly worth telling as the separation of abdominal muscles was not picked up (it was 8 cm which is very large).  It just goes to show if you suspect a diagnosis is not correct and do not think you issue has been adequately addressed by your medical professional it pays to get a second opinion from others with different skill sets and different points of view.

Here’s Louise’s story:

“Ok so it was after my second bub, a little boy born at 38 weeks induced, as I have a medical condition (cholestasis) that means early delivery to be safe.
He was born posterior left fist first but no tearing or interventions to get him out.  I delivered on my left side so I suspect the psoas injury was from his fist vs my pelvic musculature on the left side and 30 mins of pushing. My ob was away so I was under the care of another ob during delivery. He insisted I have an epidural while I was transitioning (I was too out of it to argue), and I think that contributed to the injury as I couldn’t feel, HOWEVER I had incredible pelvic bone pain (even with the epidural) while I was pushing.
I recovered well and didn’t have any worries however I saw my OB at 6 week check as I had lower left quadrant abdo pain, niggly and ‘hot’ like some inflammation was going on. Bowels etc all working fine. He said it was unusual, however as things were still fairly fresh post partum he suggested I see my GP at 12 weeks and get an ultrasound if still there.
12 weeks, saw GP, she said I was constipated. I am an registered nurse, very familiar with bowel movements, so I wasn’t happy with this diagnosis. I insisted on an abdominal examination and she insisted I had impacted constipation, that’s why I was still able to pass a stool. WHAT??
Anyway I talked to my pharmacist to get an enema as she prescribed, he thought it was rubbish but told me to try the aperients (mild laxative) instead just in case. I didn’t have impaction or constipation.  I went back to a different GP (integrative) who suggested I had serious inflammation, and to go dairy/gluten free to decrease bloating and go from there. She sent me for an abdominal ultrasound and the sonographer found I had an enlarged uterus. That was it.
24 weeks post partum we went on holiday to Whitsundays. Was very relaxed, felt a long hard lump in my abdo. It was sore and giving me a bit of grief. I pushed it and it popped in/disappeared! I think it was a hernia!  I still had some pain but not as often, the main thing was I’d get very dizzy and feel nauseous when I had my baby on my hip or carrying them. I went back to my integrative GP who sent me for a gastroscopy. That showed nothing. I told her about the hernia and she said to come back asap if I felt it again.
I fell pregnant again 10 months later, at an early appointment with my OB/ midwife I told them that left lower quadrant pain came back. They had an abdominal examination and said something felt odd around the pubic Rami (?tear) and to see Jane Barker.  I had a wait but I got in fairly soon, had a lengthy consult and she gave me a physical examination. Pelvic floor was A OK, then she pressed my psoas (hip flexor muscle). I leapt off the table. That was the pain!!!! She said I may have partially torn it so it had knotted up etc and I needed a release.
She referred me to Heather Rae at Antill. I had a few weeks wait and in the meantime I had a check up with my OB. I was filling her in on what was going on and so did an abdominal exam. I coughed, chin on chest and she placed my hand on my stomach. I could feel a really STRONG pulse!! She said that is your abdominal aorta. You have an 8cm diastasis recti divercation. That’s why you feel dizzy holding the kids, you are partially obstructing your aorta and decreasing blood flow.
So, knowing that I saw Heather. She did psoas release (gosh it hurt!!!) And I had to do Transverse Abdominus exercises. First lying down then when I could do them well, sitting and standing. I was incredibly weak trying to do them sitting first off when Heather was showing me how.  I can’t remember the reps exactly, I just know that I slowly built up from a few a day to doing them a lot,  my last appt with Heather I was 1.5cm  but I was starting my second trimester so it was starting to expand again.
Im now 5 months post partum with number three and back to 1.5cm. I’m proud of myself for trying to do my exercises. My Transverse Abdominus is still a bit weak as I have the ‘pouch’ but it’s slowly shrinking.
I’m just doing some gentle yoga and that is going ok. My first ob always advised me to do minimal exercise when pregnant (gentle walks, swimming, yoga) for my heart health. I’m glad I listened to him because I was told if I had exercised more my abdo would have been a lot worse. I was very fit and used to row/sail so I’ve always had a strong core, that encouraged the diastasis my OB told me.  I struggled to lift my kids, couldn’t vacuum, lift a basket of washing. I didn’t return to work between number two and three as I didn’t want to make it worse (as an registered nurse we do a lot of manual handling). Lucky I had long service leave!
I can do most things now. My muscles are still weak, I can get pubic symphysis dysfunction very easily if I don’t keep my pelvis in alignment lifting or pushing something.
I see a gentle chiro who keeps my pelvis in alignment if I put it out! She will do an occasional psoas release to keep things in check too.
That’s about it. Let me know if there’s anything else you want to know. I hope my story can help others 😀
Thanks Louise – I am sure this will help others.  The key points I am hoping women will take from this is:
  • strong ab’s can make abdominal separation worse (something has got to go)
  • try a range of ‘experts’ to get things back on track – don’t accept that things are ‘this way’ becasue you had a baby
  • issues around the pelvis can be mighty complex, it took 4 different medical approaches to get Louise ‘right’

 

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