POSTPARTUM ABDOMINAL SURGERY FOR DIASTASIS RECTI. DO YOU NEED IT?
I know from personal experience and from all your messages, that our postpartum body comes as quite a shock. It doesn’t look or feel the way it used to, it maybe doesn’t even *work* the way it used to, and past strategies or regimes simply aren’t getting results. This new apparent lack of control over our bodies can be super hard to accept, leaving us frustrated and lacking in body confidence. We gave life, we carried and birthed our babies, we should be feeling the most feminine, sexy and powerful of our lives. But instead we can feel like our own very essence is depleted, whilst we feel disempowered to change it.
Our workout efforts don’t seem to impact the parts of our body we most want to change, and may even be causing leaking or pain. So we scour the internet, ask our Doctors, read health magazines and confide in our friends for answers. Sadly, the conclusion many Moms come to, is that this body really is as good as it gets after babies, that we put up and shut up, that exercise won’t work and that surgery is the only way to get it back.
So is diastasis recti surgery the answer? And does considering surgery make us vain, shallow or unappreciative of our bodies and what they have achieved? More guilt… (like Moms need any more of that.)
In most cases, no you don’t need surgery. In all cases, surgery or not, MUTU System can help by reestablishing the mind-muscle connections essential for true healing, core restoration and strength.
Whether you are considering surgery as a personal choice for better function and /or aesthetics, whether surgery is recommended by a specialist Physical Therapist (see below) when your body is unresponsive to a program of core reconnection… your choices about your own body are not for the judgment or approval of others. Surgery is a big decision which will require many long weeks of healing and will impact your life and your whole body. If in consultation with a trusted medical caregiver, surgery is deemed to be the right route for you, by all means follow it with careful thought and guidance if resources and finances permit.
WHEN IS SURGERY NECESSARY TO CORRECT A DIASTASIS?
According to respected women health physiotherapist Diane Lee, rather than a defined ‘how wide is too wide’ distance, it is when the fascial system remains unable to generate tension, despite optimal deep muscle activation, then surgery may be needed to correct it. That means the midline of your diastasis, the gap itself, cannot regain tension even when the core is functional and restored. Where the trunk cannot provide stability in joint movement or loading (for example when standing on one leg, or carrying out functional tasks such as lifting or squatting) – then a qualified physical therapist will be able to determine when surgery may be beneficial to restore midline tension.
It’s important to note though, that surgery won’t teach the muscles to work right – total core training along with alignment work will very much be necessary post-surgery to achieve true core stability and strength.
Individual, professional assessment is necessary for truly personalised diagnosis and the most effective treatment and prescription. For more information on consulting a specialist Pelvic Physical Therapist or Women’s Health Physiotherapist, see below.
For most Moms, postpartum diastasis recti surgery is neither essential nor desirable. We can ‘fix’ ourselves, empowered with the right information and guidance, mindful daily movement, time and consistency. But in some cases, surgical intervention will be required, and the most powerful thing we can do for ourselves is to be informed.
SURGERY IS STILL ONLY PART OF THE SOLUTION…
Abdominal surgery such as muscle plication (sewing the 2 sides of your abdominal muscles back together), along with a tummy tuck or ‘Mommy Makeover’, can only do so much. It can tighten the tissues, bring them back together, remove loose skin and fat, but it can’t strengthen your muscles, or reconnect the essential pathways you need to regain full core function. In fact, the surgical process itself inevitably means further loss of nerve pathways and ‘mind to muscle’ connections.
Reconnecting your core – both in a physiological sense of finding and learning how to engage and use those muscles effectively and functionally; as well as the emotional mind-body connection for a woman who is not feeling good about her body – is still an essential process, surgery or not.
If you want to feel good about and in your body, you still need to ‘do the work’.
But ‘the work’ is not hardcore workouts, more or more intense exercise. It is learning how your core works, literally, what went on in there and empowering yourself to take back control and ownership. Then we can make those connections and truly understand how to build the foundations of a core and pelvic floor that work naturally, in daily movement and activity, as well as when working out.
Then we can gradually progress to the sports or activities of our choice, knowing that we are using our core safely and for long term full body health.
We know a lot of Mamas enquire about surgery and the available options and it is always a topic of conversation in the support group. We thought we would use this page as an opportunity to share a case study of one Mama’s experience, to give a better understanding of what it really means to combine surgery and MUTU System. We wanted to draw on the story of Samantha Wickes* from the USA whose experiences really resonated with a lot of our Mamas who are looking for answers, guidance and reassurance.
Hi! I’m a Mama who loves and supports MUTU System and I had surgery to fix my separated rectus muscles and umbilical hernia, and to remove my extra skin. I’m a petite Mama of 2 boys who were big babies.
After the birth of my first son in 2009, my body returned to its pre-pregnancy size within a few months. However, after the birth of my second son in 2011, I still looked a few months pregnant a year later.
In 2013 I hired a personal trainer to help me get toned and lose the baby weight. I knew I had Diastasis Recti and an umbilical hernia so we carefully avoided the no-no exercises. I got to my desired weight and looked toned, but still had the pooch and mild back pain.
In 2014 I found the 12 Week MUTU System program and followed its wonderful teachings (clean eating, exercises, alignment, etc.). I was able to reduce my gap from 3 fingers to less than 2! I felt great and had less back pain, but alas, I still had the extra skin. I wish I could say I was content and just loved me for me, but it really bothered me that I was in the best shape of my life and people still asked me if I was pregnant. Yes, MUTU does work! But if you try everything and still have the pooch, surgery may be the last resort needed to visit!
In 2015, on the advice of my primary care doctor, I consulted with plastic surgeons and decided to get a full abdominoplasty (aka Tummy Tuck). This cosmetic procedure removes extra fat and skin and tightens the rectus muscles. My surgeon said my muscles were 3-4 fingers separated – not sure if I was doing the self-test wrong, but wow! Because of the hernia I chose to have a new SERI silk scaffolding mesh added to reinforce the connective tissue. This safe mesh will dissolve within 18-24 months.
Both of my boys were delivered by c-section, so I wondered if the scar would be in the same place and if the recovery would be similar. My doctor was able to create an incision lower than my c-section scar, however the location goal should be discussed with the surgeon beforehand, as everyone’s scar/skin situation is different. The recovery pain is also different than a c-section. Some feel the abdominoplasty is worse, others easier! Everyone has a different pain tolerance, of course. This surgery is definitely much more intense than a c-section, and while the pain is controlled with medication, I never felt horrific pain – I was just very sore and uncomfortable for the first few days. The recovery is MUCH longer than a c-section, that’s for sure! I was hunched over for a few weeks and told not to lift anything over 20lbs for 3 months. (Each surgeon has his/her own post-surgery recommendations regarding compression garments, when to resume exercise, how much you can lift and when, etc.).
I think it is important to clarify that I NEVER wanted to have surgery, and I know it isn’t for everyone. It is quite expensive, uncomfortable/painful, comes with potential post-operative complications, requires much time off and assistance with child care, plus the long recovery time. Swelling of the abdominal area can last up to 6 months to a year!
I can assure you that you will need someone to watch the kids for the first week at least. You will also need a caregiver to help you get in and out of bed, to the bathroom, to your post-op appointments, keep up with your medication, etc. You won’t be able to drive for at least a week (some doctors advise you to wait closer to 3 weeks), you won’t be able to lift the kids into car seats for a few months (if they can climb in, you’ll be able to tighten them after a few weeks), I could go on and on! My kids’ ages 6 & 4 made it a little easier. They can be independent when needed and also understood not to hurt me!
As I write this, I am currently 3 months post-op and I can confidently say that choosing abdominal surgery was the right decision for me. I am standing up straight (properly aligned, of course!), have no back pain, my hernia is fixed, and my tummy is flat! Well, I do still have a little swelling below the incision, but I’m okay with that, knowing I still have many months of recovery ahead.
Overall, I’m grateful that MUTU System got me to a healthy place before surgery, which has undoubtedly helped to make my recovery easier. And…I was just cleared to start gentle abdominal exercises, so thanks to Wendy and MUTU, I have my fitness plan all ready to go!
Above you can see photos of Samantha’s journey. We are by no means recommending surgery over MUTU or vice-versa, in some cases the two go hand-in-hand as Samantha has demonstrated above. We thought it was important that MUTU be a safe place where we can cover all aspects of post-partum life, the wonderful parts of course but also the difficult decisions that some of you may be faced with.
WHO TO CONSULT
If you’re considering surgery for functional or aesthetic reasons or both, I urge you to consult and work in the first instance with a specialist Womens’ Health Physical Therapist as well as following a dedicated postpartum core restoration program. By educating yourself and retraining your core muscles to work naturally and functionally, you will very likely not need surgery. Your specialist Physical Therapist will be able to tell you for sure if your body is simply not responding to the process, but it is without doubt worth pursing the non-intervention route first.
If surgery is still recommended or desired, then the work you have done will put your body in the best possible place to recover and strengthen afterwards. Continue with gentle core restoration work post-surgery to increase circulation, aid healing, regain sensitivity and get truly strong.
Remember if you only consult a surgeon in the first instance, they will recommend surgery! So get as informed and empowered as possible. Pregnancy and birth already feels ‘handed over’, and out of control for many women, so don’t simply pass your care and healing over to a surgeon without really understanding and knowing your own body.
Whatever your own healing and strengthening journey looks like, please don’t feel guilty about any of it. Women have come to MUTU feeling ‘like a fraud’ for getting surgery… this is craziness, Lady! Your choices about what is best for your own body are for no one to judge. Get informed, make empowered, considered and mindful choices. You gave life, and every woman deserves a body that works, looks and feels vibrant and strong to reflect that.
MUTU gives you the resources you need to get there on your own terms.