When things come apart: Diastasis Recti

So I’m trying to be really positive and not dwell on the past, but I recently had hernia surgery for a hernia that didn’t exist.  And I still have the original problem that I started with.  Yes, that’s right, a faux hernia.

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About 10 weeks postop

 

I don’t know where I went wrong, but I wish that I had gotten more opinions and visited women’s specialists instead of a general surgeon.  I was diagnosed with a hernia in May because I had a small place above my belly button that bulged slightly when I worked out.  An ultrasound didn’t show any tears in the fascia, which is what qualifies a hernia, but the general surgeon said that it was a hernia and that he could fix it.  To be fair, it was a weak spot in my fascia, and it was bound to only get worse with my activity level.  I was scared and I asked for the surgery.  The general surgeon was really good, but he essentially fixed a hernia that didn’t exist, and now I have a weak spot above my belly button AND scar tissue.

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After 6 weeks of recovery, I was able to resume all of my normal activities at the end of June, which means I started my strength routine again.  Right away, I noticed a bump pop out below the incision area.  I went to the surgeon the next week for a follow-up, and he said that it was not anything.  After a month more of exercise, I have continued to feel something “pop” out along the midline of my belly near the incision.  It is not visible, but clearly I can feel something happening beneath the skin, and I am able to “push” it back into place.

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I would do anything for this little lollipop!

Post op deja vu has definitely been a test of my character.  I went back to my surgeon last Friday and met with the physician’s assistant.  She gave me a lot more insight and reassurance about what was happening, but it still does not make me happy.  Essentially, I have diastatis recti, or ab separation, to the tune of 2.5 cm (normal separation is about .5 cm), and the fascia running down the center of my abdomen is holding everything in.  The PA did an ultrasound to confirm that I do not have a tear in my fascia (I have never had a tear in my fascia), but fascia is weaker than muscle, and my fascia is having to hold in my intestines.  There is nothing that I did during my postop recovery to make this happen.  It is just general anatomy.  I am pretty thin right now (breastfeeding and training for my first 100 mile race), so I do not have much of a fat layer to act as a buffer.  What I am feeling “pop” along the middle of my abdomen are my intestines as they push through my abs and against the fascia.  I’m a living science project!

The PA told me that a tummy tuck is the only solution to ab separation, but I cannot believe that something muscle related can only be fixed through surgery.  (Also remember that these are the surgeons who operated on a hernia that didn’t exist on me.)  So, this week I have called around to a few physical therapists and made an appointment to see one on Thursday morning.

I can’t help but feel guilt, regret, confusion, and fear about my condition.  I was cleared by my OB for all activities in October after I had Cadence.  All through pregnancy and postpartum, I took fitness classes specifically geared towards the right exercises for new mom bodies.  I read about Steph Rothstein’s postpartum journey of ab separation, but I really didn’t think that I needed to worry much about it since all of my doctors had told me that I was cleared to continue any type of exercise that I wanted.  I was vocal about training for Boston and running ultra marathons.  I also thought that I had covered everything with my surgeon, who told me that I could resume all physical activities after 6 weeks postop.  Good as new.

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We are dedicated to our training schedule. 🙂

I am not sure why I am only feeling these symptoms later in my postpartum journey, other than that my intensity level has increased while I have also gotten thinner.  I am hopeful that I will be able to correct some of the separation.  The physical therapist assured me on the phone that diastatis recti is genetically predisposed, and there are some exercises that I can do to help strengthen my core again.  I’ll find out more on Thursday at my appointment.

Thank you if you have followed my story this far.  One last thing that I want to end with.  Recently I was reading my Bible and I came across the passage below.  It just reminded me about how much God wants for us to go to him in prayer for everything.  He is the ultimate Creator and Healer.  So my prayer is that my body will heal and I’ll be protected from any further discomfort or damage in my abdomen.  I do not want to worry about it every time I pick up my daughter or go for a run. I pray for peace of mind and healing.

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Do you have experience with diastasis recti?

Did you do any type of postpartum physical therapy?

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Update: You can read about my physical therapy appointments here.

When being a mom stretches you, literally: Part 2, the surgery

Update:  I’ve learned a lot since posting this blog.  Please be sure to read about the whole story from diagnosis, to surgery, to postop, and finally physical therapy.

***

It feels like I’m getting ready to write a race recap instead of writing about my surgery.  Both races and surgery do put the body through a certain amount of stress that requires recovery, I will admit that.  Within less than a month, I was diagnosed with a very small hernia from pregnancy, met with a general surgeon, decided to have surgery, had surgery, and have now pretty well recovered. If you want to read about my decision process to have surgery instead of waiting for the hernia to get bigger, you can read about that here.  Now that it is all done, I am very happy with my decision, although I do still have some more recovery ahead of me.

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Ready to go back for surgery.  My two black toenails are a gift from the Boston Marathon.

I’ll start with surgery morning.  I had to be at the surgery center by 7 am.  Knowing that I would not be able to run for a little while after surgery, I decided to get up at 5 am for a last treadmill run.  My husband and baby went with me to the surgery center, and all of the nurses took turns going into the waiting area to talk to the cute baby.  I was quickly brought back to change into a gown and get the IV administered.  Right before they wheeled me back to the OR, the surgeon asked one more time where the hernia was, and said, “Are you sure that’s where it is?”  Really?!  You are asking me this now?

I don’t remember anything about the surgery.  I woke up back where I started in the prep area.  The nurse told me to change clothes, and that is when I saw just how large the incision was on my stomach.  My hernia was about the size of a dime, but the incision was a couple of inches long.  The doctor visited me and told me that the surgery went well.  The fascia did not have a hole in it yet, but it was stretched.  He only had to stitch across the weakened area to reinforce the fascia.  And good news, fascia can repair itself, so the stitches will dissolve, and I’ll be left with stronger fascia (as opposed to a mesh that is foreign).

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The incision is bigger than I expected considering the hernia was so small.

On Friday, the day of the surgery, I felt mostly fine.  I napped and walked a mile with my husband, baby, and dog.  The surgeon had encouraged me to walk because it speeds up recovery, but he restricted me from lifting anything more than 10-20 pounds. My delivery with Cadence was really uneventful with a little tearing and stitches, so I went into this surgery thinking it would be just as simple.  My expectations were a little off.  The first night I tried to get into bed by myself only to feel intense pain in my stomach every time that I tried to lie down.  Crying, I finally called my husband upstairs to our bedroom where he had to lower me into the bed (this would be his job for many more nights to come).  If I even slightly used my abs, it was very painful. Because I am breastfeeding, I took sparing amounts of pain medication, so anyone else having the same surgery might have an easier experience with a little medication. (I also have a high tolerance for pain, so I like to know when I am pushing the limits.)

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I missed being able to hold this little baby the most of all.

One of the biggest difficulties with not being able to use my abs is that we have a 7 month old baby. My sweet husband spent the first few days after my surgery doing everything for me.  He helped me put my pants on, he carried my plate to the table, he put up all of the laundry, he held our baby horizontal across my chest so that I could still breastfeed.  He wins all kinds of awards for best caretaker.

I stayed home from work on Monday (not something that I had planned) because I could not rotate my body at all, which is required for driving.  By Tuesday I was feeling better, but I still could not cough, sneeze, wrap my hair in a towel, etc without a lot of pain.  Exercise is my favorite thing to do, and I was able to get on the bike for an easy 30 minutes on Tuesday.  By Wednesday I was up to an hour on the bike each day, focusing on high cadence and low resistance (per doctor’s instructions).

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Very slow walking around the neighborhood after surgery.

I had my post-op this past Wednesday (about one and a half weeks from surgery), and the surgeon said that I am healing well.  He told me that I can do as much cardio as I want, to which I said, “What do you MEAN as much cardio?”  Haha.  He knows that I am an ultra runner, so I hope he chose his words carefully! I am allowed to run, but the surgeon requested that I not lift any weights for six weeks.  I asked if 5 pounds weights were ok, and he again said that I am not to lift weights.  Ok, ok, but running seems to be more strenuous than 5 pounds.  I still don’t feel 100% confident to run, but I am excited to get on the stair climber and try other cardio routines.  I plan to test out running after at least 2 weeks have passed since surgery.

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I still have a big incision on my belly but it is starting to heal and it feels a ton better.

Overall, the experience has been pretty positive as far as hernias and surgery go.  And just like with running, I’ve learned more about my body and grown to appreciate God’s design even more.

I imagine that recovery form a c-section is a billion times more difficult. Does anyone have a c-section story to share?

When being a mom stretches you, literally: Part 1, the diagnosis

Update:  I’ve learned a lot since posting this blog.  Please be sure to read about the whole story from diagnosis, to surgery, to postop, and finally physical therapy.

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A few months ago, I noticed a small bump on my belly along the midline above my belly button.  At first I thought, “cool, a seventh ab.” And then after the busyness of Boston, I asked my husband what he thought.  Maybe a vein?  (I have big veins, especially post-baby.)  My husband suggested that I get a physical to make sure all was healthy, so two Fridays ago, I saw my general practitioner.  He told me that my seventh ab was in fact a small hernia, and that the only way to fix a hernia is through surgery.  I wasn’t very familiar with hernias, but the idea of surgery and recovery did not make me very happy after all of my work to get into post partum shape.  I love to run.  Everyday.  And do push-ups and planks and very active things.  No!!!!

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Small ventral hernia

I’m being dramatic, but any runner with an injury knows that it is more than just an injury.  It messes with identity.  (There is a whole other lesson there.)  The GP told me that my hernia was very small and the best thing to do would be to watch it and wait to see if it ever grew or gave me pain.  Some hernias never grow, but most do end up requiring surgery.  I have a ventral hernia, so there is a small tear in the fascia between my abs, and most likely it will grow, especially given my activity level. I asked all three doctors if I had caused the hernia due to running/exercising through pregnancy and running/exercising post partum, and they all assured me that I did not do this.  Sedentary individuals get hernias just as commonly.  When I was pregnant, my belly stretched, and organs shifted so that they put pressure on the fascia. (I mention ab separation here.)

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This tiny little 6lb 4 oz baby is worth every physical sacrifice

I wasn’t satisfied with my GP’s answer to wait until the hernia became more complicated (I hate weakness in my body, and this felt like a ticking time bomb), so I called my OB and asked for a referral to a general surgeon.  Both my OB and the general surgeon agreed that I am a good candidate to have surgery before the hernia grows, as it most likely will grow given my activity level.  It is also good to take care of it before we decide to get pregnant again.  By having surgery now, I will only need a few stitches as an outpatient procedure, while the common procedure for repair is to stitch a mesh across the fascia.

My surgeon has told me that I will be restricted to only lift 20 pounds until I am cleared at my post-op visit (Cadence is only 14.5 pounds, so this was a relief).  I am also only allowed to get on the bike or walk until I am given the green light.  The timing for a break is probably as good as it is going to get.  My body could use the rest, and I am about to ramp up my training for a 100 mile race at the end of September.  I’ll follow the doctor’s orders, but no athlete likes to scale back training.  This will be character building (or more likely my husband will discover a whole new character in me once he sees what I’m like without my endorphin fix).

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Not so tiny anymore!  Seven months!

When I first found out about the hernia, I prayed for God to take it away.  (I know, why waste a miracle on something so insignificant.  But running is important to me.)  Then I realized how much God had already answered.  He protected me physically during rigorous training for Boston at a time when I was not getting nearly enough sleep.  He protected my mind from worrying about the hernia during the Boston race, so I was able to fully enjoy that great moment in running.  I raced at a sustained physical effort for the entire Boston Marathon, and the hernia didn’t get any bigger.  I wouldn’t have gone to the doctor if my husband hadn’t encouraged it, and I am so thankful that I will get this all resolved while the hernia is still small and my recovery will be speedy.  This rest period seems to be just what I might have needed.

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I debated whether or not to go into details about the procedure, but I’ve benefited from hearing other momma’s stories online, and maybe my write-up will help someone else who noticed a seventh ab too.  🙂 If you want to read the follow-up after surgery, you can find that here.

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Stretch! I’m still amazed at this process.

Anyone else sacrifice a part of their body to pregnancy? 

What are some coping mechanisms for having to rest?  I’m going to focus on better nutrition.