Monday, March 24, 2014

Diagnosis: Diastasis Recti


During my last trimester with my second son, I had experience severe back pains.  In my mind, I thought it was the normal progression of pregnancy.  But these back pains were extreme.  I had to sleep upright on the couch with a bunch of pillows propping me up and a pillow between my legs.  As the due date neared, I had to sleep sitting up with my legs propped on a chair or just sitting up in the couch.  When I went to my midwife for my pregnancy visits, I told her about the extreme back pain, mostly located on my right side near the tail bone.  She felt the position of the baby and said that the baby was facing forward and the back of his head was towards my spine.  So I figured that the pain was coming from the baby head pressing on a nerve in my back.

When I delivered my son, I noticed that my back pain was better but wasn't totally gone.  I thought that if the baby was pressing on my nerve in my back that the pain would be completely gone.  I figured that my body needed time to heal so the back pain might take a while to heal as well.  When I came home from the hospital, I was moving kind of funny.  My back was hurting but also my hip joints were stiff.  I don't remember this happening with my oldest son but every pregnancy is different. 

I needed to get some rest because I didn't sleep much the two nights in the hospital and I was exhausted.  My mother in law was over to help out and watched the baby until baby wake to feed again while my husband watched our oldest son. I lay in the bed.  The bed felt hard and cold and it hurt my hip laying on my left side. I also had to put a pillow between my legs again because closing my legs completely would hurt my right hip. We have a tempurpedic mattress and it was cold in the bedroom so I contributed the hardest of the bed to that.  The bed would regulate with the warmth of my body temperature and my body should feel fine.  I fell asleep. 

In about two hours in my sleep, I tried to roll over to my right side and experienced the most excruciating pain I ever experienced in my life. "Awwwwww!" I shouted out loud as I tried to roll over to my right side again holding my hand on my back. It felt like a sharp pain shooting up my spine.  I couldn't move.  It felt like I was paralyzed. In order for me to move to my right side, I had to use my arms to lift my upper body to a sitting position and slowly use my hands while sitting up to turn my lower body over to lay on my right side. When I  lean my leg over to the right side, my hips would stiffen and have a numbing pain in them. This was a scary feeling to be paralyzed even for a few seconds.  I tried lying straight on my back as well.  If I try to move my legs, my back would stiffen and I would have a sharp pain in my back 

After the days that followed, I couldn't sit on the floor without the fear that I wouldn't be able to get back up because of my back and hip pains.  I would still sleep on the couch with pillows propping up my back and a pillow between my legs to elevate my hip pain.  I couldn't play with my oldest son on the floor like we use to and it was hard picking up  and putting my new born son down in his crib and play pen.  I started doing stretches to help with the pain but it wasn't enough.  Walking was becoming a problem and I was holding my back a lot so much so that my oldest son would copy me.  He would hold his back and says, "My back, my back."  I didn't realize I was saying that so much.

At my eight week postpartum appointment, I told my midwife about my back and hip pains.  She figured that I need to do some abdomen exercises to strength those muscles but first she did a checkup on me.  I lay back on the examining table and she looked at my belly.  Then she told me to do a mini sit up.  When I did a mini sit up, she noticed a bulge in my stomach. She said that I had Diastasis Recti. If you're not familiar with Diastasis Recti (DR) is a separation between the left and right side of the rectus abdominis muscle, which covers the front surface of the belly area. My midwife told me DR developed because I had my children too close together and I'm going to need physical therapy to correct it. If I don't get it corrected, there's a chance that I can develop an umbilical hernia. With the fear of developing a hernia, I called the Physical Therapist right away.

 

 
On January 16. 2014, I started physical therapy.  I was evaluated by doing some strength exercises to pinpoint exactly where the pain in my back and hips were and if the pain was caused by the Diastasis Recti. With the pain in my lower back and my hip pains and also having a weak pelvic floor, the diagnosis of Diastasis Recti was correct. The physical therapy now has to see how wide my DR was.  At the time it was a 3-3-2 which meant above my belly button the gap was three fingers width wide, three finger width wide at the belly button, and two finger width wide below my belly button.  She had me feel the gap with my fingers and I couldn't believe that there was a gap was that big.  I was told by the physical therapist that my DR was severe because it should be a two finger gap or less.  But on the bright side, the physical therapist seen women with DR who she could put her whole fist in their stomach so I guess I should be thankful. She gave me some exercises to start with to help close the gap.  All I kept thinking was how I'm going to incorporate exercise in my schedule when I'm dealing with an energetic toddler and a fussy baby.  Will I have time to do these exercises?  

I started to do these exercise at night after the baby slept.  But with him waking up sometimes twenty minutes after I put him down, it doesn't give me enough time to do the exercises. About the time I get him settled again I'm too tired to continue the exercises.  I tired to do them during the afternoon while the children were awake.  Either the baby need to be fed or changed once I start the exercise or my toddler wants to jump on my back, my leg, or if I'm on my hands and knees doing an exercise, he want to crawl under me.  So I had to figure something out. I started feeding the baby and making sure he didn't need to be change before I start my exercises.  I either have him on his Sassy's activity mat on the floor to play with or I put the activity mat in the crib and he plays in there if I thought he was sleepy. With my oldest son, I started to implement quiet time where his in his room for an hour while I do my exercise or if he's in his baby brother's room with me he helps me count the reps I do with each exercise.  If I'm doing arm stretches, I have my oldest son high five me to make the exercise more fun. 

As I write this, I no longer have to go to physical therapy.  My belly is a 2-2-0. I also started wearing a postpartum binder that helps with my back pain and closing the gap.  I have to continue with the exercises and check my belly in a month to see if the gap closes even more.  My hip pain cease and my pelvic floor is getting stronger. I'm starting to feel like I'm getting my body back again. I can pick up my infant son and put him down in his crib without too much stress on my back and I can get on the floor and play with my toddler.  Thanks to the Physical Therapy at Good Shepherd Penn Partners in Philadelphia, PA for helping me to correct my DR so I can focus on being a mother to my children instead of my hip and back pain. Now I can focus on how my children are a pain in my butt.