Surprisingly transformative surgery

Before diastasis recti, I had hobbies, I met my husband doing partner dancing, in a lifts and throws workshop. I loved long dog walks. I was lucky enough to go sailing; rigging boats and hauling in sails part of the activity. I took up ballet as an adult and loved prancing across the floor like a 6ft tall fairy. I was a happy soul, extrovert and confident. Even at 8 months pregnant with my first pregnancy, I was travelling about the country taking the dog for long walks. I appreciate that I am extremely privileged to have lived this lifestyle. This is important because by the end of this story, I had forgotten this life and these memories seemed like they belonged to someone else.

There was not ‘one defining moment’ that I could put on a form to say ‘it started here’. This was the diastasis recti. The impact of the separation of my abdominal muscles happened slowly. It happened against a background of stress, hormonal upheaval and degrading mental health.  At each stage I found a way to ‘manage’, repeatedly accepting a slightly reduced quality of life and health because I found some way to function. I received great care from the NHS through a lot of this background, but diastasis recti has only been recognised as an issue and its impacts are not yet well documented. By sharing my story I wish to add to the depth of information available for practitioners to consider.

Early indications

With my second pregnancy, I had twins. My belly ‘popped’ very early in the pregnancy. I looked very pregnant. I had a lot of abdominal pain, so I managed it by wearing a seat belt adjuster in the car to reduce the pressure. Covid’s first lockdown arrived when I was 4 months pregnant. Over the next 5 months I developed pelvic pain, round ligament pain and by the end I could not walk more than 100 yards without crippling pelvic pain. But, as with so many pregnancy related ailments, I was assured that this would all go away when I was no longer pregnant. So I managed. My husband was at home. My 2 yo was at home. We were lucky enough to get a hot tub in the garden – a huge benefit as swimming pools were shut and I could no longer fit into the bath tub and floating helped ease the pain so much.

We were hoping lockdown would let up so that we could have an au pair move in with us. My depression got worse and the intrusive thoughts became more frequent and overwhelming. At the time of birth, the midwives gave me a private room in order to allow my husband to stay with me, because I was terrified that I would not be able to cope and would abandon the twins in the hospital. Weirdly,  I understood that these were intrusive, unwanted thoughts. But I could not shake them. Fortunately, I did have great support at this time and the peri-natal mental health team were in contact. And once the babies came out, the pain stopped, and our au pair arrived to help, my depression was greatly reduced.

But my c-section scar wasn’t quite healing. And my belly wasn’t getting smaller. And post-natal compression garments caused me pain. And at 3 months post-partum, September, my mother told me to see a doctor because that wasn’t right. Why did I need to hear this from my mother? Because my mind was occupied with my screaming twins who I found very difficult to nurse, but who kept throwing up the formula I offered. I had not had a full nights sleep in a while. I had a 2 year old for whom bedtime was taking 2 hours. A bit of pain in my abdomen I could manage with paracetamol.

I saw an excellent GP. A lady who had been through this issue herself. She diagnosed my umbilical hernia and referred me on to surgery, with the advice to discuss the abdominal separation with the surgeon as they could possibly fix that at the same time.  I also found a physio who offered a ‘Mummy MOT’ and then offered follow on pilates classes specifically for those with diastasis recti. I signed up. My diastasis was measured at three fingers (5cm) wide.

I saw a surgeon, who gave me more information about what fixing the diastasis recti would entail, and outlined three surgical options:

1.       Keyhole surgery to fix the hernia. Reduce the pain. 2 week recovery time.

2.       Surgery to fix the hernia alongside repairing the diastasis via a vertical incision down my mid line. Preference was to lose some of the weight I had gained while pregnant in order to reduce the abdominal pressure and allow the shrinking of my abdominal wall.  Longer recovery time, and remaining issue of excess skin to consider.

3.       ‘Tummy tuck’ surgery via a lateral incision from hip to hip, peel back the skin, repair everything underneath and then put the skin back nice and neatly. 6-8 weeks recovery time, and then some, with a preference to be at my ‘ideal weight’ before the surgery to maximise the quality of the results and avoid skin dimpling if I lost too much weight after the surgery.

Given my ability to exercise in order to lose the weight was hampered by the pain due to the hernia, and the fact that I still had two small babies and a now nearly 3 yo, I opted for Option 1 – repair the hernia, minimal invasiveness, reduce the hernia related risks and pain. And then continue with the pilates to try to reduce the gap and restore core function.

The surgery went well in Jan 2021, done privately to speed up the process, the pain went away, life improved greatly. The pilates classes were going well, though I struggled to do anything without ‘doming’ in my abdomen. I worked hard to be able to do a single leg raise to table top. And then I kept working hard to be able to do a double leg raise to table top.

I could move better, but things were not quite right. An old foot fracture resurfaced. My hormones were a roller coaster each month. I had headaches from walking barefoot. I saw a chiropractor, a ‘functional medicine’ GP and a nutritionist to try to get myself back on track.

A brief respite

Summer 2022 (2 years post partum) and things started to improve. My foot started to heal. My mood improved. We were finishing refurbishments to the house. I had a bit more energy. I went paddle boarding again. Things were looking up. In October 2022 I thought, you know what, why not go dancing again? 20 mins later, my knees were shot and my back was in pain. I took a step back. I had found the pilates class went too fast for me to keep up, so I tried 1:1 reformer pilates. After just 2 pilates sessions, I was carrying my now 2 year old down the road and felt something pop in my belly. I tried one more pilates session, but there was pain in my midline and we agreed that I should pause the sessions and see the GP.

And so began a year of increasing pain and what felt like decreasing help. In Nov 2022, the GP saw me and said they would refer me on for vaginal and abdominal ultrasound scans. They did some blood tests too. 3 days later, I was in agonising pain, wondering if I had appendicitis and took myself to A&E where they did an Ultrasound and blood tests and concluded it was ‘probably a UTI’ and prescribed me nitrofurantoin and codeine. I was in bed for 3 days. But then things improved and I had a date for GP referred ultrasound. And then I wore a pair of trousers, and this really hurt my middle, similar to when I had previously had a hernia. But trousers don’t hurt that much? And then the ultrasound found a small hernia. I asked the radiographer to check the diastasis, which he grudgingly did and promptly dismissed it as ‘not serious’. 

I knew the answer was likely to be surgery, and I wanted to fix the diastasis at the same time to avoid another recurrence. So I put more effort into weight loss. I followed my nutritionist’s advice. Her supplements and meal plan had helped me stopped the sugar cravings. I tracked my food intake, and the weight finally started to come off.

I excitedly started a new job, in Jan 2023, with a requirement for smart clothing. I returned to maternity wear to see if that would help with more elastic waist bands. It did not. I had a headache by the end of the day and then the pain grew until I was sobbing in my car and the tradesman in the van next to me came over to see if I was ok, and tell me that I was not alone in my problems. An act of kindness I am still massively grateful for. I went home and went back to bed on codeine for three days, in week 2 of a brand new job, (not a career-building move).

I went back to my GP. “It’s probably not the hernia. More likely to be IBS.”

I tried my private health insurance that had recently come through my husband’s company. “It doesn’t sound like it’s the hernia, but I guess I can refer you on for a surgical opinion anyway.” This was thwarted by my previous hernia being too soon before we got health insurance, and ‘not covered’.

My one and only pair of shoes started to disintegrate in April 2023. ‘My foot seems better’ I thought. ‘Maybe a change of shoes wont be so bad’. I was wrong. I ended up in bed on codeine again for 3 days and then back at the chiropractor to re-align my back.  I fixed the shoes with superglue, ordered an identical pair online and carried on.

By this point, all my coping strategies are at an end. I can’t go for much of a walk without pain. I can’t walk up the hill from the common back to my house. I spoke to a physio who, over the phone, suggested swimming. 15 minutes in the pool, and… I was laid up in bed for 3 days on codeine. 

My health insurance came through with a women’s health physio. The physio I was meant to see had to reschedule twice before our first consult, leading me to have to justify why I wanted to stick with her and wait. (A wise decision it turns out). The depression was getting worse and with everyone telling me ‘this shouldn’t hurt’ and logic telling me ‘somethings not right’ and my body screaming in pain, I sought counselling to check I wasn’t imagining this. (I wasn’t).

I also returned to my NHS GP and after crying in the consulting room, she grudgingly agreed that since all the scans and tests could find nothing wrong with me except the hernia, that perhaps she could refer me for a surgical opinion, ‘before we completely rule it out.’ At every visit to my GP’s surgery I saw a different person.

Rapidly downhill

And then at the end of May 2023, despite my pain, I took my daughters to the fun fair. I planned it carefully. They can go on the rides. I can sit down when I need to. We’ll drive over to minimise the walking. We’ll meet friends so there will be other adults available and distractions for them. This level of planning was required for an outing of 2 hours, less than 2 miles from home. And then the kids wanted to go in the fun house. They needed an adult to supervise. I had a look at the fun house. I was assured I could walk around all the obstacles and not go through them. I went in. And at the top, my 3yo slipped at the top of a metal spiral staircase. Instinctively, I caught her and lifted her back up one handed. And then staggered home to spend the next 3 days in bed on codeine. This was the final straw. I stopped being able to ‘manage’. Everything went even more rapidly downhill from here.

I finally saw the physio. She was really sympathetic. Very helpful in teaching me about ‘pacing’ and ‘knowing my limits’. She freed up some trigger points. She listened. She wrote to my GP to request blood tests for the fatigue that was now plaguing me. She also requested my GP do a referral for women’s hormones. She gave me gentle stretches that would allow me to sit on the floor comfortably while I ‘played’ with the kids. There wasn’t much playing and I had no sense of humour. Everything was painful.

I was taking paracetamol and ibuprofen every 4 hours, daily just to manage the pain. Some days I added Naproxen to help me get through the day. Codeine still featured at night from time to time. I stopped driving as it caused too much pain, and it was downright dangerous with the fatigue. I would sleep all night and wake up tired and in pain. I would return to bed at 11am for a nap, that often lasted 3 hours. I would wake up from that and still be tired.

My mental health was through the floor and I was having intrusive thoughts and feeling like a failure and a burden to my family.

But my surgical referral came through. For the end of July. Given the pain, I called and they found me an earlier appointment. I saw a gastric surgeon. Who agreed that the surgery did need doing, but that it would be better done by the plastics team. He ordered a CT scan, which thanks to phoning up and finding they had had a cancellation, was done that same week. He then referred me on to the plastics team.

My therapist was worried about me and kindly wrote to the plastics team describing my plummeting mental health. But I didn’t hear anything back other than ‘I was in the list to be vetted to see whether I could go on a wait list for an appointment.’

I started making my husband do some of the chasing of appointments and insurance and scan results. His sympathy for me increased as he also found it incredibly frustrating. I began to feel less alone in my health problems. We looked into private surgery options. How expensive was it? Do you get what you pay for? Would a European clinic be worth looking into? So many options, with zero information.

And the GP blood tests results came back. I had post-viral fatigue from the Epstein Barr Virus (Glandular fever). No wonder I was exhausted all the time.

On the up

And then my husband got a pay rise. This made the surgery decision much easier and we booked an appointment as soon as we could with the plastic surgeon at our local private hospital, who had been recommended by my previous hernia surgeon. At the first appointment (August 2023), his opening words were ‘well you must be in a lot of pain’. And I felt like I was in the right place. He then listed all my symptoms because he is familiar with them from his other patients. And my husband had come with me and heard all my complaints re-worded from a doctor, and his sympathy for me increased again. And the surgeon explained what he would do and how he would do it and what I needed to do beforehand for the best outcome. He did not tell me to lose more weight. (I had lost 13kg since 1st Jan, but was still 12 kg heavier than my pre pregnancy weight). He did not tell me ‘it shouldn’t hurt’. He answered all my questions and gave me an email address to email any questions I had subsequently.  I called his appointments manager and was booked in for November. This was disappointing because I had really hoped to be seen sooner. But it was a date. For actual surgery. But then a week later, his manager called me back and said ‘they had a cancellation and would I be ready in mid-september?’ I was overjoyed. Especially because my pelvis felt like it had started to separate and was agonising and I couldn’t walk. My husband drove me the mile up the road so I could drop my 3 yo twins off for their first day at school (nursery class) and then I retired to my recliner chair for the next 10 days to wait for surgery.

I followed his instructions, had the surgery and woke up with pain at the surgical site and at the drains, but this was specific, pain that I could tell you exactly where it was coming from. Not the vaguely located but intense pain and headaches and malaise that I had been suffering during the past year.

A new woman

At nearly 5 weeks post surgery I can walk a mile comfortably. This is new.

When I am full of nervous energy I am able to leave the house and go for a walk and let all that energy dissipate.

My depression score is down to 2 (no depression). It was at 19 (severe depression) three months ago.

I have my sense of humour back and I am finding joy in the day to day life with my kids.

I can sit on the floor again, without pain, and without having to stretch first. Playdoh is fun again, not a chore.

I can engage my pelvic floor and also breathe at the same time. That’s new and exciting.

I booked a holiday because I am confident that I will be able to swim again.

I feel like a new woman and that everything will get better from here on.

I am not rushing it and, still need to fully heal. I do still get tired, but each day I can do a bit more for that same tiredness. I will take advice from my physio on how to build up strength without damaging what has just been repaired. But life is amazing. (Maybe because I am not yet fully back to solo childcare)

Whether the DR caused my issues, exacerbated them, or simply prevented me being able to find solutions, I do not know. But, I do know that repairing the DR has resolved many more issues than I expected.