Postpartum Pubic symphysis diastasis PPSD and diastasis recti during and long term for years after pregnancy.

[YourTaupeOne]

I’m posting about a health issue that I have had since pregnancy and beyond. During pregnancy around 20 years ago, as often normally happens there is diastasis (separation) in the middle of the abdomen, and the hormones that naturally normally cause the pelvic girdle which includes the pubic bone etc to be less stable to prepare for childbirth. So these two issues combined which usually happen normally in a lot of women’s pregnancies and I’m sure that being petite also contributed, made it impossible for me to walk up the stairs in the last few months of pregnancy and also difficult to generally walk at that time.
During labour it was about 12 hours from initial pains to childbirth and during the birth, it was a natural birth, it was extremely painful and when my baby was born it was so painful that I thought I had broken some bones or something. It was agony. I wouldn’t wish it on my worst enemy. After the birth, postpartum, I couldn’t walk at all for hours, the next day I could walk but it was very slow and painful and couldn’t walk far just a few metres and I had back pain for some time. It took a long time to ‘recover’. Although I got to walking again and can walk a few miles at a time now, I’ve never fully recovered from it. I have a scar about an inch wide from the pubic symphysis diastasis that happened during the birth, I have weak stomach muscles and still some diastasis recti where my stomach is pouchy and feels squidgy all over even though I am fit and slim. So my back feels like it is not supported - my body is very different because of pregnancy and the birth. So much weaker. I tried to do some exercises for my stomach over the years and managed to close the gap in the middle of the abdomen muscles somewhat but a gap still remains and weakness still.
After the birth, in hospital, even though I had suffered a painful birth, and had diastasis recti and pubic symphysis recti, and I couldn’t walk properly, a maternity nurse there actually mocked me for not being able to walk properly and accused me of having a mental issue - depression which I didn’t have. The real cause of my misery and pain was totally unrecognised and I felt misunderstood and sidelined. I tried to explain to her but she didn’t seem to care or listen to me. Over the 20 years since, I feel there is not enough stability as there was in my pelvic girdle or my stomach muscles so my back suffers. Occasionally there have been ‘flare ups’ if I can call it that - what I mean by that is that occasionally I can’t walk properly and get back pain, find it diffucult or impossible to walk up stairs, get in and out of bed, turn over in bed, do housework, it’s happened several times - sometimes for no obvious reason but other times from too much exercise or lifting things that sort of thing. But there’s no warning, I never know when I’m doing to much to cause the ‘flare up’. It makes me worried to do things generally because I don’t know when it will next cause the problems with walking etc. I think that our society expects this to get better if it happens shortly after pregnancy, but for me it hasn’t and I feel it isn’t recognised but should be. Has any one else experienced/ is experiencing this?

I’ve got another flare up at the moment, did some shopping, housework then a bit of gardening on the weekend and now haven’t been able to walk properly since 3 days ago. Lower back pain and girdle pain. Can’t walk up stairs, can’t turn over in bed easily or get into or out of bed easily, can’t bend down to pick things up off floor, difficult to lift legs into bed or move legs apart/lift legs to get dressed. Can’t get into the bath. Can’t go to work. Walking with a walking stick.

I had (a milder version of) what you're describing and it took a lot of physio to get back into shape. You haven't mentioned physio - are you still seeing one regularly?

It's a mistake to think you only need to strengthen your abs. When this happens, all the core muscles weaken, so you need exercises to strengthen your lower back, glutes, and other muscles in that area too.

It will take hard work and discipline and lots of physio but this kind of thing can usually be reversed. Obviously talk to a physio, but avoiding stairs etc might not be a good idea as the muscles will be weakening further

I'm so sorry you experienced this, and particularly sorry your midwife seemed to mock you.

Have you ever been to a physiotherapist? There are physios who specialise in women's health. They can do a full assessment and recommend therapy/exercises to help

I also had a really good experience with a chiropractor for PGP during pregnancy (I did think a good proportion of their science was a bit quack, but the hands on stuff was really helpful and I could see how it changed my posture!). Same for an osteopath, they really helped during my first pregnancy.

Ps, sorry I've just reread and your birth was 20y ago. That's a long time... speak to a physio and see what they say.

For me, I had lasting pain in my groin especially for 3-4y (with another pregnancy in that time) but I kept at the exercises and I'm 98% better now

I had the same, almost exactly- my stomach feels like my insides are hanging down. I still get terrible back and hip pain, 8 years later.

The only thing that's ever worked is amitriptyline but even with that, there are days when I'm almost incapacitated, can't walk, can't bend. I'm always in some kind of pain.

sounds the same. Did you feel supported with it or not? Do you do any exercises to try to improve the diastasis?

How often do you have bad problems with walking etc?

I have never spoken to a physio about it because of my experience with that nurse it put me off talking to people about it - this is the first time I’ve tried to get support with it since the birth.
Did it affect your back too or just your groin? How was your body affected with trying to move around? And what exercises did you do? Do you have a scar?

I could have written this myself. I am now 50 and the flare ups are getting more frequent, as in the gaps pain free in between are much shorter. It is really depressing to be suffering so much all these years later. It took me a few years after the birth of my second child before I could walk properly.
I don’t have any answers but completely understand where you’re at.

Thanks for your support. It wasn’t the midwife it was the nurse on the ward after the birth as I stayed in a day because I couldn’t walk. Yes she wasn’t nice.
I haven’t been to a physio because of her. I thought no one would listen to me or take me seriously so I have just suffered without any professional support. This flare up is the worst I’ve ever had so I am rethinking about going to a physio at last but I’m worried about going to see a physio in case they don’t listen like they didn’t at the hospital after the birth.
It’s not the first time professionals have sidelined me and not listened - at the birth of my second child, a midwife didn’t believe me that I was progressed enough to have my baby, I told her that I needed to go to the birth room right then because I could feel the baby’s head coming out but she said ‘I don’t believe that you’re having the baby so you can wait downstairs for longer’. So I started having the baby all my myself in a dark room and I was crying in pain then two women came into the room and apologised then they had to put me on a wheelchair and get my up in the lift to the birth room really quickly.

Definitely find a local women’s health physio they can give you lots of exercises to strengthen your core and protect your back. Theres also lots of videos on YouTube for diastasis recti recovery.

So initially my lower back, symphisis and groin were all in huge pain and I walked stooped over like a very old woman... it took a few months of physio exercises to start walking normally but I still had stabs of muscle pain in the pelvic floor area for years. I have a c section scar yes, that never goes away your whole life haha but no pain at the site

Thanks for the information about strengthening the lower back and glutes. I have no idea what exercises to do really. I have tried to search on the internet over the years for ideas of exercises to do. Like you say, it’s probably best to see a physio. If only I could get the courage to go to see one. Yes it is hard work trying to do exercises on parts that have been damaged from their normal function. Sometimes feels like I literally can’t move my legs up to get up the stairs it’s not always a matter of choice. Most of the time I can walk up stairs absolutely fine but several times in the past 20 years I haven’t been able to do so easily. Hopefully it won’t happen again after this time.
Did you have both diastasis recti and pubic symphysis diastasis?

I’m glad you understand. I’m around 50 too. I’m not sure if the gaps pain free are shorter for me as there’s always some level of discomfort but I think perimenopause has made it worse too because this is the worst flare up I’ve had of walking problems etc. I don’t get depressed by it but just wish I could help it and not have these problems that started and were caused by pregnancy which has long since finished. A few years is a long time to walk properly after your second child - I’m sorry to hear that. Did you also find it difficult to walk up stairs for those two years? If only that nurse had also understood the cause of my pain and misery at the time of the birth. I should have been pointed to a physio really at the time but wasn’t given a physio. Have you been to a physio and what was your experience of your birth and the professionals support/advice to you?

or, if you can afford it, a personal trainer specialising in women's health to get you started. ask at a gym

I have it really badly maybe a couple of times a fortnight. It's worse if I've been sitting still so I try to keep moving, which also hurts but not as much.
Daily I have hip and pelvic pain and can only sleep on my back.

Thanks for the advice. I will try to get to see a physio.

I am stooped over like an old woman at the moment with a walking stick too. Do you think c section caused your problems? How did you get symphysis diastasis pain from a c section?

Thanks for the advice I would have to save up

I'm sorry you were treated so poorly. I think postpartum care has improved slightly but unfortunately not enough.

I started having issues with mobility and pelvic pain a couple of years after having my first, which got worse with my second pregnancy. I found the physiotherapy through the NHS generic and not that helpful. A few months ago I privately saw a women's health osteopath who found that my pelvis was misaligned from pregnancy and that was the source of the problem. The weekly treatment was initially painful but after 3 sessions I felt a massive improvement and no longer have pelvic pain at all. If you can afford it I highly recommend paying to see a specialist in PGP / SPD.

Also, please don't worry about your issues being dismissed. It's not right that you are suffering, take someone with you who can advocate on your behalf if needed.

Physio, pilates and HRT.

sorry to hear that it happens a couple of times a fortnight for you. That’s a lot. I don’t get flare ups that much where I can’t walk properly - it happens every so often for me. Usually I’m fine with walking and sitting straight, walking stairs etc but at the moment since Saturday I’m finding it difficult to sit up straight, sit reclined for too long - I’ve found lying on my side is the best position, because, sitting is putting a lot of pressure on my back and although lying on my back is more comfy because my hips and shoulder are then not being pressed against the mattress, but I worry about lying on my back because it’s so difficult to get back up from that position. Rolling to the side from my back at the moment but feels like I’m stuck to the bed. Do you ever feel it’s difficult to get off from your back to your side and get up? Lying on your side hurts if you’ve been lying there for a while so then walking around a bit is almost a relief in a way. But generally it’s more comfy lying on my side than walking or anything else. What part of the day is worse for you for pain and what’s the best?

No the symphysis pain started in pregnancy, something in that area kind of snapped and I was in agony for the whole 3rd trimester of my first pregnancy. It took ages and ages to heal, giving me pain throughout my second pregnancy.

I also put on a huge amount of weight in both pregnancies which didn't help (it was mostly water retention) - I went from 50kg to over 75kg both times, and my body just couldn't cope with all the extra weight.

To answer your question about the exercises, I did things like glute bridges, side leg raises, and dead bugs and this thing that I called the superman exercise, not sure what its name is, on all fours where you lift opposite limbs. But as I say, best see a physio to get the right exercises for you.

The longer you leave it, the more you'll misuse the surrounding muscles and kind of lock-in bad gait and bad posture

Yes there is a lot of extra weight in pregnancy - I was about 47 kg initially then during pregnancy about 52kg. I was in pain in pregnancy too and I think my symphysis separated a bit then but mostly I recall during birth something cracked around my pubic bone I heard it and felt it break. It was horrible.

I think it's right and very sensible to do the physio route first but this sentence jumped out at me.
Sometimes feels like I literally can’t move my legs up to get up the stairs it’s not always a matter of choice.

This is a symptom of FND which can be triggered by trauma and is a neurological condition. If physio doesn't help then please ask your GP to refer you to the Neurology department.

I'm really sorry to hear about your experience and that you were dismissed by those who should have been caring for you. This can be treated and it is never to late to get treatment. You can find information on pelvic girdle pain on the Pelvic Partnership website (search on Google) and reach out to them for support (there is a helpline and Facebook support group). They also have a list of recommended practitioners on their website who are experienced in treating PGP. You may also consider a mummy mot (again can search Google), it is never too long post partum to have one of these and you may have a few issues at play causing these symptoms. You need a proper assessment, they should ask you for a full history including your symptoms and obstetric history, then do a proper hands on assessment of your pelvis and decide on appropriate treatment based on this.
Wishing you all the best.