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Original Post:
One new mom writes:
“I had my daughter 18 months ago, and am still dealing with separated abs and mild incontinence, both of which are really starting to get me down.
I don't really know where to start, and I am looking for some advice. That is, I've started (done some therapeutic pilates, regular and plenty of kegels by myself etc) but I'd like to approach getting my body back in a more focused way.
I've had a couple of recommendations for physical therapists for the incontinence from friends, but none of these therapists would be covered by my insurance. While I could afford a handful of visits to someone without it being covered, I can't afford to make ongoing visits to a therapist that way, and it's my impression that this might take a while (I've already had this problem doing pilates for the abs issue - at $75 a session, I can't go very often, and the lack of continuity has made it that much harder to follow through on for someone who already has trouble following through on an exercise routine!!).
When I've looked online at approaching the incontinence issue through medical routes (which my insurance would cover), it seems that I need someone to refer me to specialists, and I don't currently have a primary care doctor or an ob/gyn (I gave birth to my daughter at a birthing center, and my midwives have since left that practice).
I am wondering where to start! It seems a bit of a maze; I'd love to hear from anyone who successfully dealt with either or both of these post partum issues through any route. Perhaps I need to start by finding a ob/gyn who is knowledgeable and sympathetic, and can refer me to other people - does anyone have a recommendation for such a person, ideally in the area?
Thanks for any advice you might have to offer! I am sure there are lots of folks in the same boat out there.”
Feedback:
“Issue is, you MUST commit to doing the exercises (just like brushing your teeth every day) or it gets better until you stop doing them, then the muscles get soft again.
The surgery with the "sling" is fairly new and when I looked into about 5 years ago they didn't seem to know what the long term issues might be. I also know someone who had it put in and now has to go pee with a catheter for the rest of her life. Another person who had it done was happy with the pee part, but wasn't happy with the fact that when she had sex she didn't squirt like she had before she had the incontinence issues.
And yes, the 'second sneeze' issue is said to be an issue to 1 in 3 women. Whoopi Goldberg did a fun series of commercials about it HERE.
Sorry that you're going through this. It can get better!
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“My heart goes out to you. While I didn't suffer the same symptoms you describe, I have had other difficulties with post-pregnancy recovery--difficulties that are surprisingly common, highly treatable, and rarely discussed by OBs! I've been taking classes with Zoe Levine, the post-pregnancy fitness guru--they are a lot more affordable than private pilates classes, and she focuses on issues like diastisis and other aspects of post-pregnancy recovery. Her website is The Thriving Body, and she teaches classes and private lessons out of her own home as well as at the Ellie Herman Annex on 7th Avenue. She's also a good source of information for other recommended practitioners.
In terms of physical therapy, I would highly recommend going through the hassle of finding a new OB or general practitioner to give you the necessary referrals--it's worth it now and may well prove helpful in the future, too. My physical therapy helped tremendously, and I didn't have to go for too many visits to see real results--I stopped after about 6 visits and that seemed sufficient for me to learn some useful exercises that helped resolve my diastisis. I was seeing the doctors at Downtown Women OB-GYN, who gave me referrals for physical therapy and were wonderful; they are located in SoHo, but I found the schlep worthwhile (the docs and midwives are all great, and there are rarely waits in the office--in less time than I used to have to wait to see my former OB in Park Slope, I was able to go into Manhattan, have my appointment, run an errand or two, and make it back home to Flatbush.)
Good luck to you in your recovery, and take pride in your body's amazing achievement--as Gloria in Modern Family put it, you made a person out of food, so it's no wonder your body has taken some hits along the way, and it deserves to be treated well!"
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"I'm sorry you are dealing with this. But it's never too late to get help! I had a separation as well and found PT to be the best and only thing that worked. I highly recommend Renew PT in the city. They will work with whatever insurance you have. I didn't start seeing them until one year post partum and still made a fantastic recovery. My non medical opinion is that you owe it to yourself to try PT before you start thinking about medical routes like surgery or specialists. Pregnancy does a number on your body and a talented therapist can help you retrain the muscles to do what they are supposed to do.
Please don't lose hope. There is a lot you can learn to do to improve your physical situation. And the first thing they will tell you is no Pilates with a separation so may e revisit that. You don't want to do and crunch type moves when you are trying to close up the abdominal wall.
Good luck and stay positive!"
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"Two thoughts: MetroSports physical therapy at Methodist hospital has a pelvic floor program with biofeedback and, I believe, even stim, and they are in most networks.
The other is that pelvic stim devices can exercise your pelvic floor while you are doing chores, etc., because they now work remotely. These are like TENS machines…little boxes connected to electrodes on a tampon like device. In the past you’d use it in bed, but now they are available with remotes. In the US, the cost is $700 and a doctor’s prescription, and insurance covers it as durable equipment or something like that. (I did get one through insurance a couple of decades ago.) But if you have a friend in Europe, they sell for $200 and don’t require insurance.
I have no financial interest or otherwise in either MetroSport or Athena…But I do go to physical therapy at Methodist, because ist is cocnvenient and covered by my insurance. In the distant path I used Amy Stein, a PT who brought pelvic PT to NY years ago. She has a practice, Beyond Basics, in the the City. They are all terrific there, but I don’t know the insurance situation."
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"“I have, I think, very similar issues and I have found a WONDERFUL doctor. I see Dr Renuka Tyagi at Weill Cornell. She's a brilliant urologist, specializes in gyno issues, is fine diagnostician, and she has built an excellent team around her. Her PT, Alyssa Padial, is brilliant and the kindest and most effective out there.
Well-meaning people kept referring me to "specialist PTs" and I tried both of the "big names" and spent a lot of money and made NO difference whatsoever.
The thing is, certain exercises can make it worse--especially if you have abdominal separation--and in my case I had prolapses and nerve and tissue damage after a difficult delivery which made things more complicated. It's worth seeing a great doctor to rule those things out. Dr T and her PT take my Oxford Insurance and many others, so hopefully you'll only have the copay.
Dr Tyagi is extremely conservative about surgery, it is definitely a last resort. I also love her straightforward bedside manner; that she has kids herself, she is funny and has first-hand knowledge of the stuff we're going through!
My advice is to consult with her and take it from there. It will save you time, money and heartache.”
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"“In France, when you have a baby, your OB/GYN gives you a prescription for 10 hours of physical therapy (perineal reeducation). It is really useful and I have never understood why it is not the same here. The good news is that most of the time, even if you haven't completed this reeducation in the months that followed the delivery, you can still expect good results if you achieve the therapy later (I know many women from my mom generation who went through the therapy when the reached 50+ years with success). I would definitely try this option before any kind of surgery!”
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“It's been over 2 years for me and finally spoke to my doctor about it when hoping for the best wasn't working. I was in the same boat - couldn't run to catch a cab without peeing and was terrified of sneezing in public. The doctor told me about the surgical options and told me to wait until I'm done having kids. Also told me that, in the meantime, I should do kegels. I kegel'd like crazy even though I didn't have much hope for it, and lo and behold, it's helped ALOT. Just read how to do them correctly and I swear to you, it's made a very noticeable difference. Still not perfect and I've been slacking a bit but I was very pleasantly surprised. Took a few weeks before I noticed a difference. Good luck!”
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“Incontinence after birth is supposedly a very common, yet unspoken problem for many of us after giving birth. I kept hoping it would get better, but I have not seen any improvement and it's been years. I had a consultation with a doctor who said my bladder was pushed out of place and was tilted. She recommended surgery to correct it, but I wonder if anyone else might have had any non-surgical solutions that worked for them if they hadn't dealt with the issue immediately. Perhaps immediacy doesn't even matter. I can't bear the thought of wearing a pad every day for the rest of my life. It would also be nice to jog or take an exercise class without fear. And don't get me going about coughs during cold and flu season! :)”
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"You may want to consider taking individual Pilates lessons. I did this and they helped a lot! I've been to Pilates Garage and Indigo and really liked both. Just let then know you're post partum."
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"I had a separation after giving birth to my son, and chose physical therapy. I had a lot of trouble with my c-section scar which impacted the separation's ability to close. I went to Renew PT in the city for about 4 months, and I could not be happier with the care I received there. They do all sorts of PT but are known for and specialize in women's issues, particularly pre and post partum. They are truly miracle workers. I saw them at about a year post-partum and wish I had done it sooner! I did a TON of research before seeing them. I found that they incorporated much of the Tuppler Technique into the exercises they prescribed for me - the primary move is a belly pump, which Tuppler calls Elevators. They also worked with me to find and activate my abdominal muscles as well as my pelvic floor. If you have a large separation, I would suggest PT over a pilates instructor or other semi-professional approach. I feel like they teach you how to heal your body the right way, which is best for long-term maintenance. I still do the moves they taught me and I'm back to working out on my own. I can proudly report that my diastasis is closed (except for a hole around my belly button that may always remain) and that I feel stronger and more confident about my stomach's appearance. Please consider Renew PT [...] I feel like so few women talk about this as a post-partum issue, and it should be more open so that more women can get the fix they need."
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"As a personal trainer and fitness instructor who works a lot with new moms, I would really discourage "regular ab exercises" when you have any abdominal separation. If you have a separation wider than 1 finger, I'd be wary of working with a personal trainer who doesn't have a good amount of post natal training. Pilates is also wonderful for this issue, but again, work with someone who has experience. For wider than 3 fingers, you want to consider physical therapy. But traditional crunches and sit ups are NOT your friend here!"
For more Recommendations for Post Natal Physical Therapists or looking for doctors who specialize in Diastasis from members of Park Slope Parents please go HERE.
