My umbilical hernia surgery and diastasis recti repair journey - one year on
A year ago I had my third umbilical hernia surgery along with diastasis recti repair. The latter involves stitching together the most superficial layer of abs (which are usually connected with a bit of fascia). I thought it might be helpful to others to document my journey so far.
Unfortunately my first two hernia surgeries were unsuccessful (there might be a separate blog about how painful it is when surgery goes wrong and has to be repeated multiple times!). This is the reason why I decided to also have the DR repair during the third surgery as studies show that a hernia in the presence of a diastasis is more likely to recur. My diastasis was minor and had never caused me any issues. The fact that I had three surgeries within less than a year definitely slowed down my recovery so keep that in mind when reading about my journey.
*Getting around was really painful. We often don’t realise that we use our core for nearly everything we do. Turning over in bed at night took a few minutes and again, was very painful.
*My biggest issue was that I struggled to take deep breaths as my rectus muscles had been stitched together. I can only describe it as that feeling when you’re swimming underwater and need to come up for air. It was very uncomfortable. Ideally we want 360 breathing whereby the rib cage expands on an inhale but this wasn't possible at all and it's still not back a year on.
*My surgeon said I could start cardio - specifically running, cycling or swimming - one month post-surgery and gentle core work after two months. I was desperate to exercise after one month so went for a few runs. It took me a few weeks to realise how wrong this was! I trusted the surgeon blindly without applying my own knowledge to myself: always rebuild your core before returning to high-impact activity. This had the effect of overloading my pelvic floor before it was ready and I started leaking…
The frustrating and slow progress:
*When I realised the impact on my pelvic floor I immediately stopped running and went to see a women’s health physio who confirmed that my pelvic floor was indeed weak (2 out of 5). It’s not surprising since any change to any part of the core will have an effect on the rest of it. In other words, it’s a system based on pressure and the moment pressure changes in one end it can impact the other end. In my case, there was a change in my línea alba (the connective tissue that runs down the midline from the breastbone to the pubic bone) as well as my breathing. I started doing my pelvic floor exercises and noticed a slight improvement after 2-3 months of daily work.
*I also started working on my abdominal strength with the physio. It became apparent that the surgery had thrown a spotlight on the minor diastasis that was there! This was such a revelation to me. The surgery stitched up the muscles but it didn’t improve the pressure or any existing weakness so in many ways, I felt that having my diastasis repaired highlighted the diastasis to me for the first time and this really bothered me.
*Having sulked a bit (or a lot), we went back to basics and spent the next six months rebuilding my abs. I was able to do some exercises such as sit-ups without doming, but other typically easier exercises such as toe taps were out of reach. I was told that it might be two years before I could hold a plank again…
I worked with a number of great, west London physios to rehab my abs and pelvic floor including Maria and Tara at The Mummy MOT, Brittany and Move Clinics and Anat at Six Physio.
Returning to some normality:
*While working with the physio, I was now able to do some stronger exercises with good control. A few things I noticed: I still need more time to get into exercises so that I can engage my abs and pelvic floor properly. My anterior pelvic tilt - which I’ve had my entire life but it’s never caused me any issues such as back pain - is also a reason why I need extra time to get into position to execute an exercise correctly. Will this ever change? It’ll probably get better over time but it may never be perfect.
*I was able to go for a long horse ride without leaking urine which felt amazing! Being able to do the thing I love made up for not being able to do some other things. It’s still hard for me to sing long notes and this is frustrating but I keep working on my 360 breathing to get that rib expansion on the inhale.
*I was recently at the gym with my trainer Yasmine for a modified pull-up which felt great and I managed to apply just the right amount of intra-abdominal pressure.
Today it definitely feels like I’m heading in the right direction, however the fear of bringing back the hernia is certainly there. If I hold a plank for more than 30 seconds I can feel my abs switching off and I’m pushing the tissues in my línea alba out. They feel hard to touch when this happens. At other times, there’s just loose skin hanging which I’m fine with (to get rid of that, I would need a full tummy tuck which I don’t want to go through).
Would I recommend the repair to others? If a hernia is at risk of so-called strangulation, it needs to be fixed but please research your surgeon carefully (my first surgeon did two botched jobs on me!).
On the DR repair, whether you decide to have the surgery or not, please work with a specialist women’s health physio (preferably one that specialises in diastasis) first to try to heal things naturally. Core prehab and rehab should be standard as part of any DR repair in order to achieve a better final outcome (I’ve told my surgeon this). I personally wouldn’t recommend having it done (due to the negative side effects) unless you have a large diastasis that is causing you lots of pain or you have recurring hernias that are bothering you.
Here are some of my favourite #diastasis accounts on Instagram:
Antony Lo @physiodetective
Marta Kinsella @martakinsella
Munira Hudani @munirahudanipt
Grainne Donnelly @absolute.physio
Diane Lee @dianeleept
Claire Black @clairemmac - sharing her own inspiring journey
I hope this has been helpful.