At least once a week Lauren Askew is congratulated on her pregnancy, but she is not pregnant.
“It’s very embarrassing and disturbing,” he says. ‘If it’s a stranger, I just accept it because I can’t bear to say anything.
“But if it’s someone I’m going to see again, I have to say, ‘Actually, it’s a condition.'”
Lauren, 42, gave birth to twins in June 2021 and has severe diastasis recti, a condition in which the abdominal muscles separate during pregnancy and do not return to their normal position.
While some degree of separation is normal in all pregnancies (as hormonal changes cause ligaments to relax), muscles typically reattach naturally after birth.
But in one in three women, the muscles and connective tissues of the rectus abdominis (the abdominal muscles that run vertically down the front of the stomach) separate too far, so they can’t return to their position.
The condition is usually caused by pregnancy, especially if a woman has a large lump (like Lauren’s twin pregnancy) or is very small, is overweight, or becomes pregnant again quickly after a previous birth.
Genetics and pushing for prolonged periods during childbirth are linked to this condition. It can also be triggered or worsened if a woman exercises vigorously before regaining core strength in the weeks after birth, especially doing sit-ups or certain yoga positions that cause the abdominals to bulge.
Lauren, 42, gave birth to twins in June 2021 and has severe diastasis recti, a condition in which the abdominal muscles separate during pregnancy and do not return to their normal position.
In most moderate cases, if the muscles do not come back together naturally, physical therapy exercises during the first year after birth usually help. In the photo: a woman with diastasis recti.
In rare cases, strenuous exercise that puts pressure on the abdominal muscles, such as weight lifting, can cause the condition in both men and women who have never given birth.
In about 5 percent of mothers with this condition, the gap is so large and the tissues supporting the muscles are so weak that the stomach protrudes like a baby bump.
Lauren estimates that there is at least two inches of separation between her abdominal muscles; as a result, she appears to be around six months pregnant.
In these severe cases, the damaged muscles cannot properly support the spine and internal organs, meaning women can suffer from back pain, bowel problems and urinary incontinence.
They can also develop hernias, where internal organs protrude through the space.
Lack of central support may even mean that women can only get out of bed on their side, as they physically cannot sit up.
Although otherwise fit, Lauren struggles to bend over to put on her shoes. He also has chronic back pain and digestive problems such as pain and gas.
Women struggle not only with physical symptoms, but also with low body confidence and even depression, says Tina Mason, a women’s health specialist physiotherapist at Women’s Health Brighton clinic.
A 2020 study in the journal BMC Women’s Health found that it affected women in “a multitude of ways,” physically and psychologically.
“Think of it like blowing up a balloon,” says Tina Mason.
‘If you inflate a balloon a little and then release the air, it will return to its original shape.
“But if you keep inflating it, there comes a point where the balloon has stretched so much that it will never return to its shape, even when you release all the air.”
Lauren, who lives in Portslade, East Sussex, says it has had a “huge impact” on her life. She needed time off from her job as a children’s speech therapist and received counseling for her bad mood.
Although her husband Andrew, 43, has supported her, she feels the condition has affected their intimacy.
“It affects your confidence, your relationship; you feel bad all the time,” he says. “I’m a social person, but now I’m afraid to go out because I don’t feel like I can wear anything that fits.”
While the rest of her body has returned to the size 10 to 12 she was before pregnancy, she now wears size 14 to 16 leggings and loose-fitting tops to cover her belly.
In most mild to moderate cases of diastasis recti, if the muscles do not grow back together naturally, specific physical therapy exercises during the first year after birth usually help. But surgery is the only option for severe cases.
However, the necessary tummy tuck operation (commonly known as a “tummy tuck”) is not routinely available on the NHS, which classifies it as cosmetic.
David Floyd, a consultant plastic surgeon in London, believes surgery for severe cases should be considered “functional”.
He points to research showing that after surgery, most patients see significant improvements in their overall health: In a Swedish study, published in the journal BJS Open, women followed for three years after surgery experienced improvements in core stability, strength and muscle quality. of life.
The physical and psychological benefits of surgery are “enormous,” Floyd says. “Women get their core strength back, their back pain goes away, they can sit up in bed, they can run around with their kids, (urinary leakage) really gets better.”
Local NHS guidelines in some areas say repair surgery should be offered if the gap is greater than one inch, causing “significant functional impairment or disability”, the woman has had six months of physiotherapy and at least a year has elapsed since birth. But patient groups and surgeons say most NHS commissioners do not follow them.
However, although the NHS does not offer abdominoplasty after pregnancy, it does offer other cosmetic procedures: breast reduction or augmentation in cases where the size of the breast causes back pain or psychological discomfort, for example, or for prominent ears that “cause significant discomfort.”
“Women are expected to live with this condition which causes real distress,” says Tina Mason. “Of course, having a child is a choice, but if a man suffered a knee injury after choosing to play sport, the NHS would treat him.”
He adds that most of his patients are young, fit women who have lost the pregnancy weight and do physical therapy exercises; They are doing everything they can to help themselves and still look pregnant.
Tina Mason argues that the refusal to operate on them is “short-sighted” as some studies have found links between diastasis recti and conditions such as hernias and back problems, which the NHS does treat.
“Ultimately, the NHS will have to pay to fix these collateral conditions when it could have addressed the problem in the first place,” he says.
Tummy tuck costs between £8,000 and £15,000 privately. It is a relatively simple two-hour procedure, although recovery is painful and slow.
Diastasis recti is not part of any routine postnatal check-up: Lauren first raised her concerns at her six-week GP check, only to be told it was “in the early days” and should resolve on its own only. But three months after giving birth, without any improvement, she went to a specialist physiotherapist privately.
He was diagnosed with diastasis recti and put on an exercise program. However, despite working diligently on this, there has been little change. Originally optimistic that the exercise would work, he says, “I now know that surgery is the only solution in my case, since the muscles on the sides of my abs are also very stretched.”
In August, Lauren went to a private plastic surgeon, but the surgery costs £10,000 and there is a waiting list – Lauren hopes to get a place next year.
The physiotherapist who diagnosed Lauren was concerned she might have a hernia, so he referred her back to her GP. But it took almost three years of back and forth before she finally saw an NHS specialist in September to find out she had a hernia.
Although the NHS would repair this separately, Lauren wants to avoid two major procedures while caring for her twins, so she pays privately to have both repairs done at the same time.
She and Andrew face going into debt to cover the cost. Lauren is taking on extra shifts at work and the couple plans to use credit cards and get financial help from Lauren’s parents.
“It will be difficult, but I’m lucky I can find a way to pay; a lot of women can’t,” she says. “The condition can be very debilitating, but with treatment women could regain health and work.”
A spokesperson for NHS England said: “Pelvic and abdominal physiotherapy is usually the first-line treatment for conditions such as diastasis recti as it is effective in many cases, but ICBs (local health authorities) may commission other procedures if your patients need it locally.
“Individual treatment plans should be decisions between doctors and patients, taking into account the latest clinical guidance.”