"Pelvic repair" is too bad, and what really needs to be repaired is these 3 places

For medical professionals only

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This year's Spring Festival, Ms. Dai in Guangzhou went to the confinement center for postpartum "low back pain" for recuperation, and did pelvic stretching and compression of orthopedic bone, etc., but her low back pain and pelvic pain were getting worse and worse, and when she was serious, she could not walk on both lower limbs, and was diagnosed by the doctors of the First Affiliated Hospital of Sun Yat-sen University, considering that it was caused by postpartum rectus dissociation syndrome, and the "repair project" she did did did not help her improve her symptoms.

The doctor also said that strictly speaking, there is no "pelvic repair" in medical treatment, if the symptoms are obvious, it is recommended to consult a specialist doctor in the hospital for formal diagnosis and treatment.

Pregnancy gives birth

How much of your skeletal muscles endured?

During pregnancy, in order to adapt to the growth and development of the fetus and make room for the baby, the endocrine and pelvic structure of women will undergo certain changes, such as an increase in the level of flaccid hormone, which will cause pregnant women to have pain in the waist, legs, buttocks, and pubic bone, which will generally be relieved after childbirth.

The following are common:

● Pubic joint separation: a pain that is no less than childbirth!

The clinical incidence rate is 3%-8% at the pubic fiber cartilage joint on both sides of the pelvis due to external force shifting, the distance of the pubic joint is widened, and local pain and lower limb lifting difficulties occur, which can also lead to aseptic necrosis of the pubic joint. X-rays with a pubic symphytic space of more than 10 mm are thought to cause symptoms. However, during childbirth, if the ligaments are overstretched and the postpartum period cannot be effectively recovered, postpartum pelvic ring injury syndrome (PRIS) may occur, which seriously affects the physical and mental health of the mother.

● Rectus abdominis detachment (DRAM): After giving birth, my stomach is still so big!

After pregnancy, the rectus abdominis is separated at the midline of the abdomen, and the spacing is more than 2cm, which can reduce the stability of the spine, low back pain, abdominal swelling and so on. The main risk factors are: advanced age, macrosomia, polyplicity, twins, caesarean section, etc.

Image from update

Pelvic floor dysfunction (PFD): As soon as I coughed, my urine flowed out...

Pelvic floor muscle and fascia tissue abnormalities cause changes in the position and function of pelvic organs, resulting in pelvic organ prolapse, urinary incontinence, sexual dysfunction, chronic pelvic pain, etc., and there are many risk factors, while during pregnancy and childbirth, different mechanical, neurological and hormonal factors lead to weakening of pelvic floor muscles and related ligaments, which is considered to be the main risk factor for PFD.

Back pain, what should I do?

●Pubic joint separation

This is a relatively common phenomenon during pregnancy, and it is only a temporary change, most of which are significantly relieved at 6 months after childbirth, and the treatment is mainly conservative:

1. Short-term bed rest: Clinically it is recommended to use a hard board bed and take a lateral recumbent position, so that the pressure will not directly act on the pelvis and back, alleviating symptoms. However, this method should not be used for a long time, because it will increase the risk of pressure sores, venous thrombosis of the lower extremities, etc.

2. Pelvic belt binding: can promote the healing of cartilage and ligaments, it is advisable to choose a flexible style, when used, the focus point should cover the pubic joint, covering the entire pelvis; but long-term application in addition to bringing discomfort to the mother, excessive pressure may also affect local blood transport.

3. Medication for pain relief: For pain-sensitive patients, topical application of futaline ointment can be used to eliminate acute inflammatory reactions caused by ligament and tissue damage, or oral Celebrex to relieve pain.

●Rectus abdominis separation

The incidence rate in the second and third trimester of pregnancy is about 27%-100%, and the early postpartum period is about 35%-60%, and the treatment is mainly conservative treatment, and the use of surgical treatment is less.

1. Expectation: 6 months after childbirth, DRAM has a natural recovery trend, for the separation of 2-3 fingers can not be treated temporarily, although the corset can improve the appearance, but can not directly restore the muscle that has been divided;

2. Electrical stimulation: percutaneous low-frequency electrical stimulation is considered to be the main method used in clinical practice, through the electrical stimulation cycle treatment of the main muscle groups of the abdominal wall such as the rectus abdominis muscle, the muscles are passively contracted and return to normal form;

3. Exercise therapy: Whether abdominal exercises to alleviate symptoms is still controversial, some scholars believe that sit-ups should be avoided as much as possible, and the efficacy of abdominal muscle group exercises needs to be further studied.

●Pelvic floor dysfunction

With the increase in the number of pregnancies and deliveries, the incidence also gradually increases, so it is necessary to evaluate in time and choose the appropriate treatment plan, of course, "you are insistence".

Kegel exercise (Kegel): This is the classic method, do the action of tightening the anus, relax after no less than 3 seconds each time, for 15-30 minutes, 2-3 times a day. It is the main method of treatment for stress urinary incontinence. In recent years, triple SLK therapy (scientific childbirth, Kegel exercise, Ramaz respiratory training) has been shown to be an effective training strategy for prenatal and postnatal exercise in women, which can significantly improve pelvic floor function.

2. Vaginal dumbbells: Starting from the lightest vaginal cone (20g), stay in the vagina for 20 minutes, when you can control it in the vagina, gradually increase the weight of the dumbbells, and cooperate with some movements (going up stairs, lifting heavy objects, etc.). Once a day for 15 minutes, 3 months for a course of treatment.

3. Biofeedback combined with electrical stimulation: electrical stimulation can improve the excitability of pelvic floor muscle nerves and increase the contraction intensity of pelvic floor muscles, while biofeedback uses modern science and technology to stimulate the brain through sound or image feedback for pelvic floor muscle contraction training, and the combination of the two can make the movement more standardized and the effect better.

While exercising and strengthening the pelvic floor muscles, it can alleviate the relaxation and misalignment of the pelvic joints and relieve the pain caused by the separation of the pubic bone, which can be described as killing two birds with one stone.

If non-surgical methods have been tried and still have little effect, then it is recommended to consult a more professional diagnosis and treatment method.

Many pains and discomforts in the postpartum period not only increase maternal anxiety, inferiority and other emotions, but also cause fatigue due to pain, affecting the breastfeeding of newborns. With the gradual attention of modern women to the quality of life, pre-pregnancy and pregnancy education is also the key to early prevention, strengthen the training of core muscles, calcium supplementation on demand during pregnancy, control weight growth, and adhere to pelvic floor rehabilitation exercises after childbirth, which can improve women's quality of life to a large extent and further protect reproductive health.

bibliography:

Reproductive Physical Rehabilitation Group, Female Reproductive Plastic Surgery and Rehabilitation Branch of China Plastic Surgery and Beauty Association. Expert consensus on the diagnosis and treatment of postpartum rectus absection[J].Chinese Clinical Journal of Obstetrics and Gynecology,2021,22(2):220-221.

Hou Lin,Shang Min. Research progress on pelvic floor dysfunction diseases after childbirth[J].Chinese Medical Journal,2022,57(2):145-148.

[3] Human Health Obstetrics and Gynecology. Postpartum pelvic floor function rehabilitation.

This article was first published: Medical Sciences Obstetrics and Gynecology Channel

This article is written by Xu Hong

This article is reviewed: Gu Zhuowei

Editor-in-Charge: Ichikawa