The head of the General Surgery and Digestive System team at the Ruber Internacional Hospital, Santos Jiménez de los Galanes, has emphasized that abdominal diastasis resulting from pregnancy should not be considered solely an aesthetic issue. When the separation of the abdominal rectus muscles is marked, core weakness, postural changes, discomfort in the abdomen, or pain in the lumbar area may appear.
The specialist indicates that the separation of the rectus muscles is a common physiological process during gestation, although it becomes a problem if, over the months, the abdominal wall does not adequately recover its anatomy and, above all, its function.
During the first months after childbirth, the spontaneous recovery of the tissues, combined with physiotherapy and a specific program for strengthening the deep abdominal muscles, can achieve a notable improvement. In this context, he emphasizes that what is relevant is not doing more exercise, but the type of work that is done with each patient.
When the diastasis is severe, persists despite a well-structured rehabilitation, produces symptoms, or is associated with a hernia, surgical reconstruction of the abdominal wall may be considered.
In addition, he points out that diastasis can coexist with a hernia, a consequence of the sustained distension of the abdominal wall and the prolonged increase in intra-abdominal pressure during pregnancy. If both situations occur at the same time, the surgeon insists on evaluating the abdominal wall "as a whole."
Avoid normalizing discomfort after childbirth
"There is a certain tendency to consider that many discomforts that appear after having a child are an inevitable consequence of pregnancy or childbirth," Jiménez de los Galanes has asserted, encouraging not to assume them as normal when they persist, cause pain, or interfere with daily activities.
In this line, he recalls that one of the digestive disorders linked to pregnancy is gallstone disease, that is, the formation of stones in the gallbladder. This pathology is favored by the increase in estrogens, which causes greater cholesterol saturation in the bile, and by the reduction of progesterone, which decreases gallbladder contractility and slows its emptying.
The most typical sign of a biliary colic is intense pain in the upper right part of the abdomen or in the epigastrium, which usually appears after meals and, at times, radiates to the back. Nausea, vomiting, a feeling of fullness, bloating, or abdominal distension may also occur.
If the episodes recur or complicate with cholecystitis, pancreatitis, or migration of the stones to the biliary tract, it is emphasized that an evaluation by a specialist is necessary. The standard treatment is laparoscopic cholecystectomy, although in certain cases minimally invasive techniques may be employed.
Hemorrhoids and fissures during pregnancy and postpartum
Among the ailments that may be favored during gestation and after childbirth are hemorrhoids and anal fissures. The increase in the size of the uterus, which increases pressure on the pelvic venous system, hormonal changes, and the higher frequency of constipation, along with the effort made in many vaginal deliveries, influence this.
Jiménez de los Galanes emphasizes that a good part of the hemorrhoids associated with pregnancy tend to improve spontaneously in the weeks or months following childbirth. Therefore, the first line of treatment is usually conservative, focused on preventing constipation, ensuring proper hydration, adequately increasing fiber intake, and avoiding prolonged efforts when defecating.
"If after the initial recovery period the bleeding, prolapse, discomfort, or repeated episodes of thrombosis continue, it is advisable to carry out an assessment. Today we have different alternatives that allow us to adapt the treatment to the type and degree of hemorrhoidal disease," he explained.
Among these options are different procedures and minimally invasive techniques that, in selected patients, can reduce postoperative pain and promote a more agile recovery, such as the use of laser, botulinum toxin, or platelet-rich plasma.