“You have a diastasis,” said my pelvic floor physical therapist as I lay on her table waiting to hear why I kept peeing myself with simple, daily functions. “You’re <bleeping> me,” I responded thinking she was truly joking. No, she wasn’t. I began to wonder how I had a diastasis recti.
Many of you may already know about diastasis recti (DR). For those of you who are now googling DR or are skimming ahead to find out what it is, let me save you some time. Check out this post by my colleague, Dr. Blair Green, HERE. There are many articles written that explain DR and rehab but this post will share how DR can also affect your self-esteem and your relationship.
What Made the Balloon Pop
For those of you who weren’t as surprised about my diagnosis, understand that I was shocked! I thought DR was something that happened during pregnancy and post-partum. Here’s the thing: I am not post-partum. Yup, no kids…ever. How did this happen to me? I quickly learned that DR is not a “pregnant woman’s condition,” but an overall body issue for many people including childless women and men. I discovered how my incorrect posture, more so when doing dynamic movements, contributed to my separation. I learned I like to hyper extend my body or imagine me stretching my torso to appear straighter or “skinnier” at times. If I were to stand like a mannequin all day long this might not be the biggest problem of my life. However, stretching myself out while doing dynamic movements, like jumping, lifting weights, pull-ups and yoga, puts too much strain and pressure on the abdominal muscles and fascia. Imagine your abdominal wall is like a balloon. That balloon can hold a lot of pressure aka hot air, but it has a breaking point. Literally, it pops. Well, my abs popped.
Those Symptoms Meant What??
Unaware of my DR, I consulted my long-time pelvic floor physical therapist due to urinary leakage with daily movements like squatting or stepping up and down. I was also having difficulty with constipation. Despite an optimal diet and water intake, “going to the bathroom” didn’t occur daily and was painful when it did.
I had many other symptoms that I couldn’t explain or wouldn’t improve despite treatment after treatment with different medical professionals. One issue was low back pain that wouldn’t subside. Another issue during that time was my inability to lose belly fat or a “muffin” top despite monitoring my diet, seeing a dietitian and regular gym work outs. To be frank, it was all quite frustrating! Once I received my diagnosis I had to change my current exercise routine, and how I moved throughout the day. Plus, I had to incorporate daily abdominal and pelvic floor exercises to my already busy life. On top of that, I had no clue what exactly this DR thing was or how to really fix it, and the internet was less than helpful for the recovery part. I was trying to understand what was going on with me, but had very little resources, and I just wanted someone to tell me what I could do…not what I couldn’t. My DR very much impacted my physical and mental well-being. The one thing I couldn’t find information on anywhere was how this would impact my sex life.
Sex and DR
As a sex therapist, I always teach that sex is a physical activity like cleaning the house and going to the gym. With DR, you have to limit abdominal work or change how you use your abs during activity. How does this work with sex? If you have DR should you abstain from sex while you are healing? What positions and movements are ok? Does this mean my sex life is doomed as well?
DR recovery can be a long journey. I don’t plan on foregoing fun and pleasurable things in life because of mine, nor do I want you to forego those things either! How did I make it work? Again, I asked a lot of questions. I was able to realize that sex is still possible. I used the information from my sessions in physical therapy and personal training to modify intercourse and masturbation. For my personal treatment, I was instructed to keep my torso in a linear position (i.e. laying on my back) and not a forward bend (i.e. touching my toes) to better protect my internal organs during healing. I also could not be in a full plank as this put pressure on my DR. I could modify to being on my knees with hands on a wall in front of me. I used that position for push-ups in the gym and it could also be used during sex or intercourse with penetration from rear entry. I also needed to “keep chest or rib cage down” so I did not hyper extend. Lying on my back was hard at times, so I used a blanket, bolster or another firm object to help keep me propped up. I was already using this position to modify my work in the gym and I discovered it could be used for sex either with masturbation or with a partner for penetrative or oral sex. I would be careful to watch that my abs did not bulge with sexual activity, just as I would with any other task.
If your DR is severe, or you do not feel comfortable adapting as I described above, another option for intimacy while healing from a DR is something called othercourse. Othercourse is sexual play that does not involve penetration. I teach clients about othercourse when penetration is not possible for any reason like pregnancy, painful sex, or vulvar and vaginal skin conditions. For someone with severe DR or someone concerned about using the abdominal muscles, othercourse can take the worry and anxiety of worsening the DR away and allow that person to better enjoy sex and being in the moment. Othercourse can be anything you want from making out like you’re in high school again to hugging or massage to oral sex. The other great thing about othercourse is it allows you time to better focus on your body and what you enjoy or find most pleasurable. This helps when communicating your needs or desires to your partner for future intimate time together.
How I Created Change
When I found out that DR was contributing to my leaking and back pain, the first thing I did was build a support system. This included everyone involved in my well being from my chiropractor to my yoga instructor to people at my gym. They were all willing to help in the best way they could. I stopped thinking that I couldn’t live my life to realizing there were many activities I could do!
The second thing I did was change my mindset of how I saw exercise and my body. For months, I hated my body for not looking how I wanted it to look or doing what I wanted it to do. With my rehabilitation, I realized that most of those feelings came from not understanding instead of actually being angry at my body. After I began treating my DR, I saw the changes I had been wanting for several months. I began my way of moving and exercising based on my body’s needs, and I also saw more changes including physical and emotional happiness. I also felt acceptance of where my body was at in the present moment instead of living in this ideal of what I wanted my body to be. I also had to apologize to my body for blaming it and beating it up when it was, literally, injured and hurt instead of listening to it. My recovery has also helped me become more mindful of the messages my body sends. When working out, I am more in tune with my body including when it says, “that exercise is too much” or “I’ve had enough.”
Listening to my body does not mean being perfect. In fact, it means making mistakes and learning to create more change or honoring where I am at. The first time I went back to the gym to try my previous exercise routine I noticed my abdominal wall seemed swollen and more “pregnant” looking than it had been in a month or two. I figured out that I used my abs just a bit too much. Lesson learned. I communicated this to my personal trainer and we continued forward with that information to help guide us.
The biggest takeaway from my experience is to take it one day at a time. With DR, and other physical injuries, some days are better than others in terms of physical ability, including sex. Honor where you are at the present moment, use your team – your physical therapist, trainer, friends and partner – to provide support and encouragement.
Courtney Geter is a licensed marriage and family therapist and AASECT certified sex therapist who lives and practices in Atlanta, GA. She works with individuals and couples of all genders, identities and sexual orientation. She helps her clients develop a healthy sexual relationship with themselves and others. She is also the host of the Let's Talk Sex podcast. She can be found online at www.sexandrelationshiptherapist.com or on Instagram @CourtneyGeterLMFT.