By Ana Soulia, PT, DPT | Inertia Physiotherapy, Missoula, MT
The challenges of recovering from a c-section are obvious at the start. It's hard and painful to move around after your abdomen has been cut open. To be fair I haven't experienced the other version and I am certain it can be quite sore getting around after a vaginal birth as well, but having your belly cut open makes it feel like one wrong move and your guts might fall out. Ok that's an exaggeration but it doesn't feel good. I was concerned about taking pain medication because I was intending to breastfeed and I didn't want to pass the medication to my daughter. I was managing with just Tylenol and Ibuprofen for a couple of days until....I sneezed. That set off more than I could handle and I had to add some hydrocodone into the mix. There were other challenges too. I couldn't lie on my right side for several weeks because if I did it felt like something was tearing inside. In case you didn't know, the outside incision to access the abdomen in across your belly and low to avoid cutting your abdominals down the middle. The actual incision on the uterus to retrieve the baby is wherever it needs to be and in my case it was on the right side which is why it hurt so much.
Taking a short side trip, there's another pain they don't tell you about when you have a c-section. It's a gas pain that can come from surgically opening your abdomen to air. It causes irritation of your diaphragm and the phrenic nerve and results in a stabbing pain in your neck and/or shoulder. This is common after laparoscopic surgery because they pump you full of gas but, I'm willing to bet it's more common after c-section than one might guess. I've since spoken with several women who suffered with the same pain. As a PT I thought it was a 1st or 2nd rib problem and kept pushing there to try and ease the pain, to no avail. The intensity of the pain made it extremely hard to use my right arm for anything. It was particularly painful when attempting to nurse my tiny infant. I asked several nurses about this pain and no one really knew what I was talking about. Finally one nurse was interested enough to investigate and she gave me an anti-gas medication and finally the pain started to ease. I was so grateful but also wondering why this wasn't more well known and standard protocol to ask about this pain and treat as needed. This side note probably doesn't have much to do with the rest of my story but in case anyone reading this experiences the same, there's a treatment, so advocate for yourself and don't suffer. Ok, back to the main story.
After 3 days we left the hospital. I was told that I could only lift my baby. That was 5 lbs 4 oz at the time. That's not much. I couldn't even carry her in the car seat. Going home getting around was harder. The bed no longer moved up and down and I had to get out of bed every 2 hours to feed my daughter. My husband was home for a few weeks which was immensely helpful but the first week without him was rough. I remember calling a friend who had been through this a couple times and felt a sense of relief that what I was experiencing was normal. It took about a month to feel like I could carry my daughter in her car seat. I started being able to do short walks and meet a friend for coffee.
At 6 weeks my incision had healed and like most moms, I was cleared by my OB to exercise and cleared to resume normal activity. I started light gym workouts a few times a week. I was doing low impact cardio, some base core exercises and gentle stretches. It felt good to move again but I could tell I needed to keep the intensity low. At 3 months I returned to work. I would be considered fortunate in our country. I got to stay home for 3 whole months, but as another side note, this is not an adequate amount of time. It's not long enough for full healing and it's a terrible time to have to leave your infant. They are still so small and vulnerable and they are just starting to become aware as you exit what some call the 4th trimester.
Returning to work, I was able to take it easy for about 2 weeks, then bam, back to a full schedule. Work was different after baby. I pumped twice per day and I had to find time during a full work day to eat because when I was nursing I was basically hungry all the time. Most of all, I had to leave when the clock struck 5 because if I didn't get home in time to feed my daughter my boobs felt like they were going to explode or she would have already eaten and then I'd have to pump again, not my favorite activity. These are not unique problems for moms, but I do believe the stress of the non-stop schedule drove the health issues I am working to heal now. No down time and no time for self care. Exercise went out the window. I had to shovel food in whenever possible, no time for mindful eating. This is not good for gut health at any time, but especially when trying to heal from surgery and birth.
Throughout the first year of my daughter's life the image of what kind of mom I wanted to be had to adjust. I had hoped to be the active mom out jogging with the stroller. I wanted to be the mom who was back to my "normal" body inside of maybe 6 months. I felt like these moms were somehow winning and I was losing. I could walk a mile or so and payed for it with back and hip pain. I tried a spin class and experienced pelvic and back pain for several weeks. I had restriction in my right hip that I couldn't figure out how to stretch. I was not only NOT losing my belly, it somehow seemed to be getting bigger, despite nursing and eating a healthy diet. I reconciled with myself because I was older and I had a stressful job. I forgave myself because I was there for my daughter and she was doing great.
Around 14 months I attended a continuing education course that would change the course of my life forever. It was my first exposure to the concept that a problem may not actually lie in the musculoskeletal system. It may lie in the visceral system. Well, now this makes perfect sense. My insides were momentarily my outsides and you're not going back together exactly how you were before. I would learn later how other aspects of the procedure would impact my health as well not the least of which is the massive amount of antibiotics they give you. Without going into much technical detail, during the course it became obvious that my bloated belly, hip and back pain were related to deep scar tissue and inflammation of my gut. There were a lot of ah ha's that weekend. I experienced some intense emotions and came out the other side feeling more empowered and less defeated. At least I had a plan.
Upon returning home I sought a physical therapist who could help me with my visceral issues. She was immensely helpful. She treated my body with visceral manipulation and also educated me about SIBO. For those who don't know SIBO stands for Small Intestine Bacterial Overgrowth. SIBO is a condition that develops when some of the bacteria that should be in your large intestine get into your small intestine. There they feed on the food that is present in your small intestine and then off gas, leading to bloat. This would explain why after fasting over night my belly was smaller and then after a day of eating my abdomen was so distended I couldn't zip my jacket on the way home and people were asking when I was due.
For a variety of reasons, not the least of which is the mechanical trauma of the surgery itself, my Ileocecal valve had become dysfunctional. In English, the valve that separates the small and large intestine was not behaving normally. This can be the precipitating event for someone developing SIBO. My first step toward improvement was getting my Ileocecal valve reset. I also did some research after learning about SIBO and adjusted my diet. For a month I cut out sugar, grains, starch, beans and some other specific foods that are thought to feed the bacteria in the small intestine. The idea is that if you essentially starve the bacteria in the small intestine they die off and then the bloat and gas resolve.
Through these treatments, the bloat and gas improved and my gut felt less inflamed. This allowed me to better recruit my abdominal muscles eased back pain and hip pain. I was able to tolerate more activity without pain, though still not impact. I focused more on restorative movement and mindfulness. I am thankful for that reprieve but I was by no means in the clear. There were rougher waters ahead.
During my daughter's second year of life work got exponentially more stressful. I maintained a full schedule and lost pump breaks when I was no longer nursing. Admittedly I could have taken unpaid time for lunch but that wasn't the standard and I wanted to reduce my already long work days. Without any reliable time to eat during the day PT's were forced to grab food between patients. I felt terrible when I ate quickly and I've never been snacker. My coping strategy was to stop eating lunch all together. It was better to be hungry than feel sick from shoveling food in my face in the 5 minutes between patients. I was on the fast track to total burn out. I still loved my career, but I needed a change.
After attempting to find sanity through reducing to 30 hours per week, It become clear to me that I had to make a drastic change. I had been rolling around the idea of opening my own business for quite awhile. I realized it was the the only way I could achieve the schedule that would allow me to get both quality time with my patients and more time with my family. In November 2019 I made the jump and opened Inertia Physiotherapy.
What I realized once I was out of the daily battle so to speak was that I had been in survival mode for the past few years and I had a severe case of FLC (feel like crap) Syndrome. My sleep was terrible. I woke up every morning exhausted. My hands and wrists were swollen and I still couldn't wear my wedding ring. My belly was better but I was still struggling with some digestive issues and had an ever growing suspicion that I should stop eating gluten. I still wasn't losing weight, couldn't progress exercise and had more joint stiffness and headaches that I was used to. I started to read books, listen to podcasts and make small changes in my diet. I continued to work on mindfulness, restorative movement and focused on getting my business up and running. I felt my head clear a bit and with some down time in my day I started to a creative side I forgot was there. I got my head above water enough to realize I needed more professional guidance.
I have not given up on being the active, healthy, happy mom that I envisioned I would be. Through all I have learned, I have chosen a path of using food as medicine. I am grateful to work with a Functional Medicine Provider who has helped me identify and treat root causes of my problems. She is helping me fully heal my gut and the Adrenal Fatigue that resulted from years of being stuck in fight or flight with high levels of stress. It's not a quick fix, but it's so worth it to tap into the power of the body's ability to heal itself. I have a vision for how I want my life to be and I am optimistic that it can be a reality. I am grateful for the support of my family and friends. I am not quite to the finish line yet, but I believe I can get there. I am finding myself again, tolerating a more activity, mornings are getting easier and I am more in the moment than ever before. It's a marathon, not a sprint. I'm going to make it and I'll come out the other side better than before. A healthier version of myself with more capacity to be there for my family, friends and clients.
My story is just that, my story. There's power in learning someone's story. Everyone's healing journey is different. Some will identify with my story, others won't, and that's ok. If you do see yourself in any aspect of this story I encourage you to seek help. Your body is capable of more than you know but sometimes it needs to stop and ask for directions. You don't have to suffer in silence. You don't have to keep pushing through alone. Reach out and share your struggles and let's talk about how you can get on the right path toward healing.
About the Author- Ana Soulia is a Dr. of Physical Therapy and founder of Inertia Physiotherapy in Missoula Montana. She specializes in treating persistent pain and nagging injuries. She is passionate about helping her clients move well and enjoy an active Montana Lifestyle. Her Integrative Approach to PT emphasizes the need to evaluate the whole person to effectively treat stubborn problems. If you are in the Missoula area and you'd like to know more about Ana and how her practice is different please visit www.InertiaPhysioMT.com and schedule a FREE Discovery Session.
1001 S 4th St W Suite 4
Missoula, MT 59801