Hemorrhoids, Fissures and Tears, OH MY!

February 9, 2016 in Childbirth, Pelvic Floor, Post Partum, Pregnancy

Hemorrhoids, Fissures and Tears, OH MY!

Let’s talk about something! It’s not a pleasant subject. It’s the nasty little triad of issues one might face after having a vaginal birth.  I’m talking about the after effects and trauma that can happen to your bottom. It’s rarely discussed before a birth and I believe there is a reason for that.   The physical injury to the pelvic floor area from a vaginal birth can cause significant damage that leads to some rather unpleasant, uncomfortable and down right painful issues some women have to face.   I’m talking about hemorrhoids, fissures and tears that occur in the perineum during, for hemorrhoids, and after birth for all three. There are some things you need to know to help you deal with these uncomfortable issues if you find you have developed these.

HEMORRHOIDS

Let’s start with hemorrhoids!

Hemorrhoids are a swelling and inflammation of veins in or around the anus and lower part of the rectum. They can be painful and itchy. Hemorrhoids are very common in pregnancy as the increased weight from carrying the baby causes greater pressures on the pelvic floor. Also prenatal vitamins and hormones cause a slowing down of your colon and swelling of your veins, two factors contributing to constipation that can lead to hemorrhoids.

So to avoid hemorrhoids you’ll want to avoid constipation and the bearing down that usually goes along with it.

The first step is to avoid being constipated.

Diet has a huge implication on constipation. (Please consult a nutritionist for greater help with your diet) By eating more fiber rich foods you can help keep things moving in your colon. Raw veggies are a great way to increase fiber or adding flax seeds to your foods can help too. Be careful in adding too much fiber at first if things aren’t moving well especially if you aren’t doing this next thing.

That is, drinking enough water. Increasing your water intake, especially when you are breastfeeding, will bring more water to help keep things flowing through your colon. Moving your body will also do the same.

The next step it to use good toileting habits. When you sit on the toilet, you want to make sure you keep your back straight and lean forward. Avoid sitting slumped on the toilet. It can help to have your knees higher than your hips. There is the squotty potty chair you can purchase to help with this or you can use two yoga blocks, toilet paper rolls or a big fat can of tomatoes and put your feet upon.

To relax your pelvic floor you can try making different sounds to see which sound bulges your pelvic floor downward more easily. Take a deep breath and say “Grrr!” or “Shhhh” and see which one lengthens your pelvic floor. Use that sound during your next bowel movement to help move things down and out so your pelvic floor stays relaxed!

Once a hemorrhoid is in place you need to decrease any excess pressure on this tissue in order for it to heal. With all the bearing down that happens in birth the rectal tissues need to learn to come back up in and inside again. That can only happen when you avoid bearing down during a bowel movement after your birth. It’s important to allow your stool to pass on it’s own without you having to force it out. Any forcefulness will only exacerbate your hemorrhoids.

Also when dealing with hemorrhoids after birth, I find you also have to address the soft tissue in your vaginal and anal openings.   We’ll cover how to do this later in this article.

Around the anal opening is a sphincter muscle. It’s very common for this muscle to have small “knots” in it from the birth, especially if you tore. These knots don’t allow the muscles to expand evenly to allow your stool to come out. When a hemorrhoid is present, most likely there is a restriction or “knot” in these tissues that can prevent the hemorrhoid from healing. They can also lead to an even greater problem and that is a fissure!

FISSURES

A fissure is a open tear inside the rectal tissues.   Fissures have to be one of THE most painful conditions to recover from after birth.   The problem with this condition is the tear has a hard time healing because it gets reopened every time you have a bowel movement.   It makes having a bowel movement EXTREMELY painful! Some women, who have a fissure, report having chills, breaking out into a sweat and even their whole body shaking after having a bowel movement. The pain afterwards can last for hours. When dealing with a fissure for any length of time the anticipation of a bowel movement can bring fear and greater tightness to the pelvic floor area, which creates a vicious cycle that is hard to break. It’s no fun at all!

There is one thing that has helped my clients when dealing with a fissure and that is to massage their perineum and anal sphincter prior to a bowel movement. Usually there is increased tension in the anal sphincter that is on the opposite side of where the fissure lies. When you release this knot prior to a bowel movement it can lessen the pressures placed on the fissure and allow it to heal a little bit easier.   Stay tuned to learn how to massage your anal sphincter area.

 

TEARING IN YOUR PERINEUM

The third issue that is closely related to hemorrhoids and fissures is tearing in your perineum. Unfortunately tearing from birth is very common for women. Scar tissue forms to help heal a tear. Scar tissue is not as flexible as normal tissue and restricts the tissue mobility in the area. This can inhibit a stools flow out the anal sphincter and contribute to the development and prevent the healing of hemorrhoids and fissures. Mobilizing this scar tissue can help soften the tissues and allow easier flow with less pressures, helping both issues heal.

 

Caring for your Perineum After Birth

So what’s a new mama to do to help her perineum after birth?

Massage this area!

What do you do?  It’s simple!

Take your thumb pad and place it just inside your vaginal opening. Your knuckle should stay on the outside. Place your index finger on your anal sphincter. Start on one side as far as you can go and pinch the two fingers together and see if it feels soft and mushy or hard and resistant to compression. You want your tissues to be soft and supple. Work your way along toward the opposite side and see where the tissues are resistant to compression.   Where there is resistance you can apply pressure by gently compressing the area between your fingers while breathing into the area at the same time. Hold this pressure until you feel the tissues soften and release.

Scar tissue can create thickening and resistance to mobility.   Compression and pressure can help release this but sometimes scar tissue needs more. If you find scar tissue that is not releasing to pressure there can be an emotion stuck in there. Honoring that feeling and releasing whatever emotion is there is needed before it can let go. To read more about how scar tissue and emotions are connected check out this blog post.

Pinching between the anal opening and the vagina works on the upper half of the anal sphincter. For the lower part take your index finger and apply pressure around the sphincter from 3 to 9:00 if you think of it as a clock face. Check to see if you feel any spot more resistant than the others. If you do gently apply pressure with your finger in a downward motion and just hold it until you feel the spot release.

Massaging this area before every bowel movement can allow the tissues to expand more easily for your stool. This can help keep some of the excess pressure off your fissure area and potentially help it heal. Decreasing any resistant or thickened tissues helps to normalize the tissues so your stool flows through more easily.

There’s so much more to all of this that if you don’t find relief from doing the above, please go see a women’s health physical therapist or a holistic pelvic care specialist to get some help. You can find a practitioner near you by checking out these websites:   MoveForwardPT.com or WildFeminine.com

 

 

Exercise after Childbirth-Proceed with Caution! Part 1

May 29, 2013 in Abdominals, Childbirth, Diastasis Recti, Exercise, Post Partum, Pregnancy

Exercise After Childbirth- Part 1

Most new moms are ready to shed those extra pounds and jump right back into their pre-pregnancy workouts right after giving birth. With all the changes that have happened to your body over the last 9 months doing what you did before getting pregnant might not be the smartest and safest thing for your body. Certain exercises can cause long-term problems for your body. Knowing what exercises are safe to do and which are harmful is very important after having your baby.

3 Issues you want to Avoid when Resuming Exercise After Delivery

There are 3 major issues you might encounter if you are not careful with exercising immediately after giving birth. You are at risk for low back strain, prolapsing of your pelvic organs (falling out of your vagina) and diastasis recti- a separation of your rectus abdominus muscle, known as the six-pack muscle.

Each issue is so important that we’ll talk about them in a separate post so you have clear understanding on how to avoid developing these problems that are no fun to experience.

Low Back Strain/Pain

Our core muscles in our body are made up of 3 muscles, the transverse abdominus, the pelvic floor and the multifidus muscles in the back. Two of these muscles have been completely stretched to the max from childbirth and pregnancy and are very weak, the tranverse abdominus muscle and your pelvic floor muscles. The transverse abdominus muscle runs from your spine in the back around to the front and attaches into the rectus abdominus or the six-pack muscle. It acts like a corset supporting your spine. Remember how stretched out this muscle was with your pregnant belly? If you don’t do any strengthening of this muscle and just let it be it will shrink back but may not be as short as it was prior to pregnancy, thus giving you a little pooch in your belly.

So your pregnancy loosened the corset around your back and pelvis and you don’t have the support you had prior to pregnancy.

Jumping right back into doing the same exercises as you did before pregnancy can cause a strain on your back as your abdominal  and pelvic floor muscles don’t have the strength to stabilize the spine like it did before.

So your first order of exercise should be to re-strengthen your transverse abdominus muscle and your pelvic floor muscles.  Performing a kegel, or pelvic floor contraction is important in the post partum period.  Normal strength of the pelvic floor muscles is the ability of the muscles to maintain a good contraction for 10 seconds.  Click here to learn more about restrengthening your pelvic floor after childbirth.

While this is a great idea and may be a little easier for a mom who had a c-section than a vaginal birth, trauma to the pelvic floor tissues can prevent any strengthening from happening.  Helping to heal the vaginal tissues that got so strained during the birth process can help improve your muscles ability to contract.   Click here to read more on how to do that.

Working on restrengthening your abdominal muscles is also a must after childbirth.  The abdominal muscles act as a corset to support our spine.  Without this support our spine is at increased risk for injury.   The abdominal muscles get extremely lengthened during pregnancy and sometimes can separate creating a diastasis recti.  If you have any separation, this alone can cause low back pain as the muscles are ineffective in supporting the spine.   You need to heal this first and part of healing a diastasis is restrengthening your abdominal muscles correctly.   Doing crunches will only make things worse!

In my class and video, How to Lose the Pooch for Good, I present a 4 step healing process to bring your abdominal muscles back together and also how to restrengthen your abdominal muscles safely to get rid of your “pooch” for good!

Also your pelvis has just gone through an amazing transformation getting your baby out and may have some challenges getting back to it’s normal position.  This can create low back pain as well.  Opening up to allow your baby out creates an instability that takes time to solidify again.  This usually takes around 3-4 months.  I recommend you wait until then to resume any high impact aerobic activities.  Focus in on just doing your abdominal restrengthening and your kegels and walking for the first 3 months.  Then once your core is stronger then you can introduce more high impact type of activities.

But with everything you do, you must listen to your body.  If it doesn’t feel right, don’t do it!  You only have one body, so you need to learn to take care of it, honor it and do what feels right.

4 Reasons New Moms Need Physical Therapy

April 23, 2013 in Bladder issues, Pelvic Floor, Post Partum, Prolapse, Women's Health Issues

4 Reasons New Moms Need Physical Therapy: This week’s featured guest blogger is Ginger Garner, PT, MPT, ATC, PYT.  Visit Ginger at  www.gingergarner.com and www.professionalyogatherapy.org

 

Pregnancy and childbirth exact an enormous toll on a woman’s body. It is transforming and beautiful, but when a mother does not get the physical and emotional support she needs, the effects can be devastating.

I am a new mother, three times over. Each time after I have given birth, I have benefited enormously from physical therapy afterwards. I could not stand strong, fit, and wholly healed without it.  massage

I am also a physical therapist, myself, and feel that every woman should know her rights to receive physical therapy as a new mother. One of the many fields of specialization in physical therapy is women’s health. I bet you didn’t know that. That’s okay. Most doctors don’t either.

A physical therapist (PT) in women’s health is dedicated to helping women get their bodies back after birth. They can treat a myriad of issues, including pelvic and back pain, incontinence, and other ailments. The American Physical Therapy Association’s 2010-11 report titled Today’s Physical Therapist: A Comprehensive Review of a 21st-Century Health Care Profession, states “physical therapists are committed to facilitating each individual’s achievement of goals for function, health, and wellness.” The core values of a physical therapist are “altruism, accountability, integrity, clinical excellence, social responsibility, and compassion.”

The sad fact, though, is that most new mothers will never get the therapy they desperately need after giving birth.

But I am passionate about turning the tide. All too often, women in general, not just new mothers, do not receive the health care they need. Read my article which reviews the shocking statistics about the crisis in women’s health care today in the US.

A Prime Example of Falling Through the (Medical) Cracks

I have had patients and friends who have suffered from pelvic pain, sexual dysfunction, painful scarring, chronic incontinence, and lower back pain for so long that it has severely altered their quality and enjoyment of life.

A friend recently came to me asking for advice for another girlfriend. Let’s say her name is Teresa. Teresa had just undergone major abdominal surgery (think C-section) and was having awful abdominal pains and even headaches.

Knowing that the two are related, based on her surgery type and plan of care, I immediately asked if the surgeon had referred her to physical therapy. Of course the answer was no. Her plan of care did not include any post-operative physical therapy. In fact, when I asked Teresa directly, she said her doctor (a woman, mind you) had never even mentioned needing physical therapy.

I was upset by what I felt was an oversight by the physician to refer Teresa to therapy, but mostly I felt a surge of urgency to help her. This woman needed therapy immediately, yesterday, even. She was floundering, depressed, in pain, and alone at home six weeks after major surgery on her reproductive organs due to a cancer scare. She had no idea how to get better (she had been a marathoner) now that she had this huge scar (larger than that of a C-section) across her abdomen. Even coughing caused pain, and the related headaches and back pain were terrifying.

But, it was not the doctor’s fault. Not really.

Doctors are educated very little, if at all, about PT services in medical school. A good friend with an MD sister said this when asked if she had learned about PT in medical school: “sure, we had education about what PT’s do in medical school. It was a single lecture, on one day, it was optional, and it covered all allied health care services.”

Physical therapists spend a similar amount of time in earning their degree in physical therapy (7-8 years) as doctors do in medical training. There really is no way a single optional lecture in medical school can prepare physicians to know what PT’s do and how to refer for physical therapy.

The Take Home Message

Be your own advocate in health care. Before going into surgery or giving birth, educate yourself about what to expect and what you will need for your body to heal fully.

The biggest mistake a mother can make in seeking maternity care is assuming her doctor knows best. The doctor may not even know PT’s treat women’s health issues, much less how to refer to PT for prenatal or postpartum rehabilitation.

There is good news though. Here are the tools you need to get physical therapy after giving birth:

First, BEFORE you give birth, ask your doctor is he/she refers to physical therapy after giving birth. If you already have low back or pelvic pain during pregnancy, then you should get a referral for physical therapy now. Do not wait until after giving birth.

When asked why you need it (physical therapy), you can give them these four reasons:   click here to read more

 

 

 


GingerGarnerpicGinger Garner PT, MPT, ATC, PYT

Ms. Garner is an educator, integrative physical therapist, and founder of Professional Yoga Therapy Studies, an organization that creates inter-disciplinary curricula and educational competencies for using yoga in medicine and rehabilitation.  Ms. Garner received her Master of Physical Therapy from the University of North Carolina at Chapel Hill, where she completed studies in the School of Medicine and School of Public Health.  Ms. Garner began working in the field of integrative therapies in 1995, after becoming licensed in sports medicine.  Her clinical specialties include public health education, orthopaedics, and pain management, with a focus on maternal health.

Ms. Garner has been writing, teaching, and lecturing for hospitals and medical practices throughout the US since 2000, and in 2012 she joined the Caring Economics Coalition and the work of Dr. Riane Eisler, who she credits as one of her greatest mentors.  Ms. Garner now consults pro bono with medical schools at several domestic and international universities in order to develop integrative medicine curriculum in medical therapeutic yoga.  She is currently an instructor with Medbridge Education and consultant at the University of Mississippi Medical Center, Misericordia University’s Doctoral Physical Therapy program, and the University of Saskatchawan School of Medicine.  These evidence-based programs are a first of their kind in North America.

Ms. Garner considers her most important work to be in maternal health care advocacy and health care policy,  where through her multi-media platforms she works to increase awareness of, and eliminate barriers to, receiving holistic and integrative health care.   Ginger is a mother of three children, and lives with her husband and rowdy sons on a small island off the east coast of the US.  Ginger can be contacted at www.gingergarner.com and www.professionalyogatherapy.org.

Abdominal Hernia’s-Diastasis Recti in Post Partum Women

April 22, 2013 in Abdominals, Diastasis Recti, Post Partum, Pregnancy

Diastasis Recti- Abdominal Muscle Separation

Do you know what one of the most commonly untreated issues women face after delivering a baby?  It hardly ever gets diagnosed and if it does the medical community doesn’t think there is any solution other than surgery.

Diastasis Recti

I’m talking about Diastasis Recti.  This is the separation of the rectus abdominus muscle, which is the “six-pack” muscle in our abdomen.  The rectus abdominus muscle has two sets of muscle fibers that run up and down from the sternum, or chest plate, down to the pubic bone. They are connected by a connective tissue called the linea alba. These muscle bellies can become separated and the connective tissue between them stretched thin with pregnancy.   The muscle bellies get forced out to the side to make room for the expanding uterus.  Also, activities with a forward forceful movements as in coughing, sneezing, laughing, or doing sit ups incorrectly can create a diastasis or make an already existing one worse.

Abdominal Muscles

The abdominal muscles are one of the most important muscles in our body. They are responsible for all of the support and movements in our trunk and consist of three layers. The most superficial layer, the Rectus abdominus, otherwise known as the “Six-pack” muscle, helps us to bend forward or sit up from laying down. The middle layer includes the Internal and External Obliques which helps us to twist and the deepest and most important layer, the Transverse abdominus, helps to compress the abdomen in and is part of our core muscles to stabilze the spine and pelvis.

How do you know if you have Diastasis Recti?

The separation of the Recti muscles is called a Diastasis Recti. You will know if you have one if you are laying down on your back and you place your fingers pointing down toward your spine in your belly button. When you lift your head any fingers that fill the space between the two muscle fibers of the rectus abdminus let’s you know you have a separation.  One to two fingers separation is considered normal.  However you also need to check the depth of your connective tissue.  That linea alba needs to be very superficial.  If you sink down past your fingertip the connective tissue still needs to heal.

Also another key sign you have a

Doming of linea alba in Rectus abdominus with diastasis recti

Doming of linea alba in Rectus abdominus with diastasis recti

separation is when you lift your head do you have any doming in the midline of your abdomen?

There are certain things we do like getting in and out of bed, doing abdominal crunches, and playing golf and tennis that can make this separation worse and keep it from healing.

At Intuitive Hands PT we offer training and education to teach you a 4 step program to help you heal a Diastasis Recti and also to help you lose the “pooch” from pregnancy. By learning how to use your body and strengthen your transverse abdominus muscle correctly you can loose your “pooch” and bring the rectus abdominus muscle bellies back together again.

Anyone with a diastasis can be helped no matter how long your muscles have been separated.   If you are currently pregnant, reading this previous post on how to avoid developing onein the first place can help save you ton of effort in the post partum period.

Caring for your Belly During Pregnancy-Preventing Diastasis Recti- Part 2

March 27, 2013 in Abdominals, Diastasis Recti, Pregnancy

Part 2-Preventing Diastasis Recti in Pregnancy

Diastasis Recti is a separation of the rectus abdominus muscles that is a common occurrence during pregnancy.   What we do with our bodies during pregnancy can make this separation worse and the recovery process longer.   There are three aspects you need to be aware of to help prevent diastasis recti.   In a previous post we talked about the first aspect of how rib thrusting contributes to the development of diastasis recti.  See this post to review rib thrusting.

The second aspect you need to be aware of to avoid diastasis is to protect your abdominal muscles with all your activities.   Any time the belly protrudes forward forcefully, like when you laugh, cough or sneeze, the abdominal muscles get strained apart.  The more strain the more separation.  If you are in your late second or third trimester and you notice any doming in the midline of your belly, this is the abdominal muscles separating.  You want to avoid this.

The third trimester is the period of time that greatest strain is placed on the abdominal muscles.   The less your belly domes up in the middle the less separation there will be.

How do you stop the doming and separating?

You can stop the separation of the abdominal muscles by pulling the belly button back to the spine before you do any activities that may strain the belly.  So before you cough, laugh or sneeze bringing your belly button into your spine.   Also before you go to lift anything heavy, contract your abdominal muscles back toward your spine.

DON’T DO SIT UPS OR CRUNCHES

Doing a crunch shortens the recti muscles and actually makes any separation worse.  When the muscles shorten they bulge out in the middle.   Crunches also increases pressure in the pelvic bowl area.  This can weaken the pelvic floor muscles and contribute to pelvic organ prolapse.   You don’t want that!

Sit ups should be avoided and are not an exercise I ever recommend to my patients.  There are other more effective ways of doing abdominal strengthening than sit ups.

Best form of Exercises during Pregnancy

If you want to strengthen your abdominal muscles just pulling your belly button back to your spine is the safest and most effective way to do so while pregnant.  Walking is another way to strengthen the abdominal muscles, as they have to work to support the spine.  In my opinion, walking is the best form of exercise you can do while you are pregnant.

So protecting your belly by contracting your belly button back to your spine with everything you do is the second step in avoiding a diastasis recti while pregnant.

In the next post we will cover the third aspect, which is the most common motion we do at least twice a day that can contribute to diastasis recti.   Stay tuned!

If you want to know how to heal Diastasis please check out my video How to Lose the Pooch For Good and Heal Diastasis Recti 

 

Caring for your Belly During Pregnancy-Preventing Diastasis Recti

March 25, 2013 in Abdominals, Diastasis Recti, Pregnancy

Preventing Diastasis Recti in Pregnancy- PART ONE

Congratulations on being pregnant.   There is a lot of changes that will be happening to your body over the next 9 months, the biggest one happening to your belly.  You probably aren’t that concerned about your belly getting huge, because it will!  But you should!  Things you do to your belly during your pregnancy can impact your delivery and recovery.

As the belly gets larger one of your abdominal muscles, the rectus abdominus can get separated.  How you use your body can cause strain on this muscle and separate it more.  But it doesn’t have to.  The larger this muscle separates the less support your abdominal muscles have during labor and the longer it will take to heal afterwards.   It’s important for you to take care of your belly and avoid putting excess strain on the muscles of your abdomen so you can minimize the separation of your rectus abdominus muscle.

HOW TO AVOID STRAINING YOUR RECTUS MUSCLES

There are three important aspects to know about protecting your abdominal muscles during pregnancy.  Since they are each pretty involved this blog will be in three parts so you can better understand each section.  Before we get into those three aspects let’s talk a bit about the abdominal muscles and what we want to prevent.

The rectus abdominus muscle consists of two sets of muscle bellies that run parallel and are held together by a connective tissue called the linea alba.  This muscle runs from the end of the sternum to the pubic bone.  As the uterus expands the muscle bellies can separate and the linea alba stretches thin.  This creates what is called a diastasis recti.  The degree of separation depends on what activities and stresses you put on this muscle while you are pregnant.

13330_1413899876212_1494023040_31037601_6547864_sYou will know if you have this separation if you notice a bulging out or doming in the midline of your abdomen when you do activities.  Any bulging of this tissue can cause the muscles to separate more.

Avoiding any bulging is what we will be talking about in the second part of this blog post but for now lets talk about how to prevent it in the first place.

 

How do you Prevent Diastasis Recti?

The way you hold your ribcage during pregnancy is one of the biggest contributors to development of diastasis recti.

Rib Thrusting

Are you a rib thruster?  Your lower rib cage should be in the same plane as your hipbone.   The way to tell if you are is to check the bottom edge of your ribcage and see where it is in relation to the front of your hipbones.  You know those little bumps on either side of your hips, which professionals call your anterior, superior iliac spine, or ASIS for short.   If you draw a line from your nipples down to the edge of your ribcage place one finger there and then find that little bump on the sides of your ilium and see how these two points line up.  Are your ribs out in front of your hipbone?  If so, then you are a rib thruster!  If they line up in the same plane, as if walking forward to a wall, both boney points would hit at the same time, then you are not a rib thruster.  Good for you!  YOUR RIBCAGE

Thrusting your ribs puts added strain on the abdominal muscles and can separate the recti muscles, especially when you are pregnant!

 

Rib-thrusting-in-preg-edittedsmallest

Rib-thrusting-corrected-editsmallest-1To correct this rib thrusting, take that point of your ribcage and move it DOWN and back.  This movement happens at the spine and not with your abdominal muscles.  Standing with your back against a wall keep your shoulders and head touching the wall, see if you can get your lower ribcage to make contact with the wall.  If your shoulder muscles are too tight moving your ribcage backwards can cause your shoulders to pull forward.  That’s a whole other post, so stay tuned.

Work on keeping your ribcage down and back with everything you do, especially while walking.  It’s going to take a long time to break this habit.   But every chance you get, remember to bring them down and back and in line with your hipbones.

When your rib cage thrusts forward there is increased pressures in your abdominal cavity.  This increased pressure has to go somewhere.  It can go up into the diaphragm and cause reflex or go down and cause inguinal hernias or force the abdominal muscles to separate.  When you bring the rib cage down and back the pressures even out and decreases the forces in the abdominal cavity, helping everything out.

So your focus for now is to see where your ribcage is hanging out.  Work on bringing them down and back to be in line with your hipbones.

In the second part of this series we will be talking about how different activities you do can contribute to diastasis recti.

If you want to know how to heal Diastasis please check out my video How to Lose the Pooch For Good and Heal Diastasis Recti

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