The Ugly Side of Pregnancy: Post-Partum Changes to the Body

Pregnancy is a major milestone often celebrated with furor and enthusiasm. However, if you look beyond those rose-colored glasses, there is the real – and maybe not so attractive – part of pregnancy. This is not to discourage you, but to give you the real picture and to prepare better for it.

So, to help you out, here are some of the less desirable changes to the body during this special journey, and what you can do about it. Dr Coni Liu, Consultant Dermatologist from Dermatology and Surgery Clinic (Paragon) has kindly included some tips for new mommies keen to regain their body best postnatally.

Diastasis Recti

Diastasis recti is a medical term for abdominal separation. From the outside, this may look like you are still pregnant even long after you have given birth. To understand it better, we must first understand what makes up the structures that belies the abdomen and how it changes in response to pregnancy.

Our abdominal musculature is made up of the rectus abdominis muscles and the linea alba, which is a thin sheath of muscle tissue that stretches along the front midline of the abdomen. Pregnancy creates abdominal pressure which stretches and thins out the muscle sheath instead of it holding the rectus abdominis muscles in close proximity. This occurs to accommodate the growing belly.

While there is not enough information on the risk factors of diastasis recti, the following have been proposed factors:

• High age
• Multiparity
• Caesarean section
• Weight gain
• High birth weight
• Multiple pregnancies
• Ethnicity
• Childcare

Most women develop some extent of muscle separation in the post-partum period. Sometimes the tissue eventually heals on its own once your hormone levels return to its pre-pregnancy levels. However, if it fails to close on its own within 3-6 months, you could be left with a gap between your abdominal muscles which will become more obvious when you cough, sit up, or strain.

While abdominal crunches may seem like a likely solution, it can make your condition worse. However, depending on your level of healing and proper execution, you might be able to tolerate this exercise. It is necessary that you get the right help and guidance on how to engage your core muscles and do proper breathing.

In severe cases, it must be corrected to prevent concurrent abdominal bulging. Aside from aesthetic concerns, people with diastasis recti also complain of lower back pain and functional impairment. A surgical procedure called an abdominoplasty, popularly known as a tummy tuck is considered an effective management option.

How to check if you have abdominal separation:

• Lie on your back with your feet on the floor.
• Place your fingers above and below the belly button.
• Do a small sit-up. If you feel a bulge between your fingers, it could mean that you have abdominal separation.

Post Natal Hair Loss

A lot of women experience noticeable hair shedding for the first 3-6 months after delivery. This is a condition also referred to as post-partum alopecia or post-partum telogen effluvium, and it has a lot to do with your pregnancy hormones.

This causes your hair to continue in an ongoing stage of growth resulting in thicker and more lustrous strands. However, once the placenta is delivered, progesterone and estrogen level out within 2-4 days causing your hair to temporarily shed. In some cases, it can be severe that it induces visible thinning.

What women must know is that telogen effluvium represents excessive hair shedding instead of actual hair loss. Treatment is not always necessary, but if the problem fails to resolve 6 months after giving birth, your hair loss could be a symptom of other underlying conditions which should signal you to get professional help. However, stress and other factors which can strain the body can also perpetuate the problem.

To improve hair health after pregnancy, here are some reminders:

• A healthy diet high in protein to boost the hair growth process
• Take your vitamins
• Avoid over-styling your hair

Urinary Incontinence

Post-partum urinary incontinence is the involuntary leaking of urine which commonly occurs while sneezing, coughing, laughing or when doing strenuous activities. This is due to the pregnancy hormones that make your tissues more elastic for delivery. That, combined with the increasing weight of the baby,

Other causes of bladder control problems, in relation to pregnancy, include the following:

• Injury or damage to the pelvic nerve that control bladder function due to a long or difficult vaginal delivery.
• Forceps delivery which results in injuries to the pelvic floor and sphincter muscles.

It can take around 3-6 months, sometimes longer for some women, to regain complete bladder control. However, there are steps to manage this problem.

How to correct urinary incontinence:

• Kegel’s exercise

Kegel’s is a popular exercise to strengthen the pelvic floor muscles. You can identify this muscle by attempting to stop your urine flow mid-stream. Once you identified the specific muscles, continue to practice on an empty bladder. Flex the muscle for 5 seconds at a time, then relax for 5 seconds – this makes one rep. Try 5 reps on your first day and then aim for 3 sets of 10 reps a day. The National Association for Continence warns to avoid flexing the muscles in your abdomen, thighs or buttocks. You must also be able to breathe freely while doing it.

• Weight Loss

Based on research, weight loss after delivery is associated with a decreased incidence of urinary incontinence. This should encourage new moms to adapt a healthier diet not only to bounce back better but also to avoid aggravating urinary incontinence.

• Bladder Training

You can also try bladder training by trying to urinate every 30 minutes at a time before you even have the urge to do so. Then you gradually extend the time between each urination each day.

• Keep a High Fibre Diet and Increase Fluids

This is to avoid constipation after pregnancy because a full bowel can add pressure to your bladder.

• Minimise Caffeine, Alcohol, Carbonated Drinks and Spicy Foods

These can irritate the bladder and can cause it to contract easily.

Piles

Piles or hemorrhoids are swollen blood vessels in the rectal area that is common during pregnancy and post-partum. The size can be like that of a raisin or a grape, and sometimes it protrudes through the anus like a soft, swollen mass. These are caused by increased pressure on the lower rectum, and it is common especially after a vaginal delivery.

Symptoms include:

• Pain
• Bleeding during or after a bowel movement
• Swollen area around the anus
• Rectal itching

Hemorrhoids resolve on its own, but on your way to healing, you can do something to gain relief. Here are some suggestions:

• Do a warm sitz bath. It involves soaking your bottom in warm water in a tub or a sitz bath.
• Use a cold compress. Covered in clean and soft cloth, apply the ice pack over the affected area several times a day to reduce the swelling.
• Alternate treatments.  Use a cold compress and warm sitz bath alternately.
• Ask for professional health. Seek help from your healthcare practitioner for a safe topical anaesthetic or medicated suppository.

Skin Changes

Pregnancy Acne

• Hormonal changes in pregnancy cause the skin to secrete sebum that clogs pores and results in acne breakouts.
• This clears up to a certain degree after delivery.
• Severe cases can be managed with oral medications in combination with topical treatments, however, this must be consulted with your doctor first for safety especially if you are breastfeeding.
• Non-medical modalities such as chemical peels, Silkpeel, or light treatment are safe treatment options.

Pigmentation

• Melasma – also referred to as the “mask of pregnancy”.
• It is associated with hormonal changes.
• While it occurs during pregnancy, it can remain even after giving birth.
• Proper differentiation between melasma and other pigmentation issues is necessary to arrive at an effective treatment, otherwise, the condition can only be worsened.
• A combination treatment regimen can be tailored for each individual’s pigmentary concerns.

Stretch Marks

• It forms due to the rapid stretching of the skin as a result of weight gain.
• It is genetic in nature.
• These are pink and purplish streaks during pregnancy and during post-partum it fades into silvery white grooves.
• It usually runs down the breasts, abdomen, and/or buttocks.
• Since it is unlikely to reverse the changes, treatment is aimed at reducing the appearance of these marks.
• A combination of laser treatments can be used to stimulate collagen production.

Dull complexion

• It may be a result of sleepless nights, hormones, or the lack of time to attend to your usual skincare regimen.
• This can be managed with the help of aesthetic treatments like lasers to help brighten your complexion, shrink pores, and stimulate collagen for a firm and radiant appearance.

Spider veins

• These are very small, reddish blood vessels that is commonly seen on the face, chest, arms and legs.
• These form as a result of increased blood circulation during pregnancy.
• While some resolve on its own after delivery, some may persist even through post-partum.
• Vascular laser is an effective treatment.

Skin tags

• These are small bits of extra flesh that appears like skin folds on the neck, armpits and groin.
• It is possibly related to weight gain during pregnancy.
• While these are harmless, it can be unsightly and may cause irritation as it rubs against your clothing.
• It can be removed through electrocautery or cryotherapy.

Stubborn fat and loose skin on the tummy

• Once stretched, the skin may not be able to regain its original shape.
• Healthy weight loss can be achieved through a healthy diet and regular exercise.
• Adjunct therapy may include treatments like cryolipolysis, skin tightening treatments, body wraps, or lymphatic massages.

Pregnancy may not always be rainbows and butterflies, but whenever the bad days roll in, it helps that you have someone reliable to guide you along. So, if you have questions and concerns, book your consultation with Dr. Pamela Tan today, one of Singapore’s female OB-GYNE.