Roger Goldberg
Diastasis (separation of the rectus abdominal muscles) is fairly common. When it's extreme, it can cause pain and/or uncomfortable pressure. Small separations, like many other post-childbirth changes, are often not very bothersome and can be left alone. My recommendation would be to consider pelvic floor physical therapy along with core strengthening, and if the separation is very bothersome after physical therapy, then an assessment with plastic surgery might the best next step. Again, it's a very small percentage of patients who actually need surgery for this problem.

Roger Goldberg (Skokie, IL)
Incontinence after birth is common. Roughly 40% of women after "normal" childbirth have some loss of bladder control, though for many of these women, it's not very bothersome. Incontinence lasting more than 6 months after vaginal delivery, statistically, is only 10% likely to spontaneously go away over the next 5 years. So if you're having bothersome incontinence, more than 6 months after childbirth, then I'd absolutely recommend pelvic floor physical therapy. Pelvic floor physical therapists are subspecialty trained (we have around 5 here at NorthShore, and others exist outside of our system), and usually you'd need a referral from your GYN, urogynecologist or primary care physician. Highly recommended as a first step, and if no improvement, see a urogynecologist to explore other options.

Roger Goldberg (Skokie, IL)
Great question, and probably the answer relates less to my specialty of Urogynecology, and more to general advice on maintaining optimal weight. A few thoughts: (1) entering pregnancy with a close-to-optimal weight is of huge value in terms of improving the likelihood of returning to a healthy baseline after delivery. A reduced carb / calorie diet can absolutely be safe under the direction of your Ob/Gyn, (2) it is common to overlook that exercise is safe and even beneficial during pregnancy, and (3) after the baby is born, while all eyes are on the baby, don't forget to prioritize your own weight and health (both general health and pelvic health). Certainly easier said than done, but still true!

Roger Goldberg (Skokie, IL)
Hello, We actually did a fairly large study of "mothers of multiples" years ago. Firstly, along with your efforts to get right back into shape after delivery, I'd recommend pelvic floor physical therapy to get confirmation that you're honing in on the right pelvic floor muscles. With some luck and work, it's possible you'll have no troubles. If on the other hand you notice leakage which is significant enough to cause embarrassment / hesitation in your gymnastics or with life in general, I'd get assessed by a Urogynecologist. There are very few leakage types that can't be remedied with today's "toolbox" of treatment options. In our work with mothers of multiples, we found significant rates of "stress incontinence" which can be cured in >90% of cases. All in all, enjoy your upcoming adventure and know there are absolutely good options if problems arise.

Roger Goldberg (Skokie, IL)
I'm not completely clear on what you mean by "shifted", but in general: Urethral hypermobility ("looser" or more mobile urethra) is extremely common after childbirth. If you're having leakage with coughing, sneezing, bending, lifting or other physical activities,or if you're having trouble urinating, then it would be fair to ask your gynecologist about how your urethral supports appear, or see a Urogynecologist if needed. Similarly, if you're feeling something bulging out of the vagina, it's worth asking your gynecologist during an exam whether she/he notices any loosening of the urethra or vaginal supports.

Roger Goldberg (Skokie, IL)
Overactive bladder, and urge urinary incontinence ("Gotta go, gotta go!" type of bladder activity is incredibly common, and we know that even with perfect postpartum healing, women are increasingly prone to these symptoms with each pregnancy. Kegels are a great start, and I certainly recommend a pelvic floor physical therapy visit if you've never done this in the past. "Bladder drills" and attention to dietary triggers ("bladder diet") are other common self-help strategies, and information on this can be found on our website and various other places on the web. Treatments are numerous: medications, tibial nerve stimulation (acupuncture-like therapy performed near the ankle), even Botox in some cases.

Roger Goldberg (Skokie, IL)
After 12 weeks of physical therapy, you've given that approach a good honest try. Though I'd recommend keeping up with whatever Kegel strength you've achieved, I would not suggest that more physical therapy is likely to translate in to better results at this stage. Some pelvic floor weakening is inevitable after childbirth and requires no intervention, and the key question is: what symptoms if any are being caused? If it's urinary incontinence, then I'd delve into the big list of potential options with a urogynecologist or GYN ranging from vaginal devices (pessaries), medications, acupuncture, injections, even minor surgical procedures in well selected cases. If it's vaginal looseness and sexual dissatisfaction, then being assessed by a urogynecologist to check for prolapse and see if tone can be repaired. If it's bowel or sexual dysfunction, then different options exist.

Roger Goldberg (Skokie, IL)
With all of your new responsibilities, clearly this will depend on logistics and what time you can carve out for yourself. It can range from combining a walking routine with the baby, perhaps combined with a realistic home fitness App ("7 minute workout" is free to all), to others who have the resources to get to the gym or work with a trainer. Remember that it's not just minutes / hours of exercise that determine your getting into shape; eating habits play a huge role, arguably even a larger role than exercise in some cases. In terms of pelvic floor rehabilitation, there are some home-based programs (e.g. "Total Control" pelvic fitness) that are DVD based and cater to postpartum moms.

Roger Goldberg (Skokie, IL)
Right now is a good time to start your Kegels, then if the urogynecologist or GYN feels your strength is lacking, you can go on to physical therapy. Paste this link into your browser for excellent resources on Kegels and other self-help strategies: https://www.augs.org/patient-fact-sheets/

Roger Goldberg (Skokie, IL)
It doesn't sound alarming, as sometimes scar tissue / healing can cause fleeting symptoms even long after surgery. As always, it's best to be safe and have the doctor perform an exam of the area.

Roger Goldberg (Skokie, IL)
Painful intercourse can linger for months in some cases, especially if you're breastfeeding as nursing causes steep reduction in Estrogen and worsens vaginal sensitivity / dryness. If painful intercourse persists beyond 3 months and certainly if it has been 6 months, then I would certainly see your GYN or a urogynecologist to get a careful check of the area. If it's earlier than 3 months, I would recommend patience and perhaps using extra lubrication and avoiding painful positions.