Postpartum anterior abdominal wall insufficiency (PPAWIS) – Take care of your abdomen after childbirth
What is postpartum anterior abdominal wall failure?
Postpartum anterior abdominal wall insufficiency (PPAWIS) is a significant health challenge affecting many women after pregnancy and childbirth. PPAWIS is characterised by weakness of the abdominal muscles and connective tissue. The overall picture consists of a set of co-occurring lesions of varying severity and severity:
Imperfections in the structure of the anterior abdominal wall affect not only the functionality of the body, but also the silhouette, which often reduces self-confidence and worsens posture. Lack of adequate trunk support results in chronic pain and makes it difficult to perform daily activities.
What is the complexity of the PPAWIS problem?
The PPAWIS problem consists of many aspects that determine the appropriate course of action:
The treatment of PPAWIS requires a comprehensive and specialised approach, during which the surgeon draws on the knowledge and skills of reconstructive and aesthetic surgery, modern minimally invasive ventral hernia surgery.
Causes of failure of the anterior abdominal wall
Problems with the anterior abdominal wall after childbirth are mainly due to the course of pregnancy and delivery. Women who have experienced multiple pregnancies or have given birth to twins are at the highest risk , and the extra pressure on the abdominal muscles can lead to diastasis of the rectus muscles .
Among the main factors contributing to this condition are:
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How to recognise the symptoms of postpartum anterior abdominal wall failure?
Identifying the signs of abdominal muscle weakness after childbirth is crucial as it enables prompt treatment and rehabilitation measures to be taken. In-school intervention significantly increases the chances of full recovery.
Diastasis of the rectus abdominis muscles after childbirth
Diastasis involves increasing the distance between the rectus abdominis muscles and widening the so-called white crease, the fibrous structure between the muscles, which connects them. In a pregnant woman, as the foetus grows and the uterus enlarges, intra-abdominal pressure increases, resulting in a constant stretching and weakening of the white crease connecting the rectus abdominis muscles.
Hernia
The condition is most commonly accompanied by the following abdominal hernias, most commonly the umbilical and white crease hernias.
umbilical hernia
white line hernia
Hernias occur when there is a complete defect in the fascial tissue (at the level of the umbilical ring or in the course of the white crease) through which various structures and organs can migrate from the abdominal cavity towards the subcutaneous tissue.
Excess skin and subcutaneous tissue
The abdominal skin stretches during pregnancy and does not always regain its original elasticity after termination. The resulting excess skin becomes more or less of a problem at some point, which can be further influenced by rapid weight loss after childbirth, age-related skin ageing or genetic predisposition.
Weakening of the abdominal fascias
The so-called fascia-muscle corset of the abdomen stretches and weakens during pregnancy, which can lead to reduced trunk stability, an increased risk of developing hernias and affect poor posture.
What aspects should be taken into account before the PPAWIS procedure?
Every case of PPAWIS is different, hence the treatment must be well planned and closely matched to the patient. Already at the consultation stage, a thorough assessment of the patient’s condition is made and the optimal solution is planned, in which the patient is considered:
Treatment of postpartum anterior abdominal wall failure – PPAWIS surgery
When weakness of the anterior abdominal wall occurs after childbirth, conservative therapy is the first stage of treatment. Urogynaecological physiotherapy, complemented by deep abdominal and pelvic floor muscle exercises, helps to significantly strengthen abdominal structures and relieve discomfort. Surgical treatment can be performed laparoscopically or classically.
Laparoscopic reconstruction of the anterior abdominal wall
Laparoscopic, or keyhole, surgery allows the abdominal wall to be reconstructed in a minimally invasive manner through a few small incisions and the insertion of a camera and working tools under the skin, which can be used to suture the separation of the rectus abdominis muscles, i.e. reduce the width of the white line, repair concomitant abdominal hernias and reinforce the whole with an appropriate mesh. This method can be used in less advanced cases, with a lesser dilation of the white line and not much excess skin that does not require reduction, i.e. plastic surgery.
Open reconstruction of the anterior abdominal wall with abdominoplasty
In patients with more advanced disease, i.e. with a large excess of skin and/or a high degree of abdominal shell insufficiency, an open technique is used that combines correction in terms of both function and aesthetics. The operation involves a transverse incision in the lower abdomen (so that the resulting scar is ultimately hidden under underwear), plasticisation of concurrent hernias, surgical suturing and approximation of the rectus abdominis muscles, strengthening of the fascia with appropriate mesh, removal of excess skin and subcutaneous tissue, navel reconstruction and sometimes liposuction to improve body contours. Open reconstruction achieves comprehensive results in terms of function and aesthetics but requires a longer recovery period.
Rehabilitation after reconstruction surgery
Rehabilitation after PPAWIS reconstruction is a key step on the road to full recovery, helping the patient not only to regain function but also to prevent complications. The use of a special compression belt for several weeks stabilises the operated areas and promotes the healing process.
For the first 6-8 weeks, it is advisable to avoid lifting objects heavier than 5 kg to avoid overloading the tissue during the healing phase. Even seemingly light-hearted actions can impede recovery, so being careful is essential.
Exercises that strengthen the abdominal muscles and pelvic floor are key to improving flexibility and increasing strength, which counteracts trunk instability. Each exercise plan must be individually tailored and the pace is determined by the physiotherapist based on the patient’s current state of health.
The whole rehabilitation process requires a gradual approach, allowing the body to become accustomed to the new level of exertion, minimising the risk of future health problems. Regular meetings with the physiotherapist enable progress to be monitored and the therapy plan to be modified, and the early detection of the first signs of potential problems significantly improves the path to full fitness.
Holistic collaboration between specialists
General surgeon
-qualifies, diagnoses and performs abdominal reconstruction surgery.
Gynaecologist
can assess the condition of the pelvic floor muscles and structures after childbirth.
Urogynaecological physiotherapist
can prepare the body for surgery, promote recovery and work on the scar.
Cosmetologist
can help regenerate the skin and reduce surgical scars.
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