Recognizing Abdominal Separation

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Recognizing Abdominal Separation
July 18
20:03 2016

Women often spend hours—sometimes years—working on our bodies after the effects of pregnancy.

From fitting in every bit of cardio we can between breastfeeding to trying each and every diet, we relish the thought of returning to our pre-pregnancy tummy.

But sometimes that tummy you’ve been left with is less an issue of excess fat, but possibly more about something called diastasis recti. Also known as abdominal separation, this condition is caused once a uterus stretches the abdomen to make room for the growing baby, forcing the muscles in the abdomen to split and failing to heal back together again.

This uncomfortable protrusion is something that leaves women confused and insecure about the post-baby weight they feel they’re failing to lose, when in reality, surgery is required to bring the muscles back together again.

Recognizing Abdominal Separation

Recognizing Abdominal Separation

According to plastic surgeon Dr. Michael Kreidstein, there are two types of problems that can account for an abdominal bulge in the absence of fat. One problem is that the muscle is “pulled apart” in the centre, creating a gap in fascia (a layer of tissues that surrounds a muscle). In the second scenario, it may not be just the gap between muscles, but the entire membrane in between and the fascia that surrounds your muscle that has stretched.

“When we’re normally walking around, we’re not contracting our abdominal muscles,” said Dr. Kreidstein. “We’re relying on fibrous tissues—the fascia—to give our abdominal wall some shape, to hold it in position. When you actively suck in your belly, you are using your muscles. But when you relax, it is up to the fascia to prevent the ‘pot belly’ look. Fascial repair is designed to give you a flat tummy even when you are not contracting your muscles.”

The operation to repair this condition includes exposing the fascia, then either bringing the muscle back together in the midline, or tightening the fascia right across the abdominal wall. As some people don’t have very strong fascias, the same tightening effect cannot be created in all patients. Those with thick fascias can have it pulled together under a lot of tension and expect it to hold up.

Recognizing Abdominal Separation

Recognizing Abdominal Separation

“If I could compare it to a steak: our abdominal muscle is the meat, and the fascia is the gristle on the outside that’s hard to cut,” said Dr. Kreidstein. “So it’s that gristle—that’s the piece that we attempt to grab with our stitches to shorten it, tighten it, and that’s the tissue that can be repaired with stitches. You can’t get muscle to permanently hold a suture, and if you put stitches into the muscle, you’re just creating a lot of pain and grief without any benefit.”

Dr. Kreidstein explained that most patients he receives for this surgery are mothers over 40. He suggested that women first finish with their childbearing before having the surgery, as pregnancy could cause the repaired tissues to stretch out again. It is recommended that patients wait six weeks before returning to sports, so that the tissues are strong enough to withstand the strain of exercise. But with the joyous results that bring women back to their pre-baby bodies and away from confusion, the surgery promises to be one of the most powerful in the field.

“When you can take a patient who is demoralized by having no way of getting their physique back and give them an operation that puts them back into the physique they had before their pregnancies, their self-esteem goes up, they’re able to pursue activities and sports and not feel inhibited… it’s a fantastic thing.”

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