Question: I still look pregnant — especially after a large meal, five years after my last baby. She was transverse oblique and a C-section. I exercise regularly — strength training with lots of compound exercises and still, nothing helps. I may have diastasis recti — I feel I can get one and a half fingers in the gap. Is there anything I can do at this stage? Also, does this cause problems aside from the cosmetic?
Dr Grant replies: Rectus abdominis diastasis (RAD) or divarication of rectus abdominis is common in adults. The term describes the abnormally wide distance, usually defined as 2cm, that separates the two rectus muscles. These two large parallel bands of muscles lie in the middle of the abdomen on either side of the belly button and are responsible for forming the legendary ‘six pack’ in the lucky few. Pregnancy, particularly twins and triplets, is an obvious risk factor but being overweight also puts you at risk of developing the condition. As the uterus grows during pregnancy, the abdominal muscles are stretched and the connective tissue that lies between both bands of muscle (linea alba) thins and pulls apart. In most women, with normal postpartum weight loss and cessation of breastfeeding, the linea alba contracts back to normal within two months.
It is easy to detect RAD. Simply lie flat on the bed and lift your head up, similar to a ‘sit-up’ position. You may notice a small bulge running up the centre of the abdomen, most commonly between the belly button and the bottom tip of the breast bone. The presence of RAD is one of the contributing factors to making your belly stick out months or years after giving birth.
Other things that may contribute to your ‘pregnant-looking’ belly are the natural accumulation of body fat with age (oestrogen makes women more inclined to gather abdominal fat); the possibility of hormonal imbalance (e.g. hypothyroidism or early menopause); or irritable bowel syndrome (IBS). And let’s be honest, years of eating a bad diet and a high alcohol intake all contribute.
RAD by itself is benign and does not pose any serious health risk. However, if the separation of these two bands of muscles is severe enough, it may be associated with an umbilical or epigastric hernia.
These are seen as an additional bulge and can contain fat and/or some loops of bowel. Most new or early onset hernias are reducible, therefore you can push it back into the abdominal cavity. Unfortunately, a hernia has the potential to cause a bowel incarceration (strangulation) leading to a surgical emergency repair. The presence of a hernia is a strong indication for elective (pre-planned) corrective surgical repair in the form of abdominoplasty or ‘tummy tuck’ surgery.
Abdominoplasty can take up to three hours to perform and is typically accompanied by liposuction. Of course, if your RAD is not severe enough to warrant surgery, you could elect to have minimally invasive liposuction under sedation (instead of general anaesthetic). If this is something you are considering, I recommend you attend a registered consultant plastic and reconstructive surgeon.
Before you decide on surgery it is well worthwhile considering at least six months of non-invasive treatment and ask yourself are you content with your results?
Dr Jennifer Grant is a GP with Beacon HealthCheck