Thank you for your question. It has been shown in an experimental study in which a pressure transducer was placed in the bladder of several patients having the muscles tightened during a tummy tuck. This allowed the researchers to measure the pressure in the abdomen before, during and after the surgery. They found that there is no appreciable increase in the intraabdominal pressure during or after a tummy tuck.
Good luck with your surgery. Make sure that you are seeing a board certified plastic surgeon.
Before a week ago, I would have told you that there is not much to worry about. But I just recently had a patient who had a recurrence of a surgically repaired pelvic floor prolapse after her abdominoplasty. This could have been a coincidence or it could be that the increased abdominal pressure from the rectus plication contributed to the recurrence. I think that you need to understand that there could indeed be a relationship between the tummy tuck and the pelvic floor stability and that it will be an additional risk to your procedure. The risk of having pelvic floor problems is still likely quite low, but not zero. Avoiding excessive tightening of the abdominal wall might be a good decision.
In standard tummy tuck surgery, the rectus muscles are tightened routinely. This will lead to increase in intra-abdominal pressure. There is no easy yes or no answer.
The question is how tight is muscle tightening? It varies among different plastic surgeons. Also, how bad is your rectal prolapse? Is it going to worsen by time?
In my personal opinion: I would address the rectal prolapse first and then consider the tummy tuck surgery.
Its often helpful to have another consultation opinion, even just to confirm your first impression. The main issue with pelvic prolapse is a loss of support of the pelvic structures, and any increased abdominal pressure will be secondary, and is unlikely to affect the prolapse.
I am not aware of any link between plicating the abdominal muscles during abominoplasty and worsening prolapse.
Sometimes in medicine we just make our best guess. To my knowledge, there is no study linking abdominoplasty with rectus repair to worsening prolapse. Fixing diastasis is about returning things to an anatomic position. There is not evidence of a dramatic increase in intra-abdominal pressure as a result and the repair of your diastasis would not, per my understanding, worsen your GYN issues. This study has not been done to my knowledge.
You are correct to consider another consultation. A tummy tuck with tight muscle imbrication will increase intra-abdomenal pressure and could aggravate pelvic floor prolapse, even raise your diaphragm position. Best to seek a uro-gynecology specialist to work with your plastic surgeon on staging your strategy.
Abdominoplasty procedure removes excess loose skin and tighens the weakened, distended abdominal wall. The procedure does not influence the pelvic floor.