Is It Possible That Increasing Core Strength is Causing my Protruding Abdomen? (photo)

I'm a fit 35 ,.5'6" 138 lbs. I crossfit regularly.Have 4 children, the last pregnancy was twins. I have a ton of stretchmarks and saggy skin, naturally. This year despite eating well and working out consistently, my abdomen sticks out further now than ever! If I hold it in, I look fine, I can see slight abdominal definition (hard to see under loose skin), but when I relax my tummy, I look 6 m pregnant. Is it possible that as my abs get stronger, they protrude more and would benefit from a tuck?

Doctor Answers 13

Exercise doesn't repair muscle separation after pregnancy

When the rectus muscles in the front of the abdomen are pushed apart from pregnancy, it is called a diastasis and exercise cannot improve it much. that is because the muscles contract vertically, but the separation is horizontal. It is routinely repaired as part of a tummy tuck. Core strengthening will not make it better or worse.

Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Muscle plication to repair protruding upper abdomen.

Thank you for the question. 

Congratulations on being fit! The most likely reason for your protruding upper abdomen is the separation of your recti muscles as a result of your 4 pregnancies. 

The more you work out the more they tend to separate. You would highly benefit from plication (tightening) of the muscles which can be done during the tummy tuck procedure. 

Best of luck...



Dana Khuthaila, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 68 reviews

Is It Possible That Increasing Core Strength is Causing my Protruding Abdomen?

Not likely. Rather, the cause is the separation of the rectus muscles caused by the pregnancy, particularly the twin pregnancy. 

Yes, you would have great benefit from a Tummy Tuck in terms of correcting the muscle separation, and removing the excess skin. Congratulations on your perseverance.

All the best. . 

Jourdan Gottlieb, MD
Seattle Plastic Surgeon
4.6 out of 5 stars 45 reviews

Protruding Abdomen Related to Increasing Core Strength?

Thank you for the question and pictures.  You should be proud of what you have accomplished through healthy diet and exercise, after several pregnancies, especially a twin pregnancy.

No, increasing core strength is not  increasing the “protuberance” of your abdominal wall.  This protuberance, as you know, is related to separation of the abdominal wall muscles (diastasis recti) that occur during pregnancy, especially twin gestation.

 At some point, you may be an excellent candidate for tummy tuck surgery,  during which the rectus muscles are re-approximated in the midline.  You may find the attached link helpful to as you learn more about this procedure.

 I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 reviews

Protruding tummy

Thanks for your photos... quite a change when you relax your tummy.  Surgery can correct this but consider having plication of your muscles as close to anatomic as possible instead of the traditional  midline plication that would likely make the bottom of your belly button never see light again.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Abdominal strengthening exercises cannot correct abdominal wall laxity after pregnancy.

The connective tissue that houses the abdominal musculature stretched out in some women after pregnancy. There's nothing wrong with the muscle. Exercise will not repair attenuated fascia.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Is It Possible That Increasing Core Strength is Causing my Protruding Abdomen?


Increasing your core strength will not cause your abdomen to protrude. The common causes of protrusion of abdomen are increase in the intra abdominal contents such as visceral fat deposits, a hernia where your abdominal contents such as intestines bulge forward through weakness in your absominal wall ( six pack muscle layer) and a very lax muscle layer with separation that is unable to hold back any of the abdominal contents.

It it unlikely you will have a lot of intra abdominal fat as you are quite fit. See a Plastic Surgeon who can examine you to see if you have a hernia or separation of the rectus muscle. Both of these can be fixed during a tummy tuck with excellent results.

Hope this helps

Naveen Somia, MBBS, PhD, FRACS
Sydney Plastic Surgeon
5.0 out of 5 stars 73 reviews

Wide separation between the rectus muscles of the anterior abdomen

You most likely have a wide diastasis recti or separation between the two paired rectus muscles.  With exercise you are able to tighten the muscles but once the space between the muscles is stretched they can not get better on their own.  An abdominoplasty would address this problem, reconstruct your anterior abdominal wall and really so off the results of your exercise routine.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Toning and Your Abdomen

Working out is not making your abdomen protrude more.  You can blame the effect of that muscle stretch on the twins, and yes, it will get worse as time goes on and nature takes its toll.

A tummy tuck is a great idea for you to tighten the muscle stretch as much as possible.  (It will not take you back to age 15 before any babies,  though).

Keep up the good work with weight control and fitness training anyway!

Deborah Ekstrom, MD
Worcester Plastic Surgeon
4.7 out of 5 stars 39 reviews

Abdominal Weakness After Twins

Any patient who has had twins most likely has a diastasis of their rectus muscles, meaning the normal 1cm fibrous line between their muscles in the midline of the abdomen has been stretched out.  In some women, this can be more than three inches wide.  Because of that, you can increase your core strength all you want, strengthening the muscles, but it will not tighten the midline since their is no muscle their - just a stretched out fibrous tissue.  With your increased activity, this may be putting more strain on that midline, making it distend even more.  A full abdominoplasty with muscle wall plication may work the best.  I hope this helps.

Christopher V. Pelletiere, MD
Barrington Plastic Surgeon
4.8 out of 5 stars 73 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.