Intra abdominal pressure and abdominoplasty?

Question

I was under the impression that if you have a diastasis recti, your intra abdominal pressure is too much. However, I thought that an abdominoplasty also increases intra abdominal pressure. Can someone please explain to me what happens to IAP when you have a DR and post surgery? Thank you

Gary M. Horndeski, MD · Answer

Intra abdominal pressure is determined by the compliance of the anterior abdominal wall, capacity of the abdominal cavity and the contents to the abdominal cavity. When abdominoplasty is performed the diastatis recti is completed. The capacity of the cavity has decreased as well as the compliance. This results in increased intra abdominal pressure. With large increases of intra abdominal pressure, it is possible to develop distress and even blood clots. When I do an abdominoplasty, I keep the patient in the hospital overnight to monitor the changes that can be associated with intra abdominal pressure.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question. It's essential to understand that a diastasis recti (DR) refers to a separation of the abdominal muscles, which can lead to increased intra-abdominal pressure (IAP) and a protruding abdomen. An abdominoplasty, also known as a tummy tuck, involves tightening the abdominal muscles, which can also increase IAP. However, a skilled plastic surgeon will take steps to minimize the potential risks associated with increased IAP during and after the surgery.

During an abdominoplasty, the plastic surgeon will typically use sutures to bring the separated abdominal muscles closer together and create a firmer abdominal wall. This can reduce the IAP and provide a flatter appearance to the abdomen. However, the sutures used during the procedure can also lead to increased IAP in the short term. To minimize this risk, patients are typically advised to avoid heavy lifting and strenuous activity for several weeks after the surgery.

It's important to note that an abdominoplasty is a major surgical procedure, and patients with a DR should consult with a board-certified plastic surgeon to discuss the potential risks and benefits of the surgery. The plastic surgeon will carefully evaluate the patient's medical history, current health status, and cosmetic goals to determine if the procedure is appropriate for them.

In summary, an abdominoplasty can increase IAP, but a skilled plastic surgeon can take steps to minimize the risk and achieve optimal outcomes for patients with a DR. Thank you for your question, and I wish you the best of luck. 
Sincerely, Dr. Katzen.

Jonathan McCue, MD · Answer

The diastasis happens when your core muscles are stretched by weight gain (visceral fat) and or pregnancy. Afterwards, the diastasis will remain stretched out to some degree depending on your tissue elasticity and risk factors like smoking. Sewing your rectus muscles together during an abdominoplasty does indeed increase your intra-abdominal pressure but to a reasonable degree. If you have a lot of visceral fat still, then the pressure can be too high and you risk the diastasis repair coming apart.

Camille Cash, MD · Answer

When a lax abdominal wall or diastasis is corrected the space available behind the muscle wall is decreased.  This is what leads to the increase in intra abdominal pressure.  As a patient heals this pressure will normalize and become more comfortable.  However, this can be influenced by the presence of excess visceral fat.  I encourage you to discuss your concerns with a board certified plastic surgeon near you.

Paul Drake, MBChB · Answer

Prior to developing the diastasis, the pressure will have been high - that's one of the underlying reasons for the muscle separation. The diastasis allows the pressure to reduce. You would expect the pressure to increase again after the repair, so it has to be strong, and can sometimes come apart postoperatively. As tissues relax, this pressure will gradually reduce and it will feel more comfortable. The amount of increased pressure depends on the extent of the diastasis and whether a hernia has developed.

Mats Hagstrom, MD (license on probation) · Answer

If you have excess visceral fat then IAP will increase with muscle tightening.  If not than there is plenty of room for viscera just like it was pre pregnancy.

From your post I’m guessing visceral fat or obesity may be playing a role.

MH

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