How do I fix my distended abdomen? Is it my core strength or something more? (photos)

Question

I am 33 and After 3 large babies (last 3yrs ago) all C section I have been struggling with the "great expandable belly". I am 5'6" 132 . My stomach grows and shrinks intake, food, etc. obviously not tearably abnormal, but the quantity at which it does so seems extreme. At rest my stomach currently is 34" circumference when I flex my abdominal muscles it is at 31". I also have a stretch marks and long belly button. Do I have a weak core or is there something to fix? What are my best options?

John Mesa, MD · Answer

“Bulging of the abdomen after multiple pregnancies may be secondary
to laxity of the abdominal fascia (soft tissue “container” that holds the
viscera in the abdomen) and or separation of the “six pack muscles” in the
midline (diastasis of the recti). Abdominoplasty, by correcting the diastatis
of the recti and laxity of the abdominal fascia can significantly improve the
anterior bulging of the abdomen. Patients interested in determine if abdominoplasty
could improve their belly “bulging” or “expandable belly” should consider making
a consultation with a Board Certified Plastic Surgeon

John Mesa, MD

Board Certified Plastic Surgeon

NJ & NYC

Don W. Griffin, MD · Answer

Diastasis or separation of the abdominal muscles often occurs after multiple pregnancies. While core strengthening will always improve your results, you can have really strong ab muscles, but still have looseness of the abdominal wall and bulging because the muscles are so stretched out. In an abdominoplasty, the surgeon will tighten the muscles, eliminating the gap between the muscles from your ribs down to the pubic area. This along with core strengthening, will give you the flattest tummy possible.

Christopher V. Pelletiere, MD · Answer

It is not unusual for women who have had multiple pregnancies to develop a diastasis of their rectus muscles, leading to weakness in the abdominal wall and increased projection of the abdomen.  Without an examination, it is hard to determine if you have this or not, but chances are pretty high in multiple pregnancy women.  The best thing to do is to go for a consultation with a board-certified plastic surgeon and see what will work best for you.

William Andrade, MD · Answer

Thanks for your question.  After having babies, some women develop a gap between their abdominal muscles called a rectus diastasis.  A plastic surgeon would be able to tell you if this has occurred.  Generally, strengthening the muscles will not make a diastasis resolve, but there are surgical options.

Kenneth Hughes, MD · Answer

If there is an issue with abdominal wall laxity, surgery would be appropriate.  I
would search for the board certified plastic surgeon who you feel is
most likely to give you the best results and who performs hundreds of
these procedures each year. I would look at patient reviews as well as
before and after photos on that surgeon's website.Kenneth Hughes, MDLos Angeles, CA

Brian J. Lee, MD · Answer

You appear to have significant laxity of your abdominal wall that exercise probably will not change. A physical examination would be best, but it looks like you would have a great result from a standard tummy tuck. Seek consultation with a reputable plastic surgeon in your area. Good luck.

Jaime Campos Leon, MD · Answer

Hi, there thanks so much for sharing your pictures and for your question, It is quite  normal after pregnancies to have that kind of problem in your abdomen,  If you have a tummy tuck in your case mostly to repair your abdominal muscle wall you will feel much more confident about it. It would be like wearing an inner corset all the time. Please have a virtual (Skype) or an in person consultation so you can discuss your options, concerns and expectations thoroughly, good luck in your PS Journey!Respectfully,Dr. Jaime Campos-Leon

Karol A. Gutowski, MD, FACS · Answer

You may have a weakening of the abdominal wall. If excercise does not help, consider a consultation with a plastic surgeon.

Peter E. Johnson, MD · Answer

Actually to a degree everyone can extend and contract the abdomen, and posture and tone are quite important. After three pregnancies there can be an element of muscle spread with loss of tone called diastasis. Some evidence is the wide and deep or long BB. Diastasis repair through the c-section top to bottom can help if this is the issue. Strengthening and a sound "core" never hurts.

Mark D. Wigod, MD · Answer

Patients with a distended abdomen post pregnancy and / or weight loss most likely have a rectus diastais.  This is a splitting of the rectus muscles down the center.  It is not a hernia and repairing it is not covered under insurance.  Most  abdominoplasty techniques repair this split with significant improvement of the distention.  At the same time, skin is removed and tightened.  There is no work out to make it better, just an operation.

How do I fix my distended abdomen? Is it my core strength or something more? (photos)

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