How Do I Know if I Have Torn Abdominal Muscles?

Question

I have 2 kids - ages 4 and 2, both delivered via c-section. After 2 pregnancies, my belly is never the same, although I've always had a little pooch - I can't tell if I have a torn abdominal muscle. No matter how much I exercise and do ab work, I still couldn't get the old belly back (not necessarily flat but not protruding at least). . . Been thinking about getting a tummy tuck but I want to gather as much information as I can before making a decision. . . Thank you.

Adam Tattelbaum, MD · Answer

Thank you for your question.  During pregnancy the enlargement of the uterus and the gain in intraabdominal weight leads to stretching of the connective tissues that surround the abdominal wall muscles.  The connective tissue stretches but often does not come back after childbearing leaving the abdominal wall loose.  The muscles are usually just fine.  This separation of the muscles, particularly in the midline is called diastasis rectus.  Some doctors mistakenly consider it a hernia which is not.  During most routine abdominoplasty surgeries this separation or diastasis is repaired bringing the muscles back together in the midline and flattening the abdominal wall.  You should see a board certified plastic surgeon who can confirm this diagnosis for you.  Only an examination will determine what course you should take but it sounds from your description that you are a good candidate for full formal abdominoplasty with muscle tightening.
	 
	Best wishes.

Richard J. Bruneteau, MD · Answer

The findings that you describe are extremely common
following pregnancy. During pregnancy, the abdominal wall becomes stretched by
the rapid expansion of the intra-abdominal contents.In many cases, this results in separation of
the paired rectus muscles which results in a midline separation called a
diastasis.This separation extends from
the pubic bone to the rib cage and is especially noticeable when the abdominal
muscles are flexed.Flexion typically
results in a midline bulge that extends from the pubis to the rib cage.Correction
of this problem usually requires an abdominoplasty.The underlying muscles are repaired and the
excess skin is removed as well.This
hopefully flattens your lower abdominal bulge.If you’re
considering abdominoplasty surgery, consultation with a board certified plastic
surgeon is appropriate, this surgeon should be able to formulate a treatment
plan that addresses your anatomic findings and achieves your aesthetic goals

Vincent N. Zubowicz, MD · Answer

There is nothing wrong with the abdominal muscles a woman with abdominal wall laxity after pregnancy. The fascia (connective tissue) is stretched and can be repaired within abdominoplasty. The muscles are left alone.

Kenneth Hughes, MD · Answer

If you have rectus muscle separation or diastasis, a tummy tuck with plication of the muscles can significantly improve pooch.

John J. Edney, MD · Answer

During pregnancy the intra-abdominal expansion stretches the overlying muscle and skin.  Very commonly women gain additional fat in the abdominal area during pregnancy.  The stretching can separate the connection of the rectus muscles of the abdominal wall.  The separation is called a diastases recti.  Normally this separation can be palpated preoperatively.  After pregnancy if stretch marks are present it indicates that the underlying deep layer of skin has been torn and should not be expected to retract.  A physical examination performed by an experienced plastic surgeon should be able to determine the degree to which each of these components contribute to the lower abdominal "pouch".  If there is loose skin both above and below the umbilicus a full tummy time will be required to optimally correct the problem.  During the course of the tummy tuck the separation of the muscle can be repaired.  If there is no separation of the muscles and no loose skin above the umbilicus a mini tummy tuck may be the solution.For a simple and illustrated explanation of tummy tuck and body contouring
procedures, watch my video.

Jeffrey Zwiren, MD · Answer

The resting tone of the abdomen is due to the quality of the anterior rectus fascia. This is an investing fascia that wraps around the rectus abdominis muscles. These are the two paired muscles that make up the so called 6 pack. Think of these muscles like sausages wrapped in a fascia. During a pregnancy the fascia can stretch and can separate the muscles in the midline, this is known as a diastasis recti. Unfortunately this fascia has no elastic qualities of its own and once stretched will remain permanently stretched unless it is repaired surgically. This is what gives you the increased abdominal girth.

Daniel Kaufman, MD, FACS · Answer

During pregnancy, and as we age, the muscles of the abdominal wall can lose their tone, elasticity, and overall integrity. Obviously, there are always things that can be done to strengthen the abdominal wall and delay the onset of this loss. When a muscle is torn, it is usually a traumatic event that causes pain in a specific location. So, unless you've sustained an injury, it is unlikely that your muscles are torn. Your muscles can, however be distended and weak due to the mentioned factors. Additionally, you may even have an abdominal wall hernia or "bulge". The only way to be sure is to consult with a Board-certified plastic surgoen and undergo a physical exam. Good luck and fare well.

Robert L. Kraft, MD, FACS · Answer

After two pregnancies, your muscles are not torn but the connective tissues have spread and weakened. This is called a diastasis rectus. It is repaired during the abdominoplasty and will minimize the protrusion. Caesarean sections contribute to this problem. The best way to gather information is to see a plastic surgeon for a comprehensive examination and a recommendation.

Jourdan Gottlieb, MD · Answer

With pregnancy, the abdominal wall problems are typically not "torn muscles" but rather separation of the rectus muscles, the two vertical muscles that run either side of the midline of the abdomen. If you lay on your back and begin a situp and see a vertical bulge, that is a finding of what we call "diastasis rectus"

	A visit to a plastic surgeon is a more reliable way of determining the status of your abdominal wall, and what can be done to improve it. 

	When you ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes.

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