maternity
Your
POST-BABY BODY
T
he birth went smoothly, the baby
is healthy, all is well; except,
when you look down at your
tummy you realise you still look
pregnant. This is normal, at least for a time.
Your uterus returns to the pelvis and it goes
back to its original size around six weeks
after birth. This means your postpartum
belly will start to look and feel flatter and
smaller. After a few more months, most
women will have lost the majority of the
weight gained during pregnancy.
By maintaining healthy eating habits
and getting back into regular exercise
(once cleared by your doctor), it’s possible
to get your body fighting fit again. In some
cases, however, there may be medical
reasons your stomach doesn’t go back to
its pre-pregnancy dimensions.
What causes the post-pregancy
belly pouch and why is it so hard to
get rid of?
The uterus grows significantly in size
during pregnancy to accommodate and
support foetal growth. Before
pregnancy, your uterus is about the size
of a small orange and is situated deep
in your pelvis. By the time a growing
baby reaches full term, the mother’s
uterus will be the size of a large
watermelon, extending from the pelvic
area to the bottom of the rib cage.
Additionally, all the abdominal tissues
expand to accommodate pregnancy –
specifically, the skin and subcutaneous
tissue stretch and expand and the rectus
muscles (those "six pack" muscles) split
further apart. During pregnancy extra fat is
also gained in the process of supporting
the foetus. After pregnancy, the extra fat is
typically lost relatively easily with a healthy
diet and exercise. The skin and muscle
changes may be harder to undo, though.
Our skin is elastic, but only to a
certain extent. Once it has been
overstretched, it can never fully return
to its pre-stretched state. This
is why the abdominal skin often
remains lax even after a mother has
returned to her pre-pregnancy weight.
As for the muscles, the separated
rectus muscles (a normal phenomenon
during pregnancy) normally realign
themselves within three to six months
after the delivery. However, in some
cases, they remain separated and this
condition is called rectus diastasis. It
happens more often in mothers
with twins, polyhydramnios, and large
babies. It’s worth noting that certain
abdominal exercises, such as sit ups,
actually worsen rectus diastasis.
Lax skin and rectus diastasis are
very difficult, and in some cases
impossible, to correct with exercise and
diet alone.
Are these problems purely
cosmetic? Does it have anything to
do with my back pain?
Many people think lax skin and
separated rectus are purely cosmetic
problems. This is not always the
case and it’s easy to overlook the
functional impacts these changes have.
Severe lax skin can result in recurrent
dermatitis, which in turn can lead to
other skin problems such as infection
and hyperkeratosis. The rectus
abdominis muscle forms part of the
core muscles and is the main muscle
on the anterior abdominal wall. With a
rectus diastasis, the burden to support
the trunk may be shifted to the back
muscles, resulting in chronic low back
pain, a less stable core, and may leave
you more prone to injury.
What can be done?
After your full recovery from pregnancy,
it’s possible you will still have
moderate to severe rectus diastasis.
If physiotherapy or other methods
of treatment are not successful
in alleviating back pain or other
symptoms, the rectus diastasis can
be repaired with surgery. This involves
surgical suturing of the rectus muscles
to re-oppose them.
For severe skin laxity, a procedure
called abdominoplasty (a.k.a. tummy
tuck) can be done during the same
surgery. The procedure involves
mobilising the anterior abdominal skin
and subcutaneous tissue, redraping
it, and trimming the excess tissue. It
leaves a curvilinear scar in the lower
abdomen. Preoperative markings
are made to ensure the scar can be
concealed under most bikini bottoms. A
Caesarean Section scar can be excised
in the process.
What is the recovery like?
The procedure takes around four hours
and is performed under general
anaesthesia. Most patients can be
discharged in two-three days, return
to work in a week, and resume light
exercise in about two weeks. Heavy
lifting should be avoided for six weeks
though. Your doctor may ask you to
wear a pressure garment to facilitate
your recovery.
After the surgery, women can
gradually resume abdominal exercise
to strengthen their weakened muscles
and overall core function.
Dr. Richie Chan
Specialist in Plastic Surgery
OT&P has five clinics
located clinics across
Hong Kong.
www.otandp.com
Winter 2019
19