Ask the Doctor: Five years after my last baby was born, I still look pregnant. How can I fix this?


Question: I still look pregnant – especially after a big meal, five years after my last baby. She was transverse oblique and a cesarean section. I train regularly – strength training with many basic exercises and still nothing helps. I may have diastasis recti – I feel like I can get a finger and a half in the gap. Is there anything I can do at this stage? In addition to cosmetics, does this also cause problems?

dr Grant replies: Rectus abdominal diastasis (RAD), or divariation of the rectus abdominis, is common in adults. The term describes the unusually wide distance, usually defined as 2 cm, that separates the two rectus muscles. Located in the center of the abdomen on either side of the belly button, these two large parallel bands of muscle are responsible for building the legendary “six pack abs” in the lucky few. Pregnancy, especially twins and triplets, is an obvious risk factor, but being overweight also puts you at risk of developing this condition. As the uterus grows during pregnancy, the abdominal muscles stretch and the connective tissue that lies between the two bands of muscle (linea alba) thins and stretches. In most women, with normal weight loss after childbirth and cessation of breastfeeding, the linea alba recedes within two months.

It’s easy to spot RAD. Simply lie flat on the bed and raise your head, similar to a sitting position. You may notice a small bulge running down the middle of the abdomen, most commonly between the belly button and the lower tip of the breastbone. The presence of RAD is one of the factors that contribute to your tummy protruding months or years after birth.

Other things that can contribute to your “pregnant looking” belly are the natural accumulation of body fat with age (estrogen increases women’s propensity to gain belly fat); the possibility of hormonal imbalance (for example, hypothyroidism or early menopause); or irritable bowel syndrome (IBS). And let’s face it, years of poor nutrition and heavy drinking contribute to this.

RAD itself is benign and does not pose a serious health risk. However, if the separation of these two muscle bands is severe enough, it can result in an umbilical or epigastric hernia.

These are considered an extra bulge and may contain fat and/or some loops of intestine. Most new or early-onset hernias are reducible, so you can push them back into the abdominal cavity. Unfortunately, a hernia can cause intestinal entrapment (strangulation) that leads to emergency surgical repair. The presence of a hernia is a strong indicator for an elective (preplanned) corrective surgical repair in the form of an abdominoplasty or “tummy tuck”.

A tummy tuck can take up to three hours to be performed and is typically accompanied by liposuction. Of course, if your RAD is not severe enough to warrant surgery, you can opt for minimally invasive liposuction under sedation (rather than general anesthesia). If you are considering this, I recommend that you see a registered plastic and reconstructive surgeon.

Before deciding to have surgery, you should consider at least six months of non-invasive treatment and ask yourself if you’re happy with your results.

dr Jennifer Grant is a GP at Beacon HealthCheck Ask the Doctor: Five years after my last baby was born, I still look pregnant. How can I fix this?

Fry Electronics Team

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