New moms know that parenthood means grappling with a huge amount of change, as schedules, activities, and responsibilities are all affected.
Women who have given birth also have to adjust to their body post-pregnancy.
While some women undergo physical changes that are relatively minimal, the strain of pregnancy can leave other women with long-lasting changes that go beyond just aesthetics, causing chronic pain or urinary incontinence.
To help these women, doctors are now investigating the potential medical benefits of “tummy tucks,” or abdominoplasty.
New research from the journal Plastic and Reconstructive Surgery found that a tummy tuck may do more than just make cosmetic changes. It may improve both chronic pain and urinary incontinence.
Most people think of this surgery as a way to remove stretched skin or excess fat, such as after major weight loss.
But in postpartum women and some weight loss patients, the surgery also includes repairing abdominal muscle separation, or diastasis recti, by stitching it back together.
When Kileen Valenzuela, blogger at Cute & Little, started experiencing pain in her lower back on a daily basis after her second pregnancy, she sought the advice of her doctor.
“I was told that the problem was with my ab muscles and the fact that I didn’t have much of an abdominal wall left, as it had been severely stretched out with my pregnancies,” said Valenzuela.
Her doctor explained that her back was compensating for the loss of her ab muscles by trying to stabilize her core. They confirmed what she had already suspected: She had diastasis recti.
“I had noticed my abs protruding in a weird way even after I was ‘cleared’ for exercise,” said Valenzuela.
During pregnancy, the fascia, or connective tissue, between the abdominal muscles stretches to allow the abdomen to expand for the growing baby. It naturally retracts after pregnancy in most women, but in some cases it doesn’t, explained Dr. Alastair Taylor, a reconstructive and plastic surgeon with the Canberra Aesthetic Plastic Surgery Clinic in Australia, who didn’t treat Valenzuela.
Physical therapy can help in some, but not all, cases.
Valenzuela started work with a fitness professional who was trained on diastasis recti to try to rehab it naturally. She also tried a few online programs.
“While they did help me gain more awareness with my core, it didn’t fix my back pain issues, and ultimately I still had quite a significant amount of ab separation,” Valenzuela said.
“It got to a point where it would hurt even to sit at my desk,” she explained.
Her doctor suggested abdominoplasty to help with her back pain.
The evidence that a tummy tuck can help
In the study published this month, Taylor and his co-authors — from the Canberra Aesthetic Plastic Surgery Clinic in Australia and other institutions — looked at women who had given birth and who were planning on having a tummy tuck to see if the procedure could help with pain and urinary incontinence.
They studied 214 women who had an average of 2.5 deliveries and were an average age of 42 years old.
Before having tummy tuck surgery, they completed questionnaires assessing back pain and experiences with urinary incontinence and how both impacted their daily life.
Following the surgeries — which were done by nine different surgeons from different practices and using several different methods — the patients received the same questionnaire at six weeks and six months postsurgery.
By six months, the women reported an average improvement in back pain of 85 percent. Meanwhile, there was a 73 percent improvement in incontinence.
“Abdominoplasty not only restores the trunk to its prepregnancy shape, it also restores the function, converting a moderate disability to a trivial issue that no longer dictates what can be achieved,” said Taylor.
The symptoms that can last after giving birth
Back pain and incontinence are two of the major physical problems that women face after pregnancy, especially after twins, bigger babies, or multiples, said Dr. Alexes Hazen, a reconstructive and cosmetic plastic surgeon at NYU Langone Health, who didn’t work on the study.
The study notes that between 5 and 21 percent of women experience chronic back pain more than two years after childbirth. A whopping 25 to 38 percent of women experience urinary incontinence 10 to 12 years after pregnancy.
The abdominal muscle separation and weakness from pregnancy leaves the lower back unstable and unsupported, but repairing and tightening the core can help, Hazen said.
The procedure can also provide relief by off-loading any excess skin, which can be like carrying around another 5 pounds, weighing down the back.
“Incontinence is often a result of the internal muscles of the actual pelvic floor, which are different than the abdominal muscles,” Hazan explained. “So if the urinary incontinence is due to that, then the tummy tuck will not improve the incontinence. If however, there are other contributing factors, then perhaps it could help.”
The study authors noted that they have several theories as to how the tummy tuck could improve urinary symptoms, but aren’t entirely sure of the exact mechanism.
One strong theory is that the procedure returns some of the tension distributed throughout the fascia network that’s lost during pregnancy. This could lengthen the urethra and improve urinary continence.
Still viewed as a ‘cosmetic’ option
Valenzuela was surprised to find that the procedure, which she deemed a medical necessity, wasn’t covered by insurance. Instead it was considered a purely aesthetic surgery.
Still, she was financially able to afford the procedure and wanted to have it done for her health. “It seems unfortunate that those who cannot financially afford it do not have an option,” she said.
For her, the surgery has been life-changing. “I don’t have back pain anymore, and I feel like myself,” she explained, noting that the first month after surgery was hard due to the recovery process.
Most insurance companies don’t consider abdominoplasty a medical necessity, therefore it’s not covered — despite the positive health outcomes it can have for postpartum women.
“I think they absolutely should cover the muscle repair part of the surgery,” said Hazan. “And if the skin overhang is significant, they should [cover that] as well.”
“There are many operations performed for relief of chronic pain and instability,” said Taylor.
If someone were to rupture their ACL in their knee playing a sport, for example, they’d get it fixed instead of living with the pain, he explained. And insurance would cover the cost of the surgery.
“Abdominoplasty can be seen as a procedure to fix similar instability and pain issues that only get worse with time,” he said.
With more widespread research on the health benefits that can come from abdominoplasty in postpartum women, it’s possible that the procedure could be covered by insurance in the future.
Until then, women will have to shell out their own money if they want the surgery.