When the post-baby belly just won’t go away

When Annie had her baby, she was surprised that two months later, she still looked like she was five months pregnant.

The weight elsewhere had fallen off, but not around the tummy, and the skin there appeared flabby and wrinkly. Many women, just like Annie, struggle with the belly area after childbirth.

And most of these women may have a condition known as diastasis recti abdominis (DRA).

DRA is a partial or complete separation of the rectus abdominis muscles --also known as the six pack muscles, which meet at the mid line of the stomach.

This condition is a common occurrence during and following pregnancy since the uterus usually stretches the abdominal muscles to accommodate a growing baby. The muscles however are expected to shrink back after giving birth.

DRA is the condition where the muscles get pushed too far apart and don’t come back together as they should.  According to PubMed Central, DRA affects 60 per cent of women all over the world.

Who is most likely to get it?

A study that investigated sit up performance among women in New York found out that pregnant women had significantly weaker abdominal musculature compared to non-pregnant women. Dr Hussein Habib, a Mombasa- based gynaecologist, says that a few things increase chances of a woman experiencing DRA.

“Multiple pregnancies, being overweight and intrinsic factors such as genetics, predispose women to DRA after delivery. Closely spaced multiple pregnancies do that too because of repeated, prolonged stretching of abdominal muscles.”

Can it be corrected?

DRA does not resolve spontaneously and neither can you find quick fixes. However, it can be corrected.

 It is a common practice for Coastal women in Kenya to tie their tummies tightly with a cloth after birth. Others wear postpartum corsets. The intention is to tighten the abdominal muscles and prevent the bulging of the tummy so that with time, it becomes flat. But does it work?

“I have seen many mothers do it, but there really isn’t any scientific evidence to support the practice. What I know for sure is that postpartum physical exercises, done after being cleared by your doctor, can help.

They improve and maintain the tone of abdominal muscles. Also, it does help to have had strong abdominal muscles before pregnancy,” says Dr Habib.

Research published in the Journal of Women’s Health found out that out of all the women who experienced DRA, 90 per cent were those who had not exercised before they got pregnant or in the course of pregnancy. Also overweight women were more likely to suffer abs separation.

Sometimes DRA may need surgery

The effectiveness of physical exercise to correct DRA depends on the severity of the muscles’ separation. “Some women during pregnancy develop structural problems such as hernia. These protrusions have to be corrected before embarking on correcting DRA”, cautions Dr Habib.

He further adds that surgery may be considered to strengthen abdominal muscles especially when exercise and healthy diet have not been fruitful in getting the tummy to a better size or when the condition is causing a functional impairment.

Suitability for abdominoplasty also called a tummy tuck, depends on a myriad of factors including general health, underlying medical condition and smoking. Smokers are linked to complications in wound and tissue healing.

“Additionally, mothers are always advised to practice exclusive breastfeeding. EBF seems to play a role in baby fat management,” he says.

It is also important to note that such surgeries are considered “cosmetic” and they may not be covered by insurance.

Dr Mukuhi Ng’ang’a, a consultant general surgeon at Aga Khan University Hospital explains that the postpartum belly is different from the large belly found in overweight people. The latter responds relatively well to diet and exercise while DRA requires a lot more time and patience to correct.