Tummy Tuck Considerations
Why is a pelvic floor physical therapist blogging about a tummy tuck?? I thought they were “all natural” and “anti-surgery” kinds of people. First of all, we are not anti-surgery by any means. Pelvic floor physical therapists generally do encourage people to try the most conservative measures possible (seeing your pelvic floor physical therapist) prior to jumping into a surgery as a means to “fix” something. Secondly, when surgery is necessary, we are definitely proponents of having all of the information before getting started. Thirdly, surgical candidates often benefit from meeting with a pelvic floor physical therapist BEFORE AND AFTER the surgery.
Let’s get to it, what is a tummy tuck? The medical procedure is actually called an abdominoplasty. This procedure typically is performed to remove excess or loose skin of the belly (often postpartum), remove excess belly fat, and to tighten weak fascia in the abdominal wall. Stretch marks below the belly button can be often be removed during this procedure, and any existing C-section scars can often be incorporated into the abdominoplasty scar.
One common postpartum condition that might lead someone to consider a tummy tuck is Diastasis Recti, which is a separation of the rectus abdominis muscles (the vertical abs that create the “six-pack” look to our abs). The separation of the rectus abdominis muscle is a normal part of pregnancy as the abs separate to create space for the growing baby. In the postpartum period, most women will see a significant decrease in the gap between the abs, and as we have discussed in a previous blog it is common for women who have symptoms related to this ongoing gap to see a pelvic floor physical therapist to help them recover from this condition.
Most women see a significant improvement of their symptoms with re-training their core muscles with the help of a physical therapist, but a gap might still remain in their abdominal wall. There are two main reasons that someone may choose to have surgery with Diastasis Recti - 1. Cosmetically they would like to decrease the space between their abs, or 2. They do not feel as though they are able to achieve enough strength/stability of their core despite training the muscles in order to return to their previous levels of function, such as returning to high level weight training or competitive athletics. In either case, it is important to note that abdominoplasty is almost always considered a cosmetic procedure and may be subject to exclusion from your insurance coverage.
Undergoing a tummy tuck is no joke! Abdominoplasty is major abdominal surgery and takes many months to recover completely, likely up to a full year. Making the decision to have a tummy tuck procedure should not be taken lightly, as much preparation should go into the months and weeks leading up to the surgery. Just like other procedures, seeing a physical therapist to strengthen and coordinate muscles prior to the surgery will ultimately assist in your recovery post-surgically. Meeting with surgeons to have a good idea of the healing timeline post-surgical is also important, so you understand the need for assistance of childcare and household chores, as well as accommodations for your sleeping arrangements that might need to be made (recliner chair versus a bed).
After a tummy tuck, the surgeon will have tightened the fascia (thick fibrous tissue that connects our muscles) throughout the abdomen and it is common to experience difficulty with relaxing the abdomen in the post-surgical phase. This can create too much tension in the core and even lead to urinary leakage, prolapse, or pelvic pain symptoms that may not have been present pre-surgically. Again, this is when it is imperative that you have a connection with a pelvic floor physical therapist post-surgically that can properly guide you through care while healing from the tummy tuck procedure. Even if none of those symptoms appear post-surgically, a pelvic floor physical therapist can help guide you through how to slowly progress abdominal strengthening to help you reach your goals post-surgically in a way that is safe and will not compromise the surgeon’s work.
If you’re considering a tummy tuck procedure, I suggest you reach out to a pelvic floor physical therapist who can work alongside your surgeon to provide you the best possible outcome!
Written by: Renee Hancock, Physical Therapist, Pelvic Floor Specialist
