Hot search! A woman's intestines and internal organs bulged out after giving birth to her second child! Everyone needs to know about this disease...

Recently, a hot search about "a woman's intestines bulged out after giving birth to her second child" caused concern among many female friends.

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The internal organs in the abdominal cavity should be perfectly and reliably protected by the abdominal wall muscles, fat and other tissues. However, women with loose abdomens after giving birth can actually see the movement of their intestines directly in their abdomens. This will undoubtedly make people scared and worry about their health and even the safety of their lives. It will also make women who originally had plans to have children even more panicked.

The disease that causes this symptom is called "rectus abdominis separation". This article will explain it in detail, hoping to help pregnant women who have already experienced rectus abdominis separation, and also provide a reference for rational analysis of fertility risks for female friends who are planning to have children.

What is rectus abdominis separation

People with low body fat percentage, especially those who exercise their abdominal muscles seriously, can see "eight-pack abs". The eight-pack abs are actually the rectus abdominis muscles, and the groove in the middle is a white fiber-like structure formed by the fusion of the aponeurosis of several groups of abdominal muscles, called the "linea alba".

The essence of rectus abdominis separation is that the linea alba becomes loose and weak. When the pressure in the abdomen increases, this weak area will bulge out, and the internal organs that were originally protected in the abdominal cavity will also bulge out, forming a longitudinal bulge, which looks like the abdominal muscles are separated from the middle, so it is called "rectus abdominis separation". Our intestines are constantly moving slowly. If the fat layer at the part where the rectus abdominis is separated is not thick, the movement of the intestines can be seen on the bulge.

In the past, when defining this disease, some scholars used a distance between the rectus abdominis muscles of ≥ 2 cm as the basis for diagnosis. However, studies have found that some people do not have visceral bulging despite a widened distance between the rectus abdominis muscles, while some patients, despite having a flat abdomen and normal distance between the rectus abdominis muscles, still have bulging of the linea alba after increased abdominal pressure [1].

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Therefore, abdominal rectus separation is more likely caused by excessive stretching of the entire abdominal wall, rather than just widening of the linea alba. Although the name of the disease is "abdominal rectus separation", the width of the linea alba, that is, the distance between the rectus abdominis muscles, is not the most reliable assessment standard for abdominal rectus separation. Whether there is bulging of weak parts and how severe the bulging is are also important references for diagnosing the disease and medical intervention.

Causes of Rectus Abdominis Separation

Many people have heard of "rectus abdominis separation" from their own or others' experience of childbirth. In fact, childbirth is not the only cause. There are many causes of rectus abdominis separation.

A variety of congenital developmental abnormalities are associated with rectus abdominis separation[2]. Among acquired factors, pregnancy experience, obesity, and diabetes are all risk factors for rectus abdominis separation[3]. Since rectus abdominis separation is related to the relaxation of the abdominal wall muscle fascia, which belongs to connective tissue, some diseases involving connective tissue can also affect rectus abdominis separation[4]. Therefore, rectus abdominis separation is not a problem exclusive to postpartum women, but a disease that can be encountered by men, women, young and old.

However, despite the various causes, the pregnancy experience is still the most important influencing factor. Throughout the pregnancy, the uterus, which contains the fetus, placenta, amniotic fluid and other contents, continues to grow, the abdominal wall also expands, and the pelvic floor continues to bear increasing pressure. This means that every pregnant woman may face the risk of rectus abdominis separation.

One study showed that 100% of pregnant women had abdominal rectus muscle separation at 35 weeks of pregnancy, but this percentage dropped to 39% six months after delivery.[5] Another cross-sectional study found that 20.9% of women still had midline protrusion six to eight months after delivery, and nearly 80% of women said their abdominal muscles were weaker than before pregnancy.[6]

These studies and a large number of clinical follow-up results have shown that abdominal rectus muscle separation peaks in the third trimester and is relieved after delivery. Although most people can gradually recover after delivery, a considerable proportion of people still have abdominal rectus muscle separation after delivery. Moreover, women who are older and have had more pregnancies are more likely to have abdominal rectus muscle separation[3].

The dangers of rectus abdominis separation

As mentioned above, rectus abdominis separation means that there are weak areas of loose abdominal wall. Therefore, once you encounter situations where you use abdominal pressure, such as lifting heavy objects or sitting up from a supine position, these weak areas will bulge excessively under pressure, and in severe cases, you can even see the shape and movement of the intestines in the abdominal cavity.

Fortunately, although this symptom looks very scary, it only means that the protective ability of the abdominal wall is reduced, and there is no direct harm to the internal organs. However, it is worth mentioning that it is necessary to distinguish between rectus abdominis separation and another disease with similar symptoms but much more dangerous - abdominal wall hernia.

Although patients with rectus abdominis separation can see bulges and even intestinal tracts in their abdomen, the abdominal wall itself is intact and there is no risk of intestinal tract getting stuck. Abdominal wall hernias can also cause abdominal bulges and visible intestinal tracts, but that is caused by congenital or acquired abdominal wall defects or weakness, which then causes the intestinal tract and other organs in the abdominal cavity to protrude through the defects to the surface of the body. In this case, there is a possibility of intestinal incarceration. If the intestinal tract gets stuck in the gap, there is a risk of strangulation, obstruction, and even ischemic necrosis.

Therefore, if related symptoms occur, especially when the intestines can be seen in the bulge in the abdomen, it is best to go to the hospital and let an experienced doctor identify it. If it is only caused by rectus abdominis separation, there is no need to worry. If it is caused by abdominal wall hernia, surgery is required to repair the gap. In rare cases, abdominal wall hernia and rectus abdominis separation may exist at the same time. Cesarean section wounds occasionally heal poorly, and abdominal wall incisional hernia may also occur in parturients with rectus abdominis separation. Therefore, women who have cesarean section with rectus abdominis separation need to be more cautious and seriously rule out the possibility of abdominal wall hernia.

Back to the point, rectus abdominis separation means that the abdominal wall is loose and the abdominal muscles are weak. The abdominal muscles belong to the core muscle group of the body. The core muscle group has many functions such as maintaining posture, supporting the spine, protecting internal organs, and maintaining body stability and balance. Therefore, as a member of the core muscle group, weak abdominal muscles will also lead to a series of related functional impairments accordingly. For example, it will be difficult to complete some movements that require abdominal pressure, and the body's stability will decrease. Long-term abdominal muscle weakness may also affect the body posture, causing excessive fatigue of the back and waist muscles, and causing low back pain. Although these hazards are not as intuitive as abdominal bulges, they actually affect women's physical health.

Prevention and solution methods

According to the risk factors for the disease, controlling weight to avoid obesity, preventing diabetes, and making reasonable birth plans are the most effective and fundamental prevention methods. If you are sure you have a birth plan, develop a habit of physical exercise. Prenatal exercises to strengthen the abdominal muscles can significantly reduce the risk of rectus abdominis separation [7].

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Most people can recover on their own after childbirth. If the recovery is not ideal, the current first-line treatment is still to control weight, avoid obesity and exercise[8]. Exercises especially emphasize strengthening the rectus abdominis muscles, which can improve rectus abdominis separation[7,8]. If necessary, you can ask a professional doctor to guide the exercise.

If exercise does not produce good results and you do not plan to have children in the future, you can choose surgery to tighten the loose linea alba and skin to improve your appearance and restore abdominal wall function.

Last words

Having a child is a very important decision. It not only means that you have to be responsible for a new life, but also means that many physical changes brought about by childbirth are irreversible. Therefore, before deciding to have a child, you should fully understand the various benefits and risks and make a prudent decision.

However, after entering clinical work, I realized that many people actually know nothing about pregnancy and childbirth, not to mention the various possible risks and diseases. They only realize that childbirth is risky after they have encountered various problems. This is wrong, and no one should be forced into this way.

So every time I see related topics, I really want to talk about it. I hope to provide reference for girls who have not yet given birth, help women who have childbearing plans to prepare for what may happen, and hope that women who have already encountered various problems can get help.

References

[1]BraumanD.Diastasisrecti:clinicalanatomy.PlastReconstrSurg.2008;122(5):1564-1569.doi:10.1097/PRS.0b013e3181882493

[2]DigilioMC,CapolinoR,DallapiccolaB.Autosomal dominanttransmissionofnonsyndromicdiastasisrectiandweaknessofthelineaalba.AmJMedGenetA.2008;146A(2):254-256.doi:10.1002/ajmg.a.32044.

[3] CavalliM, AiolfiA, BruniPG, etal.

[4]McPhailI.Abdominalaorticaneurysmanddiastasisrecti.Angiology.2008;59(6):736-739.doi:10.1177/0003319708319940

[5] Fernandes da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis rectiabdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvicpain. ManTher. 2015;20(1):200-205.doi:10.1016/j.math.2014.09.002

[6]GluppeS,EllströmEnghM,BøK.Primiparouswomen'sknowledgeofdiastasisrectiabdominis,concernsaboutabdominalappearance,treatments,andperceivedabdomin almusclestrength6-8monthspostpartum.Acrosssectionalcomparisonstudy.BMCWomensHealth.2022;22(1):428.Published2022Nov2.doi:10.1186/s12905-022-02009-0

[7]BenjaminDR,vandeWaterAT,PeirisCL.Effectsofexerciseondiastasisoftherectusabdominismuscleintheantenatalandpostnatalperiods:asystematicreview.Physiotherapy.2014;100(1):1-8.doi:10.1016/j.physio.2013.08.005

[8]AkramJ,MatzenSH.Rectusabdominisdiastasis.JPlastSurgHandSurg.2014;48(3):163-169.doi:10.3109/2000656X.2013.859145

This article is a work of Science Popularization China-Starry Sky Project

Produced by: Science Popularization Department of China Association for Science and Technology

Producer｜China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.

Author: Doctor Feidao Duanyu

Reviewer: Lan Yibing, deputy chief physician, Department of Obstetrics and Gynecology, Zhejiang University School of Medicine