Treating incontinence with a tummy tuck (Ep. 53)

The other day I was in the office and had a patient came back to see me six months after her abdominoplasty. And this is a patient who is fairly typical of the abdominoplasty patient population. She was in her early forties. She had had a couple of kids and wanted to reverse the changes. that had occurred in her stomach area after having her children.

Now, the one thing that made her a little bit different than most of my abdominoplasty patients is that the complaint that brought her into the office was very different. She complained primarily of stress incontinence. So anytime she would run, she would cough. She would laugh. She would get on a trampoline with her kids.

She would leak a little bit of urine. It was super embarrassing as you can imagine. And if this is you, you know how embarrassing that is, but her cosmetic complaints were really secondary to her functional complaints. And as we got to talking back at her initial consultation, we really got into the functional improvements that we make with it.

tummy tuck surgery. Now, if you go back and listen to the tummy tuck podcast, and I'll put the link in the show notes here. There are really three things that we do when we do an abdominoplasty. We address loose skin. We address extra fat and then we address the muscle laxity that accompanies pregnancy or significant weight changes.

And it is the muscle improvements that can improve the symptoms of stress incontinence.

Now, how this actually works, we don't 100 percent know, but we are I'm pretty certain that it is related to the pressure changes and the reestablishment of the normal functional movements and normal functional patterns of the musculature of the anterior abdominal wall. So after having children, the muscles of the anterior abdominal wall stretch.

Your rectus muscles or your six pack muscles, which are supposed to go straight up and down between your lower rib cage and the front. part of your pelvis widen and separate in the middle to varying degrees. Some women have just a small amount of rectus diastasis. Some women have significant amounts of rectus diastasis.

So as much, almost as wide as my hand or wider. And as you can imagine, that significantly impacts the function of those muscles. They can no longer pull in a straight line. They're trying to pull in an arc. You lose a lot of power that way. women end up not only with stress incontinence, but with chronic lower back pain because of core muscle imbalance.

The back is stronger than the front and trying to compensate. So you lean forward and are using accessory muscles and end up. with really chronic lower back strain. So by re establishing, re centering those muscles, straightening them up and down in the midline, we can re establish the function of those muscles.

We also change the pressure on the inside of your abdomen, which, you know, in the way that women's bladders and urethra and all that are put together, pressure changes and decreasing in pressure can cause the bladder and urethra to change slightly in their anatomy and is thought to contribute to some of that stress incontinence.

And this is a benefit of abdominoplasty surgery that is really overlooked. It is not uncommon for me to be in consultation with patients who are seeking a mommy makeover or a tummy tuck. And they end up saying, well, you know, I know I've got some rectus diastasis, but my primary care doctor sent me to a physical therapist to help improve that.

And the unfortunate reality is that all but the most minor. rectus diastasis really needs surgery to fix. There is no amount of physical therapy that is going to shrink, loosen, stretched out tissue in your midline, and bring those muscles back together. It just didn't going to happen. And so as that diastasis is worse or gets worse, then.

Fixing those muscles really becomes important because you can't fix it any other way. How is that done? So with an abdominoplasty or tummy tuck, you know, everybody's familiar with the incision down low in the panty line. Those muscles are exposed and then using permanent sutures, those muscles are drawn back together.

Toward the midline and repaired straight up and down the middle and it takes muscles that are curvilinear they're shaped like this and Makes them go straight up and down again and you know the shortest distance between two points is a straight line and You can generate the most power pulling a straight line as opposed to pulling in a semi circle.

What women will notice after abdominoplasty surgery is that certainly after their recovery, you know, so six weeks, two months, three months and beyond, that their lower back pain has significantly improved, if not completely resolved, and that stress urinary incontinence, so incontinence with Jumping, running, laughing, coughing has significantly improved or has completely gone away, as was the case with my patient.

She actually almost started crying when she was relating the story that she had just finished a 5K for the first time since she had had kids. and hadn't urinated on herself. And it sounds kind of gross, but it was really a touching moment. And the kind of moments that make this profession so enjoyable.

There are a couple of studies in our literature, which I'll also link in the show notes, that have looked at this. Populations of 200, 250 patients that have been reviewed. Anywhere between 50 and 90, I think it's 90 percent of women with stress incontinence experienced some form of improvement.

After an abdominoplasty surgery. So this is something that's not just a, one off here in the office. This is, been shown over and over again to be the case. So if you are one of those patients who is experiencing chronic low back pain after kids, if you're experiencing chronic stress urinary incontinence, then Consideration of an abdominoplasty, not just for the cosmetic benefit, but also to treat some of the functional problems that can be the result of multiple pregnancies or significant weight loss, is really something worth looking into.

So if you enjoyed this, please leave a five star review on Apple podcasts. That really helps the show out. If you have any comments, questions, or ideas for future shows, you can either DM me on Instagram @drjasonhall or you can shoot me an email media@drjasonhall. com. Thanks. And we'll see you on the next show.