Like most new moms, Olya*, 31, expected her body to change after pregnancy and childbirth. But the Bellevue mother of two didn’t anticipate how drastic the transformation would be. Six months after giving birth to her second child, she still looked six months pregnant. Well, sort of — her belly didn’t actually resemble pregnancy’s evenly round bump. Rather, it slanted to one side, with a protruding belly button that looked like the end of a half-inflated balloon.
She felt cosmetically disfigured, she says, and that wasn’t even the worst part. Every day, she fought lower back pain, aching numbness in her legs and debilitating fatigue. “By the end of the day, I couldn’t even stand up,” she says.
Worried that something was seriously wrong, Olya consulted her primary care doctor, who scanned her pelvis via ultrasound and declared her healthy. Unsatisfied, Olya made an appointment with her ob-gyn. After a brief physical exam, her doctor suspected diastasis recti, which is a vertical separation of her lower abdominal muscles, and an umbilical hernia near her belly button.
Olya was referred to Helen Kim, M.D., of Proliance Surgical Specialists at Bellevue’s Overlake Hospital Medical Center. Kim confirmed the diagnosis. Pregnancy and childbirth had left Olya with severely damaged abdominal muscles. Unable to properly support her lower back and internal organs, Olya’s compromised core caused her backaches, leg pain and weakness.
And there was even worse news: All the sit-ups in the world wouldn’t help. The strain of pregnancy had forced the muscles to separate beyond the point of self-healing. The good news: There was a fix. Olya needed an abdominoplasty and a hernia repair, a package of surgical procedures better known as a “mommy makeover.”
Fixing the floor
Olya is not alone. At least one-third of all women experience problems related to the pelvic floor — a hammock-like layer of muscle and connective tissue that supports the uterus, vagina and bladder. While tears in the abdominal wall like Olya’s are less common, any issue with the area can wreak havoc on a woman’s physical appearance and quality of life, says Kim.
Enter mommy makeovers, designed to help women regain their pre-baby bodies. The surgery can include a number of different procedures, including breast augmentation, breast reduction and vaginal tightening. Depending on the needs of the patient, mommy makeovers can also correct prolapsed, or collapsed, pelvic organs, including the uterus, bladder and vagina, to remedy pelvic pain, urinary incontinence and pain during sex.
Plastic surgery is nothing new; according to the American Society of Plastic Surgeons, the number of tummy tucks performed in the U.S. increased 85 percent between 2000 and 2010. In Seattle alone, the number of locals researching mommy makeovers has jumped 32 percent in the past year, according to Seattle-based RealSelf, an online community and resource for information on cosmetic procedures.
These fixes cost a pretty penny. Because procedures such as breast augmentation and vaginal rejuvenation are considered elective, they’re often not covered by insurance. (Surgeries such as hernia repair and to correct prolapse usually are.) Per RealSelf, mommy makeovers cost an average of $12,000, but can set patients back as much as $50,000. But many women, including Olya, say it’s well worth the cost.
“My husband and I talked about it and decided to go forward with the surgery,” she says. “I needed to be able to care for my children without pain. That’s the most important thing to us.”
Therapy without bandages
Surgery isn’t always the obvious choice, however. It can be pricey, carries risks and often isn’t recommended for women planning additional pregnancies. That’s when nonsurgical pelvic floor physical therapy (PT) might help.
While PT can’t repair abdominal muscle tears or hernias like a surgical mommy makeover can, a 2016 study shows that basic strengthening exercises effectively treated mild pelvic organ prolapse, helped stop urinary incontinence and reduced or eliminated pelvic pain. Common exercises include pelvic floor contractions (aka Kegels), lunges, squats or small, controlled movements such as squeezing a rubber ball between the knees.
The results can be surprising. Tacoma mom Amber started pelvic floor PT when her now 2-year-old son was 6 months old. She wanted to stop leaking urine whenever she sneezed. Amber figured she needed to tighten her pelvic muscles, but PT revealed that it was her overly tense pelvic muscles that were actually causing the problem.
Amber’s physical therapist used vaginal biofeedback, an electrical readout that showed the levels of tension in her pelvic floor, to help her learn to relax those muscles.
“Now, I’m always mindful of tension in my pelvic floor,” Amber says. “I know what to do when symptoms flare up.”
A doctor’s referral isn’t necessary for PT, although many women talk to their ob-gyn or midwife about the option. Treatment is often covered by insurance and generally involves three to six sessions every few weeks, with exercises assigned as “homework” between sessions.
It’s never too late to seek out pelvic floor PT, says physical therapist Peg Maas, a board-certified women’s health specialist at Seattle’s Swedish Medical Center. “There’s not a window of time for addressing these concerns, even if it’s been years since you gave birth.”
As for Olya, she got surgery last September. She’s still recovering, but her back and leg pains are gone, and her energy has returned. At her six-month checkup she was given a clean bill of health and told to “go out and live life.” That, she says, was always the goal.
“I wanted to be active with my kids. I wanted to play with them and chase them and lift them up. That’s what this was about, for me,” she says. “Recovery has been tough, but I would do it again.”
*Name changed for privacy