Tips to protect a key body part you may not think about

It is a large part of the body that lies deep inside, out of sight and perhaps out of mind: your abdominal core. A new and rapidly developing area of medicine focuses on abdominal core health, including how people can incorporate it into a healthy lifestyle and how to address complex medical problems that arise when it is compromised.

We asked Dr. Charlotte Horne, a Mayo Clinic metabolic and abdominal wall reconstructive surgeon, about the importance of abdominal core health, how to protect it and how to identify risk factors for problems that may require surgery.

“The abdominal core is the outside muscular container of your abdominal wall,” Horne says. “This starts at the diaphragm and goes all the way down to the pelvic support muscles. Most of the core is muscle and connective tissue. It’s a muscular container that holds your internal organs in. Every time you breathe, bend, bear down to have a bowel movement, you’re using these muscles.”

The abdominal core includes abdominal muscles that people may think of as the “six-pack” and oblique muscles and tissue that wrap all the way around the upper part of the abdomen and connect to the midline of the body, Horne adds. Many nerves lie between the layers of muscle and tissue, including those that extend to the groin, thighs, back and hips.

Those muscles function as a unit, and that unit needs to operate well for you and your body to perform daily activities, Horne says. One way to strengthen the structural integrity of your abdominal core is to engage it during your normal activities, she explains: You do not have to do thousands of situps or become a bodybuilder.

“One of the things we’re realizing is that we need to educate people how to appropriately engage those muscles when they do everything from going from lying to sitting and sitting to standing, lifting objects and other basic movements in their daily lives,” she says. “When people do yoga or Pilates, they think about pulling their belly button into their spine. That helps stabilize the deeper muscles of the abdominal wall.”

Improving abdominal core health involves conscious engagement of the abdominal muscles, “bringing everything in and holding it in,” Horne says.

Abdominal risk factors

Risk factors for abdominal core problems are wide-ranging. They include cancer treatment; inflammatory bowel disease; chronic or severe coughing; and complications from pregnancy (diastasis recti) and surgery. The most common problems are hernias, when part of an organ or tissue bulges through a weak spot in muscle.

“Coughing can cause large hernias. When you’re coughing, you’re bearing down and there is a sudden, acute change in intra-abdominal pressure, almost like punching from the outside in or from the inside out,” Horne says. “When you’re doing that all of the time, it causes significant stress to your abdominal wall.”

Avoiding smoking and excessive alcohol consumption can help protect abdominal core health. Smoking increases the risk of chronic coughing, while heavy alcohol consumption to the point of cirrhosis can cause hormonal changes that in turn weaken the abdominal wall, Horne says.

Protecting your core

As knowledge about abdominal core health grows, approaches to protecting it and healing it are advancing, Horne says.

For example:

■ Pregnancy causes muscles to expand to accommodate a baby, and sometimes those muscles do not go back to normal. Exercise regimens during and after pregnancy can help to stabilize them.

■ Health care experts are realizing that restrictions on movement after surgery might not help and sometimes might be harmful. Rather than telling people not to lift anything, it may be more appropriate to explain how to safely re-engage those muscles and tendons, Horne suggests.

■ People with inflammatory bowel disease are more likely to have surgery and therefore are more likely to develop hernias. Surgeons now know that in those patients, mesh should be placed in different anatomic planes to prevent the mesh from touching the bowel and potentially causing problems later, Horne says.

■ Pelvic floor physical therapy can help women experiencing urinary or fecal incontinence after pregnancy or menopause, she says.

■ There is growing recognition that mesh used to repair hernias isn’t one-size-fits-all. Horne’s research focuses on hernia repair in women, including mesh and mesh techniques.