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News — ROCHESTER, Minnesota — 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. , a metabolic and abdominal wall reconstructive surgeon at , explains what abdominal core health is, how to protect it and risk factors for problems that may require surgery.

"The is the outside muscular container of your abdominal wall," Dr. 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 includes abdominal muscles that people may think of as the 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, Dr. 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, Dr. 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 sit-ups 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 , 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," Dr. Horne says. 

Risk factors for abdominal core problems are wide-ranging. They include ; ; ; and complications from pregnancy () and . The most common problems are , 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," Dr. Horne explains. "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 can cause hormonal changes that in turn weaken the abdominal wall, Dr. Horne says. 

As knowledge about abdominal core health grows, approaches to protecting it and healing it are advancing, Dr. 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.
• Healthcare experts are realizing that restrictions on movement after surgery may not help and sometimes may be harmful. Rather than telling people not to lift anything, it may be more appropriate to explain how to safely reengage those muscles and tendons, Dr. Horne suggests.
• People with inflammatory bowel disease are likelier to have surgery and therefore are likelier 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, Dr. Horne says.
• 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. Dr. Horne's research focuses on hernia repair in women, including mesh and mesh techniques.

In her practice, Dr. Horne specializes in complex hernia surgeries.

"Most of the patients that I care for have more of their abdominal contents outside of their abdominal cavity than inside," she explains.

Even with hernias as large as 10 to 15 centimeters, surgeries can be performed with a robot to minimize the incision, or can be done with a mix of robotic surgery and minimal open surgery, Dr. Horne says. She uses 3D-printed models to help plan surgeries. Sometimes is used to lengthen the abdominal wall muscles, she adds.

"The best part is that patients go from a dysfunctional abdominal wall to one that is functional within about a week in the hospital," Dr. Horne says. "Seeing them at their checkup a year later is the best thing because they go from saying `I couldn't do anything' to `I've gone on all these trips, I've done all these things that I've wanted to do for years but haven't been able to.' They are so happy that they can put that whole thing behind them, which is great."

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