Help! I still look pregnant despite giving birth eight years ago

Dr Flo,
I am 39 years old. I have two children. I still have a big and flabby stomach despite my youngest being eight years old. I used to have a flat tummy. I have worked hard for the past five years through dieting and exercise and I have gone back to my previous weight, but my tummy still looks the same. Sometimes people think I am pregnant because of my small body and the big stomach. What can I do about it?

Mercy

Dear Mercy,

The abdominal wall has several muscle layers. The ones closest to the skin, the “six-pack” muscles (Rectus abdominis), are two sheets of muscle on the left and the right that run from up to down and meet in the midline. During pregnancy, the abdominal muscles and tissues expand because of the growing baby, and also because of the pregnancy hormones. In many women (60 per cent), this expansion during pregnancy or the process of labour leads to separation of the left and right rectus muscles (diastasis recti). This causes a pooch or bulging of the tummy. The bulge is more visible when you strain your abdominal muscles. You may also develop back pain, pelvic pain, urine incontinence or constipation.
As the muscles regain strength after delivery, the gap between the muscles starts to shrink. In some people, however, the separation does not correct completely.
To check if you have the separation, lie on your back, legs bent, feet flat on the floor, then raise your shoulders up off the floor, supporting your head with one hand, and look down at your tummy. Move your other hand above and below your bellybutton, and along your midline ab muscles and see if you can fit any fingers in the gaps between your muscles. A physical therapist can also check if there is separation and check the width using calipers if it is there. An ultrasound can also be done to check for the separation.
To manage it, you need a skilled personal trainer so that you get exercises that are specific for the issue. Exercises that make the tummy bulge out like sit-ups and crunches may actually worsen the situation. In cases where the separation is severe, surgery can be done to correct it.

Dr Flo,

What causes dandruff on the head and what is the cure for this? I have had it for many years and I do not know how to treat it.

Musa

Dear Musa,

Dandruff refers to white flakes of dead skin on the scalp, which may also be associated with itchiness and scaling of the scalp. This can be due to seborrheic dermatitis, where the skin is irritated, inflammed and oily; or due to dry skin; or due to build up of dirt and skin cells because of not washing hair regularly. It can also be due to fungal infection or due to contact dermatitis, that is, irritation of your skin because of being sensitive to hair products.
Dandruff is more common in men, in people who have oily scalps, in people who have some neurological diseases and those with weak immune systems.
The condition may last for several years or even a lifetime. To manage it, wash your hair and scalp daily with a mild shampoo to remove dead cells and dirt. Also avoid scratching your scalp because it irritates the skin, which may lead to more itchiness and scaling. Avoid over-drying your scalp, for example by being in the sun for long and not taking enough fluids. If this does not work, you can use medicated shampoos and you may need to try several until you find one that works for you.
Since you have had the dandruff for a long time, you would benefit from visiting a dermatologist for examination of the skin, diagnosis and treatment.

Dr Flo,

I am 21 years old. I usually experience sharp pain in my breasts just before and during periods, and they feel swollen. Could this be something serious? What should I do?

Wangechi

Dear Wangechi,

What you are experiencing is actually a normal response of your breasts to the hormone progesterone. Progesterone levels rise after ovulation, that is, around two weeks after your periods, and stay until your next period. It is not an illness. You could have a breast check up and ultrasound scan to ensure that nothing else is wrong with your breasts. You can take painkillers to try and manage the pain and also use bras with good support.

Dr Flo,

I had a pimple on the back of my head, I pressed out the pus, then it developed again. This happened on and off for several years. There is no more pus, but there is a swelling which itches at night and when it is hot. It has grown bigger, it is dark in colour and looks shiny. I also have several similar swellings on my chest which sometimes itch. What could this be?

J W

Dear J W,
It seems as though you may have keloids, which are an overgrowth of scar tissue. When there is an injury or infection on the skin, scar tissue forms to protect the area and help with healing. A keloid may be reddish or brown in colour, it may be itchy, and it may grow over time. You can have keloids forming where there is a rash, cut, burn or even an injection site. You are more likely to develop keloids if one or both of your parents have it.
Keloids are usually not dangerous. If the growth continues or if you want it removed, visit a dermatologist. After examination, a test may be done to check for other diseases. Treatment may involve steroids, cryotherapy and laser or radiation treatments.

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