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Stretch marks. Striae Gravidarum. The marks of pregnancy. Call them what you will. But they are the one thing that all women dread will occur as soon as they get pregnant.

• But what are stretch marks anyway? And why do they occur?
  Well, the reason lies in the anatomy of the skin. The skin has two layers a thin upper layer called the epidermis, and a thicker, lower layer called the dermis. Scattered in the dermis are fine protein filaments called elastin that, like a piece of rubber band, are capable of stretching on being pulled. But just as a rubber band can stretch only so far and no further, these elastin fibres can also be stretched only to a certain extent. If stretched further, they snap. The increasing bulk of the uterus during pregnancy causes the skin to stretch to a great extent and the elastin fibres are torn. The torn elastin produces scars on the skin called Stria Gravidarum or stretch marks.
  

• They occur on the lower abdomen of all pregnant women, right?
  Well, right and wrong. They appear in most pregnant women, but not in all and not just on the lower abdomen. Stretch marks occur when the skin is stretched in a very short period of time, as in pregnancy or in obesity. They occur:
  • In the lower abdomen in pregnancy.
  • Along the sides of the breasts either in pregnancy or in obesity.
  • Upper thighs.
  • Occasionally even on the inner sides of the upper arms.
  
  

• But can stretch marks be prevented?
  Thankfully, the answer is yes, to a certain extent. Although some women are genetically prone to develop stretch marks, it has been noted that athletes and women accustomed to heavy, physical labour get very few or no stretch marks. This is regardless of whether their female relatives have stretch marks or not. The reason for this is that that these women have very well-developed and strong abdominal muscles. These muscles can easily take the weight of the growing uterus and prevent it from pressing forwards on the skin rather like wearing a strong muscular belt under the skin. The skin is thus stretched less, less elastin fibres are damaged, and there are fewer stretch marks.
  
  Again a supple, healthy, well moisturized skin is capable of stretching more without any lasting damage. So if a woman can strengthen her abdominal muscles and keep her skin healthy and supple, there is less chance of her developing stretch marks.
  

• But how? How do I develop my muscles and keep my skin moisturized?
  Gentle exercises for the abdominal muscles can be started as soon as pregnancy has been confirmed or even as pregnancy is being planned.
  • Exercise 1 : Standing erect, raise both arms above the head. Bend forward slowly to touch your toes. Hold the position for a count of 100. Then slowly straighten up. Do this exercise at least once daily.
  • Exercise 2 : Standing erect, raise both arms above the head and clasp your hands. Now bend slowly to your left as far down as you feel comfortable. Hold for a count of 10. Straighten up slowly and then bend to your right. Hold to a count of 10. Straighten up. Exhale as you are bending and inhale while straightening up. This makes one set. Do at least 3 sets once daily.
  • Exercise 3 : Stand straight with feet about 12 inches apart. Place hands on your back at the waist. Slowly bend back, as far back as you feel comfortable. Hold to a count of 10. Straighten up. Now bend forward slowly, hold the position to a count of 10. Then straighten up. Exhale as you are bending and inhale while straightening up. This makes one set. Do at least 3 sets once daily.

  These three exercises will strengthen the abdominal and back muscles as well as gently stretch the skin. They also improve the posture during pregnancy.

  Caring for the skin : Keep the skin moisturized by applying oil olive oil, coconut oil, almond oil or any good baby oil thoroughly over the skin of the abdomen, hips and thighs. Massage it in with sweeping upward strokes. You can do this before you exercise so that the oil is properly absorbed as the skin is stretched during exercise. This will make the skin supple and healthy and capable of stretching without damaging the elastin fibres.
  
  A Good Diet : Take a good diet with lots of fresh fruits and vegetables and adequate liquids. And do not forget your daily vitamins. This will ensure a healthy and supple skin.
  

• But what happens if the stretch marks have already occured? How do I get rid of them?
  The good thing about stretch marks is that they fade over time. When they are first formed, they are reddish or purplish, but later they become thin silvery lines that may not be visible at first glance. The bad thing about stretch marks is that they can be removed permanently only by surgery. The elastin and collagen growth can be stimulated to some extent by cocoa butter, Vitamin E, wheat germ oil and lanolin. But to remove the marks completely, laser surgery, blue light therapy and other surgical treatments are the only options. Many creams and lotions available on the market also claim to be able to remove stretch marks but have yet to be medically proved.

The author, Dr.M.D.Mazumdar is a consultant gynaecologist with more than fifteen years of experience in private practice. She runs an Online Consultation Clinic at http://www.gynaeonline.com , where she answers questions on Pregnancy and Gynaecology. For more information on Care during Pregnancy, click http://www.gynaeonline.com/care.htm