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Pelvic Therapy after Cesarean Delivery


There are a lot of things we hear as pelvic health providers that get our blood boiling, but this is likely at the top of the list …


“... my doctor said I don’t need pelvic floor therapy because I didn’t have a vaginal delivery.”


In what world would a surgeon say the same thing about an ACL repair? Knee replacement? Rotator Cuff Repair? Any and ALL surgeries result in similar outcomes: swelling, scar tissue formation, muscle guarding and resultant change in how muscles function.


Delivering a baby via Cesarean Section is major abdominal surgery.


*a little louder for the people in the back*


DELIVERY VIA CESAREAN SECTION IS MAJOR. ABDOMINAL. SURGERY.


And it needs to be treated as such.


This month’s blog is dedicated to mommas who delivered via C-Section, what we treat and why pelvic floor therapy should be the standard of care after this operation.


WHAT IS A “C-SECTION?”

Delivery via Cesarean Section (AKA a “C-section”) is a surgical procedure in which a baby is delivered through an incision through the mother’s abdomen and uterus. The incision is made above the pubic bone and is most likely horizontal (although we have seen vertical, as well). There are seven layers to cut through to get to the baby: skin, fat, fascia, muscle, peritoneum, uterus and amniotic sac. C-sections are often performed in emergent situations (elevated fetal heart rate), breech births (baby is feet down), stalled labor, large baby, placenta previa (where the placenta covers the mother’s cervix), twins/multiples, prior C-section or mother’s co-morbidities including infection, diabetes or high blood pressure.




WHAT CAN DEVELOP AFTER A C-SECTION?

Honestly, symptoms that arise after a Cesarean delivery are not much different than symptoms after a vaginal delivery. They just may occur for different reasons. Moms can and often experience urinary incontinence, feeling of core weakness, low back pain, constipation, pain with transfers and painful sex. Let’s break down the "why":


1) SCAR TISSUE


With any surgery or incision, scar tissue is formed. We cannot change the consistency of the scar tissue but adhesions or restrictions in the surrounding tissue can affect a lot of bodily functions. When I think about the location of C-Section scars I immediately think of the bladder. The bladder sits up front, closest to the pubic bone and when it is filling or stretched, it signals our brain that it needs to empty. Scar tissue restriction in this location can send premature signals starting a cascade of bladder urge and frequency. We also know our body likes to “hug” our scars. Think of the position we assume to protect this region, likely with a rounded back, hunched forward like we have a stomach ache. It can be incredibly uncomfortable to stretch the abdomen to stand up straight, not to mention a lot of these scars can develop hypersensitivity. This can make clothes seem like a painful stimulus. Scar tissue mobilization is a very important tool for mommas and therapists to perform to desensitize this area and ensure pain or restriction is not affecting posture or mobility. Finally, most people avoid their scars as they can be associated with trauma. All birth, no matter how to plan or not, is a trauma to the body. We must consider the momma’s birth story and be sensitive to her individual experience.


2) ABDOMINAL FUNCTION


Your body has continuously changed for 40 weeks. Hormone fluctuations aside, there was a lot going on mechanically; center of gravity continuously shifts forward, often finding us in “pregnancy position” with hands on back, relying on hip ligaments and bony spine for stability. Growing a human is exhausting! As abdominal tissue stretches forward, it is lengthened and at a disadvantage to engage often leading to back tightness/pain and decreased glute activation. THEN, in the process of delivering this baby, your center of gravity has shifted yet again. The body cannot be expected to automatically adapt from 10 months of change. Ribs have flared, boobs have engorged, breath patterns have changed because a tiny human was smushing on your diaphragm (breathing muscle), abdominal tissue has accommodated. In the case of a cesarean birth, women often find themselves having a harder time to engage through the deep core, or transverse abdominis. A trained specialist can assess and address common muscular imbalances, check your bony alignment, and help you regain the neuromuscular connection to your deep core to allow you to feel strong and return to movement safely.


3) PELVIC FLOOR MUSCLES WORKING OVERTIME


One of the biggest misconceptions about pregnancy is that you need to keep the pelvic floor muscles strong. The fact is, with growing baby and lengthened abdominals, the pelvic floor muscles are working OVERTIME for support. We often need to maintain length and range of motion of these muscles to prevent symptoms related to “too tight” pelvic floor muscle including: stress incontinence, painful sex, constipation, urinary frequency/urge. After a C-section, we often see women complaining of tightness in the pelvic floor felt when trying to have sex or eventually put a tampon in. This can be a result of the scar tissue from above pulling on these muscles below creating traction. In this scenario, soft tissue work around the scar and through the pelvic floor should alleviate these symptoms, along with restoring function to your deep core. Your “deep core” is actually consisted of 4 groups of muscles; name of the game is to restore motion to the ones working overtime and wake up the ones that have been less active.


Every mother, baby and birth is unique. No matter how to plan or not to plan your birth was, vaginal or via cesarean section, birth is trauma to the body. It is important to note that trauma can be physical, emotional or both and is completely subjective. Cesarean deliveries can still result in pelvic floor dysfunction due to scar tissue restriction, muscle imbalance, altered breath and abdominal function. Symptoms can feel like but are not limited to scar sensitivity, urinary urge/frequency, leakage, painful sex, low back pain and core weakness. Bottom line is you know your body best and if something feels “off” or just not right, there is conservative treatment for it. As pelvic health therapists working with women in the postpartum period, our goal is to restore balance through the core and pelvic floor to allow for pain-free movement so you can get back to the activities you love (yes, rocking babies is weight lifting and chasing toddlers is cardio).



Healthy and Happy 4th Trimesters for All,

Dr. Carly & Dr. Katie

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