Pelvic Floor Therapy After a Cesarean Birth
We often hear the question from c-section mamas, “I didn’t deliver vaginally! How could pelvic floor therapy help me?”
And the truth is…we wish ALL women who have had a cesarean birth would receive pelvic floor therapy because there are huge benefits to integrating it into your c-section recovery.
In this blog, we take a dive into why pelvic floor therapy after a c-section is so important and what a session might look like!
Your Pelvic Floor After a C-section
Of course we know that a vaginal birth can impact our pelvic floor but the changes start way before baby is born. Pregnancy itself puts a huge amount of strain on our pelvic floor muscles. The weight of a pregnant person’s increasing blood volume as well as the growing uterus and placenta puts consistent stress on the pelvic floor. Additionally, due to the secretion of a hormone called relaxin, the ligaments in the pelvis loosen, leading to greater flexibility and instability. This can lead to pelvic floor dysfunction in the form of urinary incontinence, pain with sex, constipation, and prolapse among other issues.
Although baby doesn’t travel through the birth canal during a c-section and, because of this, there is less direct pressure put on the pelvic floor muscles, a c-section is still a major abdominal surgery that can have long-lasting impacts on a woman’s mobility and pelvic floor function (or dysfunction!). There are two major ways a c-section can affect your pelvic floor:
Scar Tissue Restriction
During a c-section, 7 layers of tissue, including the Superficial Abdominal Fascia, is cut through. The Super Abdominal Fascia is connected to the urethra as well as the perineal body. If scar tissue builds up in either of these places after a c-section, a woman might experience urinary issues.
Pelvic Floor Tension
A c-section following nine months of gradually increasing weight put on the pelvic floor can lead to tight and weak pelvic floor muscles. Pain in general, but especially after a major surgery, can lead to extreme amounts of tensing up and guarding which can then result in an overly tight pelvic floor. This tightness can lead to urinary issues such as incontinence, lack of sensation and awareness, urgency, and inability to relax the pelvic floor enough to release bladder contents.
In addition to urinary incontinence, other issues may arise from this tension and restriction within the pelvic floor and abdomen, which include:
Urinary urgency and frequency
Constipation
Pain with sex
Core weakness
Lower back pain
It’s important to note that all these issues are common after having a c-section but NOT normal. Pelvic Floor Therapy after a c-section can help you eliminate urinary leakage, help you have easier bowel movements, strengthen your core and help you have pain-free sex!
How Can Pelvic Floor Therapy Help After a C-section?
Introduce Movement and Modifications
Early therapy sessions after a c-section can include teaching modifications of daily movements to minimize pressure on the incision site and abdominal muscles (for example, how to get out of bed, postural support for breastfeeding, etc.) as well as reintroduction to diaphragmatic breathing techniques to re-engage the core and assist in decreasing post-surgery swelling. A pelvic floor therapist will also provide strength and mobility exercises to help you get back to exercise and activities you love safely and pain-free.
Assess your abdomen
A pelvic floor therapist will assess the restriction and mobility of the scar tissue at the incision site and the surrounding area at your abdomen. They may also perform a diastasis recti exam, checking for any separation between the rectus abdominis muscles and will assess the integrity of the fascia at the midline. They may also check your ribcage and infrasternal angle because this will tell them more about your core, diaphragm and pelvic floor relationship and the ability for these structures to work together effectively.
Do Manual Therapy
Once the incision is healed around 6 weeks postpartum, a pelvic floor PT can assist you in beginning scar tissue mobilization and desensitization. Because you may experience increased sensitivity (and sometimes even pain) at the incision site and around the scar even after it is fully healed, a pelvic floor PT can also assist in introducing different textures and varying pressure in order to desensitize the scar site. Manual therapy performed by a PT can help release restrictions in the soft tissue and increase blood flow to promote healing and decrease pain. Not only will they do this at the c-section scar, but throughout the body to help improve overall posture and mobility.
Perform an internal pelvic exam
If you are comfortable and with your consent, a pelvic floor therapist may also perform an internal pelvic exam. This involves one gloved finger with lubricant in the vaginal canal without the use of a speculum. Internally, a pelvic floor therapist will be able to assess the tension, coordination and strength of your pelvic floor muscles.
Lastly, after a long pregnancy and major surgery, pelvic floor PT is here to help you strengthen your abdominal muscles and retrain your core in order to get you back to all of the activities that make your life so fulfilling.
How Soon After my C-section Should I Start Pelvic Floor PT?
You can start any time! We see patients as soon as 4-6 weeks after their c-section and we love that! But some women don’t find us for YEARS after their c-section and, even with such a large time gap between surgery and participation in pelvic floor PT, they see huge improvements in their pelvic floor function and mobility. There’s no such thing as “too late” in the case of seeking pelvic floor support.
