C Section Recovery
A discussion of the most common surgery, common myths, and important factors to improve outcomes during C section recovery.
According to the NIH, a C section is the most common surgery in the United States, with over 1 million Cesarean deliveries occurring every year. (1)
A C section involves disruption to 7 layers of tissue including the skin, subcutaneous tissue, fascia, abdominal muscles, peritoneum, uterus, and amniotic sac. In other words, a C section involves deep trauma to the abdominal wall.
Despite significant tissue disruption, many women are not automatically referred to a rehab provider afterwards.
In our opinion, it is because much of the medical community view a C section simply as a gynecological/obstetric surgery. However as pelvic floor physical therapists, we view C sections as an orthopedic trauma.
Moving around after a C section
Postoperatively, patients have a difficult time with mobility as the core is involved in almost every movement. With a 4-inch incision across the abdomen, your ability to cough, sneeze, get up out of a chair, and even pass a bowel movement can be significantly disrupted.
Most patients fall into a flexed, rounded (think fetal position) posture. This flexed posture helps ease the tension through the abdominal incision, however it can significant affect core function, and cause pain elsewhere including lower back pain, neck pain, and even shoulder pain.
As you heal, it is important to work on slowly trying to stand up taller to decrease contraction and stiffness through the incision.
Some patients initially find that splinting (or hugging a pillow) while coughing, sneezing, getting out of a chair, and even while toileting can help ease the incisional pain and increase your ability to recruit your core muscles.
Scar mobilization after a C section
C section scar mobilization is very important as the scar itself can cause issues such as bladder urgency, painful urination, and decreased bladder capacity. In addition, C section scars can cause menstrual irregularities and fertility concerns, so having good mobility through the scar and underlying tissues is very important. (2)
It is very important that as you feel comfortable, you begin to gently touch your incision.
We recommend placing your hand in a pillowcase first and then gently touching the incision and the area of your abdomen around it. As you tolerate the pillowcase, you can begin changing textures to include rougher textures like an older towel, and jean material.
As your incision heals, steristrips fall off, and once the scab falls off you can begin being a little more aggressive with your scar mobilization. If you are unsure how to progress scar mobilization, a pelvic floor physical therapist can help show you C section scar mobilization that is a little more individualized towards you. Your pelvic floor physical therapist can also perform techniques such as cupping.
Returning to exercise after C section
One of the toughest things after a C section is returning to exercise. The reason for this is because patients typically have a difficult time activating their deep core after a C section. We always recommend that patients begin by working on deep breathing and retraining the core to expand on inhale and contract on exhale.
As breathing becomes easy and more automatic, progressing to core exercises is the next step. Typically we recommend working with a postpartum rehab specialist such as a pelvic floor physical therapist can help you with individualized core exercises.
Painful intercourse after C section
The stiffness and immobility in the core after a C section can contribute to painful intercourse. In addition, we find that due to the flexed posture and tendency to keep the core drawn in after a C section, that many patients do experience painful intercourse after a C section.
It is also important that we investigate what led to the C section in the first place. Many times we do find that pelvic floor muscle tension, and thus subsequent stiffness in the pelvis can contribute to the reason someone has a C section.
Low back pain after C section
Many patients experience lower back pain after a C section due to the tension and pulling of the abdominal scar, the postural changes that occur immediately after a C section, as well as the decreased deep core activation that happens after a C section. Research shows that patients with lower back pain have decreased deep core activation. (3)
Many patients will seek help for lower back pain through a traditional physical therapist, which is great. However, often patients won’t connect that the low back pain may be the result of a C section. Unfortunately, most traditional physical therapists won’t even look at your C section scar (or even ask about delivery method!), because they aren’t trained the way a pelvic floor physical therapist is.
Even if your lower back pain occurs several years after your C section, you should still seek out help from a pelvic floor physical therapist.
You can still have pelvic floor dysfunction despite having a C section
Many patients think that just because the baby didn’t pass through the pelvic floor, that they are spared from having pelvic floor dysfunction and therefore shouldn’t’ see a pelvic floor physical therapist. Unfortunately, this is the furthest form the truth.
Pregnancy in and of itself is a risk factor for pelvic floor dysfunction and symptoms such as prolapse, urinary incontinence, and constipation. The pelvic floor and deep core muscles co-contract (meaning they work together). Therefore, disruption of the core muscles through an abdominal incision also results in disruption to how the pelvic floor muscles are working.
All in all, C sections are major abdominal surgeries that need to be taken more seriously from a rehabilitation prospective. Pelvic floor physical therapists can be wonderful assets to your care team and can help you navigate C section recovery, navigating pain and concerns, and help you safely return to exercise.
Reference
2: https://www.sciencedirect.com/science/article/pii/S0015028222004137
3: https://www.sciencedirect.com/science/article/abs/pii/S0003999302560172