Pelvic PT and Cesarean-Section Surgeries

Postpartum care in the U.S. often falls short, particularly concerning Cesarean section recovery. Many women are unaware of the benefits of pelvic floor physical therapy (PT) after a C-section. Contrary to popular belief, even without vaginal delivery, the pelvic floor can still be affected and thus pelvic PT can significantly help with many postpartum symptoms that are common with c-sections.

The Impact of a C-Section on Pelvic Health

Postpartum bodies undergo significant changes regardless of delivery method. While a C-section avoids the vaginal canal, the changes that the body experiences during pregnancy stresses the abdominal and pelvic floor muscles, affecting urinary, bowel, and sexual functions. Additionally, the incision area can restrict tissue, causing a variety of other symptoms.

What to Expect in Post-C-Section Physical Therapy

A pelvic PT will assess the abdomen, posture, breathing mechanics, and restrictions of the scar. Therapy involvements managing scar tissue through various techniques to improve mobility and reduce pain or sensitivity.

Internal Vaginal Exam

An internal vaginal exam helps assess the pelvic floor’s ability to contract and relax, and can identifying areas of tightness or weakness. While it may not seem like this would be affected during a c-section, scar tissue restrictions can extend further down the pelvis and can cause pelvic floor dysfunction such as urinary frequency, vaginismus, or constipation issues.

Addressing Tissue Restriction from Cesarean Scars

Scar tissue from a C-section can lead to various issues, including:

• Cesarean Shelf: An indentation caused by tissue adhesion, which is not only aesthetically bothersome, but can also influence the ability of the abdomen to efficiently function.

• Painful Sex: Scar tissue can extend downward into the pelvis and create tension in the pelvic floor causing discomfort during intercourse.

• Pelvic and Back Pain: Restrictions can also create and contribute to low back pain or sacroiliac joint pain.

• Bowel and Bladder Issues: Adhesions can make it difficult to empty the bladder or bowel completely, or create as sensation of urgency or frequency.

Causes and Solutions for Cesarean Shelf

A Cesarean shelf can result from tight incisions, excess fat, diastasis recti, and loose skin. Pelvic PT can help by:

• Testing for diastasis recti

• Providing scar and belly massage

• Focusing on core work and diaphragmatic breathing

The Benefits of Pelvic Floor Physical Therapy by a Certified Pelvic Therapist

Engaging in pelvic floor physical therapy with a certified pelvic therapist offers numerous benefits that extend beyond immediate postpartum recovery. These professionals are specifically trained to address the unique challenges faced by women who have undergone a C-section. Here are some of the key benefits:

Comprehensive Assessment

A certified pelvic therapist conducts a thorough assessment of your pelvic floor and surrounding muscles. This includes evaluating your posture, breathing patterns, and overall body mechanics. This comprehensive approach ensures that all contributing factors to your pelvic floor dysfunction are identified and addressed.

Personalized Treatment Plans

Certified pelvic therapists develop personalized treatment plans tailored to your specific needs and recovery goals. These plans incorporate a variety of techniques and exercises designed to improve pelvic floor function, reduce pain, and enhance overall mobility. The individualized nature of these plans ensures that you receive the most effective care possible.

Expertise in Advanced Techniques

Certified pelvic therapists are skilled in advanced techniques such as manual therapy, myofascial release, and dry needling. These techniques can significantly improve scar tissue mobility, reduce adhesions, and promote healing. The therapist’s expertise ensures that these techniques are applied safely and effectively.

What Pelvic Floor PT Can Do

Pelvic floor physical therapy can address several issues commonly experienced after a C-section. Here are some key interventions:

Manual Therapy

Manual therapy involves hands-on techniques to release scar tissue and improve mobility. These techniques can include:

• Soft Tissue Mobilization: Gentle manipulation of the soft tissues around the scar to reduce adhesions and improve flexibility.

• Myofascial Release: Targeting the fascia (connective tissue) to relieve tension and improve movement.

• Trigger Point Release: Applying pressure to specific points in the muscles to alleviate pain and improve function.

Desensitization

Desensitization techniques help reduce hypersensitivity around the scar. This can include using items with different textures, such as tissues, towels, or brushes, to gently stimulate the area. Over time, this can decrease pain and discomfort associated with the scar.

Dry Needling

Dry needling involves inserting thin needles into the skin and muscle to promote blood flow and reduce scar tissue adhesions. This technique can be particularly effective in improving mobility and reducing pain in the scar area.

Self-Care Tips for Cesarean Scars

In addition to professional therapy, self-care practices can significantly aid in the recovery process. Here are some tips for managing your cesarean scar:

Scar Massage

Begin gentle scar massage around the incision area immediately postpartum to promote healing and blood flow. After six weeks, you can start massaging directly over the scar. Move the scar up and down and side to side, spending extra time on tight areas. Regular massage can prevent issues like pain, discomfort, and urinary or bowel problems.

Proper Nutrition and Hydration

Maintaining a healthy diet and staying hydrated are crucial for tissue healing and overall recovery. Ensure you consume a balanced diet rich in vitamins and minerals to support your body’s healing process.

Gradual Return to Exercise

Slowly reintroduce physical activity into your routine, focusing on low-impact exercises that promote pelvic floor strength and flexibility. Activities like walking, swimming, and gentle yoga can be beneficial. Always consult with your pelvic therapist before starting any new exercise regimen.

Comprehensive Physical Therapy After C-Section

Pelvic PT can include various techniques and exercises designed to address specific issues and promote overall recovery. Here are some common interventions:

Diaphragmatic Breathing

Breathing exercises can help improve core stability and reduce tension in the pelvic floor muscles. Diaphragmatic breathing involves deep, controlled breaths that engage the diaphragm and abdominal muscles. This can help improve posture, reduce stress, and enhance overall pelvic floor function.

Core Strengthening

Strengthening the core muscles is essential for postpartum recovery. Pelvic PT includes exercises to target the transverse abdominis, obliques, and other core muscles. Strengthening these muscles can improve pelvic floor support and reduce the risk of further dysfunction.

Education and Support

Certified pelvic therapists provide valuable education on proper body mechanics, posture, and daily habits that can support your recovery. They offer ongoing support and guidance, helping you navigate the challenges of postpartum recovery with confidence.

When to Seek Professional Help

While self-care practices are essential, professional intervention can provide significant benefits. Consider seeking help from a certified pelvic therapist if you experience:

• Persistent pain or discomfort around the scar

• Difficulty with bowel or bladder function

• Pain during intercourse

• Signs of diastasis recti (abdominal separation)

• A noticeable “shelf” or bulge around the incision site

Conclusion

Pelvic floor physical therapy is a critical component of postpartum recovery, especially after a C-section. By addressing scar tissue, improving pelvic floor function, and providing personalized care, certified pelvic therapists can help you achieve a smoother, more comfortable recovery. Whether your surgery was recent or several years ago, it’s never too late to benefit from pelvic PT and enhance your overall well-being. Contact us now to set up an evaluation!

Written by:

Dr. Jana Richardson, PT, DPT, WCS, PRPC, CIDN
Dual Board Certified Pelvic Floor Therapist and Owner of Chicago Pelvic Health

Dr. Jana Richardson is a highly accomplished pelvic floor therapist with dual board certifications and extensive experience in treating complex pelvic floor dysfunctions. As the owner of Chicago Pelvic Health, Dr. Richardson is dedicated to providing personalized and effective care for her patients. With a Doctorate in Physical Therapy, and specialized certifications in Women’s Health and Pelvic Rehabilitation, Dr. Richardson is a leading expert in her field. She is also certified in Integrative Dry Needling, further enhancing her ability to offer comprehensive treatment plans. Dr. Richardson’s commitment to patient-centered care and her passion for helping individuals achieve optimal pelvic health make her an invaluable asset to the community.

Contact Information: