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Agape Physical Therapy

Does having a c-section prevent me from having any pelvic floor concerns?

"I had a c-section, so my pelvic floor is totally fine! But I am leaking urine when I cough or sneeze, what’s up with that?”

Time and time again, I come across patients that are surprised by the pelvic floor dysfunctions they have sustained after delivery, even though they delivered their baby via cesarean versus vaginally. 

It is well-known amongst most pregnant women where the pelvic floor muscles are located, and that if they are delivering vaginally, there is a direct link to the pelvic floor being impacted. But when the delivery is made via cesarean, where is that connection? In a review article supported by OBGYNs, they acknowledged the effect on these muscles during the prenatal period. “This controversy fuels the debate about whether or not women should be offered the choice of elective caesarean delivery to avoid the development of future pelvic floor disfunction.  It has been demonstrated that pregnancy itself, through mechanical changes of the pelvis and hormones, can be a significant risk factor for these dysfunctions; urinary incontinence and genital prolapse’’. 

Although you have or are about to have a c-section, let’s not discount the last 9-10 months that you have carried your baby. Actually, let’s rephrase that — your pelvic floor muscles have carried your baby! These muscles are located at the bottom end of your pelvis, and act like a hammock to various pelvic organs including your bladder, rectum, and your uterus. Pregnancy is already associated with a decrease in pelvic and perineal strength and endurance. As the pregnancy progresses, these muscles bear increased stress or load from the baby; therefore, putting them at risk for weakening, tightening, or even becoming overactive. Following the delivery of your beautiful baby, these muscles may or may not return to their normal muscle length to provide the support and function they are meant for. This is where we end up with pelvic floor dysfunction following delivery, even with a c-section! Makes sense?

Now, let’s talk about some facts and figures. Some of the most common complications postpartum following a c-section include back pain, bowel and bladder dysfunction, and scar tissue/adhesions. Women are 2-5x more likely to experience lower back and pelvic girdle pain following a c-section versus a spontaneous vaginal delivery. As well, bowel and bladder dysfunction is significant higher after a c-section in the postpartum period. These dysfunctions can include urinary or fecal incontinence, frequency, urgency, and/or pelvic organ prolapse. There are also multi-layer adhesions that occur in the cesarean scar (in close to 50% of women) that can increase the risk for miscarriage, uterine rupture in the future, increased difficulty with future labour and deliveries, and potentially a risk for future bowel obstructions. 

So do I have some good news? Of course!

Studies have shown that physical therapy is a helpful tool in the recovery and rehab after a c-section. 

How can Pelvic Floor Physical Therapy help?

Scar mobilization
We can perform scar tissue mobilization on and around your c-section scar to help break apart the adhesions that have formed since your delivery. Whether you are 8 weeks postpartum or 8 months postpartum, this can be helpful. 

Pelvic floor muscle retraining
Retraining your pelvic floor after childbirth has many benefits; most importantly for re-establishing the support needed for your pelvic organs to ensure proper bladder and bowel function. As a pelvic floor physical therapist, we are specialized to help you retrain these muscles correctly (this doesn’t just mean kegels!). 

Back to exercise and activity
From the stretching of your abdominals during pregnancy, to the overbearing weight on your hips, lower back and pelvis, we can safely guide you through exercises to help stretch and mobilize the muscles that may be hindering your way back to exercise and activity. 

Core Stabilization Exercises
Similar to the above point, we are trained to provide appropriate core exercises for both the pregnancy and postpartum period. It may be challenging and/or difficult to connect with your core during this time, therefore we can help you target the right muscles safely and appropriately. 

Bladder and/or Bowel training
Other than re-training your pelvic floor muscles, as a pelvic floor physical therapist, we can educate you on how to retrain your bladder and bowels, manage constipation and recognize signs of an overactive or weak bladder, that are sometimes common during this time. 

If you would like to consult with one of our pelvic floor physical therapists, feel free to reach out to either our Penfield or Pittsford locations. Both in-person and telehealth consultations are available!


References
Fonti, Y., Giordano, R., Cacciatore, A., Romano, M., & La Rosa, B. (2009). Post partum pelvic floor changes. Journal Of Prenatal Medicine, 3(4), 57-59.
Stone, J., Skibiski, K., Hwang, S., & Barnes, C. (2020). Physical Therapy in Addition to Standard of Care Improved Patient Satisfaction and Recovery Post-cesarean Section. Academy Of Pelvic Health Physical Therapy, APTA, 45(1), 10-19.
Wasserman, J., Steele-Thornborrow, J., Yuen, J., Halkiotis, M., & Riggins, E. (2021). Chronic caesarian section scar pain treated with fascial scar release techniques: A case series. Journal Of Bodywork And Movement Therapies, 20(4), 906-913
Nabila Jutha, PT
Women's Health Therapist
[email protected]
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