Cesarean Birth

Physiotherapy after a Cesarean Birth

One of the most common myths I hear as a Women’s and Pelvic Health Physiotherapist is that women who have experienced a cesarean birth do not need pelvic floor physiotherapy as their pelvic floor “was not affected”. On the contrary, I HIGHLY recommend seeing a pelvic floor physiotherapist minimum 6 weeks postpartum regardless of whether you’ve experienced a vaginal or cesarean birth.

To put into perspective, we are often referred to see a physiotherapist after knee or hip surgery, following abdominal surgery should be no different. Not to mention following the 40-ish weeks of significant change to their physical body while baby was growing and being nourished by mom (and will continue to be nourished by mom after birth).

During a cesarean birth, the physician will begin with an incision in the skin, then continues through subcutaneous tissues, fascia of the abdominal muscles, parietal peritoneum (tissue that lines the abdominal cavity), and finally the uterus. As such, there are a lot of tissues that require healing, and would benefit from treatment to regain full function and mobility.

In addition, pregnancy in itself impacts the abdominal wall, by stretching and expanding to make room for the growing baby. Pelvic floor muscles must also work overtime to support organs and growing baby for 9 months! To accommodate for these physical changes, your posture must adapt to stay balanced and move, which further challenges how the muscles are working.

Finally, cesarean sections are not always planned, and are often emergency procedures. Meaning that women still go through at least the beginning stages of vaginal birth (including pelvic floor lengthening, pushing, etc.), which can still impact our pelvic floor muscles and other tissues.

With that being said, here are 5 reasons to see a Pelvic Health Physiotherapist post cesarean section:

  1. Incontinence: Pregnancy in itself increases the risk of developing urinary incontinence. Although this risk is less after a c-section versus vaginal birth, we often see women post cesarean who experience either Stress Urinary Incontinence or SUI (leaking with sneezing, coughing, exercise), and/or Urge Incontinence also referred to as UI (leaking due to urgency to get to the bathroom). A study by Rortveit, Daltveit, Hannestad, et al. found that 16% of women post cesarean experience urinary incontinence, versus 10% of nulliparous women (never given birth), and 21% of women post vaginal birth. In addition, a study by Groutz, Rimon, Peled, et al. found that SUI is just as common with women who underwent a cesarean section performed for obstructed labour than with vaginal delivery. Pelvic floor physiotherapy can help regain full function of our pelvic floor muscles, not only post-partum, but also during pregnancy!

  2. Core weakness: Returning to normal physical shape can take time and effort, especially with all the physical changes that your body goes through during pregnancy and after birth. Add in an invasive abdominal surgery that can also contribute to weakness in the core muscles. Although the cesarean incision does not go through the abdominal muscles, the fascia that surrounds theses muscles are cut, allowing the surgeon to pull the abdominal muscles apart to continue towards baby. This can create trauma and injury to our muscles, nerves, and other tissues – thus causing muscle weakness and pain. In our sessions, we assess all of the abdominal muscles, including our transversus abdominis – our deep corset-like core muscle in the front wall – to ensure proper function and ability to contract with functional tasks – such as lifting and carrying baby.

  3. Low back pain: As mentioned above, core weakness is extremely common during pregnancy, and after a cesarean section. One of the main functions of our core system is to stabilize our spine in order to prevent injury. Therefore, it is quite common that women post cesarean experience low back pain, especially with the increase in demands on the body with a newborn (i.e. feeding, lifting, carrying). In addition, mobility and lifting are somewhat restricted for the first 6 weeks, which can also limit how we move, and how much we move. Pelvic health physiotherapists can help teach you proper exercises for YOUR body and help guide you to reach your goals!!

  4. Incisional pain: Pain and soreness at the site of incision is very common after a c-section – after all, it’s a major abdominal surgery with many layers of tissue affected!! Sure, they usually say you can restart your normal daily routine after 6 weeks, but tissue healing takes a lot longer than just 6 weeks!! Often times, women post c-section will experience pain and numbness around the incision, as small nerves can get injured during surgery. As nerves regrow, sensation can slowly return. A Pelvic Health Physiotherapist can help regain tissue mobility and function, and teach very useful tips and tricks, such as:
    • Performing abdominal and scar tissue release for ALL layers affected
    • Teach self-release techniques for abdominal and scar tissue massage
    • Teach different ways to hold and nurse baby (i.e. football hold) to alleviate incisional pain
    • Recommend oils/ointment (i.e. castor oil packs) to help with scar and tissue healing
    • Guide you as to what safe exercises you should/shouldn’t be doing according to what YOUR body requires

  5. Painful intercourse: A lot of women post cesarean section are very surprised that sex can be quite painful after birth. Resuming intercourse post birth isn’t always easy –  women have less natural lubricant due to hormonal changes in the body, so tissues may feel very dry and uncomfortable (especially if you’re nursing). In addition, pelvic floor muscle tension is quite common, as the muscles worked extra hard to support baby for 9 months during pregnancy. Birth, whether it’s vaginal or cesarean, can be very traumatic. Therefore, you might feel physically ready, but mentally scared or fearful. It is important to start again when you feel ready, both physically and mentally. Pelvic floor physiotherapy can help with these barriers, with manual work for releasing tissue tension, recommendations on lubricants and comfortable positions for intercourse, and help with relaxing the pelvic floor and nervous system.

Seeing a pelvic health physiotherapist is beneficial for not only women after giving birth vaginally, but also for women post cesarean section. It can help alleviate incisional/abdominal and low back pain, can help with return to intercourse, and can also help restore core strength, and overall wellness.

Lisa Flanders Physiotherapist

Written by Lisa Flanders, Physiotherapist. Lisa has a clinical focus on women’s health including pre and postnatal, gender diverse and applied pelvic health and high performance athletes. She currently lives and works in Ottawa, Ontario, Canada.

Disclaimer – Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.