Recently we have been talking a lot about how to alleviate pain and discomfort during pregnancy. As a result we’ve received a lot of questions about an often overlooked topic: maternal postpartum care. More specifically, there is a lot of conversation around how to speed up Cesarean Section (C-Section) recovery time. Today I will delve into how pelvic floor physical therapy supports a faster recovery time from your C-section delivery by making the entire recovery process smoother. We’ll help you gain a better understanding of:
- Pelvic floor health as it relates to c-section recovery
- Common pelvic floor issues after a c-section delivery
- The benefits of pelvic floor therapy post c-section
- Effective exercises to strengthen the pelvic floor and aide in c-section recovery time
It is very important to consult with a healthcare provider if your c-section scar is painful, irritated, or shows signs of infection. Additionally, please consult your provider before beginning a postpartum exercise regimen. The pelvic floor physical therapists at Optimize Pelvic Health will assess your particular situation, and recommend what’s most appropriate to support your c-section recovery.
Understanding Your C-Section
Before we move into how to reduce your C-Section recovery time, lets dive into some detail to help you understand more about your C-Section.
A C-section is a major abdominal surgery that includes 7 different incisions through 7 layers of tissue (yeah, that’s a lot to take in… deep breaths).
The first 3 incisions are horizontal (AKA transverse) and include:
- Skin
- Fat (adipose tissue)
- Fascia (connective tissue)
The next four incisions are vertical and include the:
- Abdominal muscles
- Peritoneum (more connective tissue)
- Uterus
- Amniotic Sac.
The bladder is moved downward between the uterine and amniotic scar incisions.
Your C-Section: A Visual Guide
A C-section includes two types of incisions, an abdominal incision and a uterine incision:
- Abdominal Incision: This incision is made first and is either completed vertically or horizontally. Horizontal incisions are more common.
- Uterine Incision: These incisions are made in the lower belly and the uterus. Low transverse incisions are the most common.
*For more information on C-Sections please visit the Mayo Clinic’s web-page.
As you see in the above diagrams, a C-section is a major abdominal surgery that directly affects multiple layers of your body’s tissue to include skin, muscle, fascia, and your uterus. As we will talk about later, a Cesarean Section can cause both short and long term complications that your pelvic floor PT will address.
How Pelvic Floor Health Relates to C-Section Recovery Time
At Optimize Pelvic Health we often get questions like, “I had a C-Section…will pelvic floor physical therapy even help me?” The answer is almost always a resounding yes!! Pelvic Floor PT is not only beneficial, but in many cases a crucial part of your post c-section recovery, and reducing the time it takes to get you back to being you!
Pregnancy Affects Your Pelvic Floor
“Baby doesn’t pass through the birth canal during a C-section delivery, so why would my pelvic floor be affected?” It is true that you do not pass Baby through the birth canal during a Cesarean section, however your pelvic floor does a lot of work (and changes significantly) during pregnancy.
Your pelvic floor is divided into four compartments, each of which is placed under significant stress during pregnancy:
- Anal/Posterior: This includes your anus, anal canal, sigmoid, and rectum
- Genital/Medium: This includes your Vagina and Uterus
- Peritoneal: This includes your endopelvic facia and perineal membrane
- Urinary/Anterior: This includes your bladder and urethral
In short, your pelvic floor muscles and organs are affected by pregnancy regardless of vaginal or C-section delivery, and if left untreated can lead to other complications both in the short and long term. Any complications are obviously not something we want, but even the smallest setbacks will likely increase your C-section recovery time.
Common Issues Post C-Section Delivery
A C-section is an invasive procedure, and generally requires a minimum 2-3 day hospital stay. Upon discharge the first step to speeding up your recovery time is to:
- Follow your health care provider’s recommendations
- Regularly check your C-section incision for any signs of infection
Additionally, if you experience any of the following symptoms contact your health care provider:
- Fever
- Excessive bleeding
- Red or swollen incision
- Leakage/discharge from incision
- Increasing pain
These are all signs of potential infection and must be addressed immediately by a health care provider.
Pelvic Floor Issues Will Increase C-Section Recovery Time
As stated above Baby doesn’t pass through the vaginal canal during a C-section delivery. However your pelvic floor muscles and organs are placed under significant stress during pregnancy, and a C-section delivery can compound this stress in many areas. Often times this stress can increase symptoms such as:
- Urinary leakage and incontinence
- Pooping and other Bowel issues
- Pain During Sex
Existing pelvic floor symptoms may further complicate, and extend, your C-section recovery time. Properly functioning pelvic floor muscles play a crucial role in:
- Contacting to hold in pee and poop
- Relaxing to empty bowels and bladder
- Support internal organs (ie: prevention of prolapse)
- Sexual function
Your pelvic floor muscles may be both weak and tight as a natural byproduct of pregnancy, but that does not make it normal. This is where a pelvic floor physical therapist comes in!! Therapists such as those at Optimize Pelvic Health will assess your pelvic floor and work with you to get your pelvic floor muscles functioning properly.
Incision Site Tissue Mobility
As with any surgical wound, a mother who delivered by C-section may notice significantly reduced mobility of the tissue surrounding the healing incision. This can be caused by scar tissue, adhesions, myofacial restrictions, muscle damage, and severed nerves. The depth of the incision magnifies the pervasiveness of scar tissue and adhesions. This can contribute to each of the below:
- Back Pain
- Cesarean Shelf
- Incision Site tightness, pain, numbness or hypersensitivity
- Inability to fully empty your bladder
- Pain with sex
- Pain/strain during bowel movements
- Painful Periods
- Pelvic Pain
Cesarean Shelf
Lets expand a bit on Cesarean Shelf, as it is common, but highly manageable through therapy. Cesarean shelf is a bulge of excess tissue above a c-section scar which creates a “shelf.” It is often caused by:
- Scar tissue adhesions
- Excess fat
- Loose skin
- Diastasis Recti
If you leave it untreated Cesarean shelf can contribute to many of the symptoms listed in the previous section to include bladder and bowel difficulties, pain with sex and discomfort when wearing certain types of clothing.
Additional Issues Affecting C-Section Recovery Time
As stated previously a C-section involves directly cutting into the abdomen, and through all connective tissue at the incision site. We already spoke about tissue mobility restrictions at and around the c-section scar itself. However there are additional symptoms that include:
- Abdominal pain
- Difficulty activating the abdominal muscles
- Muscle pain with activity
- Pain when wearing certain types of clothing
C-Section tissue complications rarely resolve without therapy, and if left untreated often lead to pain and limited function for Mom. Contact a Pelvic Floor Physical Therapist today to begin your recovery journey.
Do’s & Don’ts For A Faster C-Section Recovery Time
In most cases it is safe to resume low intensity exercise approximately 6-8 weeks post C-section, however this is not always the case. It is very important to consult with your physician before resuming any exercise plan.
Do’s:
- Check with your physician before resuming exercise
- Focus on healing, hydration, and rest for at least the first 6 weeks post surgery
- Ensure you are cleared for the type of exercise you plan on doing
- Begin with low intensity exercise such as walking, light core work, and pelvic floor strengthening exercises.
- Consult a pelvic floor physical therapist: they will perform a comprehensive assessment of your pelvic floor, and all related body regions. They will also provide a personalized plan to get you back to your exercise regimen.
Don’ts:
- Assume you will automatically be “cleared for exercise” at your 6-week postpartum follow up
- Translate the “clear for exercise” from your physician to mean you are fully healed. At this point your tissues will not be completely healed, nor will they be ready for high impact exercise.
Exercises To Strengthen Your Pelvic Floor Post C-Section
Walking
The first step in your C-section recovery should focus on healing, hydration, and rest. An important component of healing is light walking. As early as the first day after surgery it is recommended that you get out of bed for some light walking each and every day. Walking promotes blood flow and aides in healing.
Re-up your Core
After you are cleared by your physician it is extremely important to begin the process of re-strengthening and retraining your core. Part of what makes the core such an important area of focus is due to the significant changes this region goes through during pregnancy. Add a major abdominal surgery into the mix, and the core needs some help to regain function and strength.
Additionally, a strong core will help with most pelvic floor symptoms you may experience. The following are a few gentle exercises that promote blood flow and work the core muscles, without excessive strain.
Belly Breathing
Diaphragmatic Breathing
Ball Squeeze
Bridges
Cobra Stretch
Transverse Abdominis Activation
If during the course of exercising you develop any of the following symptoms please contact a pelvic floor physical therapist.
- C-section scar numbness, pain, or sensitivity
- Low back pain
- Pain with intercourse
- Pain/strain when pooping
- Pelvic Pain
- Symptoms of pelvic organ prolapse
- Urinary/fecal incontinence
C-Section Scar Management Techniques
After approximately 6 weeks postpartum you can begin to massage your C-section scar, and the surrounding area. To accomplish this gently move the scar up and down, and side to side. Do this for about 2-3 minutes, 3-5 times per week. Start on areas that are easier to mobilize then move to areas that feel the tightest and/or most difficult to mobilize. Massaging your C-section scar will help:
- Avoid C-section shelf
- Avoid pain with sex
- Avoid pain when wearing certain types of clothing
- Avoid bladder and bowel difficulty
- Less scar discoloration
- Facilitate a softer and flatter C-section scar
Focusing on C-section scar management as mentioned above may significantly reduce your C-section recovery time in comparison to not performing scar massage. No matter how long postpartum you are, this technique is beneficial.
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