Physical Therapy after a C-Section [Infographic]
A C-section is major abdominal surgery involving the delivery of a baby through horizontal incisions made in the abdomen or uterus along the pubic hairline. Women can experience significant pain at the c-section incision site due to scar tissue formation, limiting mobility in the abdominal area and contributing to pelvic pain and pelvic floor dysfunction. After a c-section, physical therapy can play a critical role in helping women recover, reducing incision site pain, normalizing pelvic floor muscle tone, decreasing tissue sensitivity, improving core and back muscle strength, addressing urinary or bowel problems, and optimizing women’s function and mobility.
How C-Sections Affect Postpartum Recovery
A c-section is major abdominal surgery involving the delivery of a baby through horizontal incisions made in the abdomen or uterus along the pubic hairline. In the United States, 30% of all babies are born via c-section, making it one of the most common inpatient surgical procedures.
A c-section causes significant tissue trauma which can cause the body to respond by tensing to guard the impacted area, tightening muscles of the abdomen and pelvic floor. This can exacerbate pain from the c-section incision site. At the incision, changes occur in the body’s fascia system and scar tissue is formed from collagen, a tough fibrous protein, during the healing process. The collagen fibers in scar tissue form in a linear single direction, which can contribute to tightness. Adhesions can also form, which are scar tissue in the underlying fascia (connective tissue) and myofascial layers that attach to other structures close by to it. The formation of scar tissue and adhesions can contribute to pain sensitivity around the incision as well as limited mobility and nerve irritation around the scar.
Common symptoms after a c-section include:
Pain and sensitivity at and around the incision
Reduced mobility and elasticity in the abdominal area, making bending forward or lifting difficult
Limited mobility and flexibility in the hips and low back
Low back pain from weakened core muscles
Myofascial trigger points in the abdominal muscles that can refer pain to the urethra or clitoris
Pelvic pain during intercourse
Nerve irritation surrounding the area around the incision
Pelvic immobility and pelvic floor muscle tightness
Urinary urgency and frequency
Scar tissue restriction from the c-section incision can contribute to a “cesarean shelf.” A cesarean shelf occurs when various layers of healing tissue along the incision adhere to one another, and the scar becomes indented. The tissue can then puff out, creating a shelf. Scar tissue from a c-section incision can also complicate the healing of diastasis recti, which is a condition in which the two sides of the rectus abdominis muscle separate, causing a visible gap in the abdomen. Tightness and mobility restrictions around the incision site can limit core strengthening needed to address diastasis recti. Approximately 43% of women who deliver via c-section also experience pelvic floor dysfunction, which can lead to tightness in the pelvic floor muscles, urinary and bowel issues, painful sex, and pelvic organ prolapse.
A c-section can also contribute to the development of chronic pain around the incision site and in the pelvic area. A 2020 study found that of 462 women who underwent a c-section, 25% experienced chronic pain three months post-birth and 1 in 4 had continued pain at the incision site 3 months postpartum. Women with a history of c-sections also have a higher incidence of low back pain and are as likely to have incontinence or pelvic organ prolapse as those who deliver vaginally.
Physical Therapy After a C-Section
After a c-section, physical therapy can play a critical role in helping women recover, reducing incision site pain, normalizing pelvic floor muscle tone, decreasing tissue sensitivity, improving core and back muscle strength, addressing urinary or bowel problems, and optimizing women’s function and mobility.
Physical therapists utilize scar tissue massage and mobilization to reduce incision pain and tightness and soften and flatten scar tissue around the incision. At four weeks post-delivery, a therapist can initiate gentle myofascial release on the incision site. At 6-8 weeks post-delivery, when the incision has closed, scar tissue mobilization can begin, which helps reorganize the collagen fibers of the scar tissue into a similar pattern to normal tissues such that the scar moves and stretches like the skin around it. Manual therapy can help to reduce adhesions in underlying connective tissues and improve the elasticity and mobility of the body’s fascia, which reduces pain and tightness around the incision.
The physical therapist also provides posture and body mechanic instruction for a safe return to functional activities and guides women through restarting aerobic and strength training as they heal. This can range from helping women start walking shortly after surgery to more intensive aerobic conditioning after 6 weeks and progressing women through a core strength and stability program. The therapist can also address pelvic floor dysfunction through targeted pelvic floor rehabilitation to relax tight pelvic floor muscles and strengthen weak pelvic floor muscles. Pelvic floor rehabilitation involves a variety of treatments, including internal and external mobilization of joints and soft tissue in the pelvic area, bladder training, sensory, motor, sympathetic, and parasympathetic nerve re-training, postural training, manual therapy, and stretching and strengthening exercises of the pelvic floor muscles.
Several recent studies have highlighted how physical therapy can be critical for a more successful, long-term c-section recovery. A 2021 University of Missouri study found that women who received physical therapy after a c-section had significantly improve outcomes compared to those who did not receive physical therapy post-c-section. The study assessed 72 women who had a c-section between 37-and-42-weeks gestation. Thirty-nine of the patients received standard care as the control group (physical therapy consult, written information on scar management, and a general program of suggested abdominal exercises). The intervention group of thirty-three women received six weeks of physical therapy that involved scar mobilization and manual therapy to the low back, hip, and soft tissue as well as stretching, core stabilization exercises, and a home exercise program.
Women who received physical therapy achieved substantially lower pain levels more quickly than those in the control group and the physical therapy group had higher patient satisfaction at 14 weeks and 6 months post-c-section The physical therapy group also had significantly improved self-reported ability to perform exercises at 14 weeks through 18 months post-c-section compared to baseline, whereas the control group reported lower levels of exercise ability compared to baseline.
A 2022 study assessed the effectiveness of face-to-face physical therapy training and education prior to an elective c-section in improving post-operative outcomes. The study involved 54 women, 27 of whom received the physical therapy training (intervention group) and education intervention and 27 of whom received standard nursing care (control group). Women in the control group has higher pain scores post-operatively and higher doses of additional pain medications than the intervention group. Pain upon returning to functional activities decreased significantly within 2 days in both groups; however, the physical therapy group had lower pain when returning to activity. The physical therapy group also had a shorter hospital stay than the standard care group.
Whether you had a c-section recently or years ago, physical therapy can help you! Physical therapy can help to decrease pain and improve mobility, function, and strength in the abdominals, back, and pelvic floor.
