How pelvic floor physical therapy can help a cesarean shelf

Last Updated:

cesarean shelf

One third of women deliver by cesarean section, and the postpartum maternal care leaves something to be desired here in the US, particularly the education on a cesarean shelf. As a pelvic physical therapist, I often hear women say, “Well, I had a cesarean, so I don’t think pelvic PT would help me.” However, this could not be further from the truth! It is common for women who have had cesarean deliveries to assume that pelvic PT will not be helpful for them. The truth is that pelvic PT can be hugely beneficial in helping reduce pain and improving mobility, function, and quality of life, no matter the type of delivery. Our postpartum bodies are different from our pre-baby bodies, no matter the type of delivery you had and your pelvic floor is a big player in both vaginal and cesarean births. 

Specifically, postpartum cesarean moms may need scar massage to minimize scar restriction and the tummy “shelf” that can persist, abdominal restrengthening, and pelvic floor rehab. Remember, even though you had a cesarean delivery and have a section scar, your pelvic floor is affected by the pregnancy itself.

How a c-section affects your pelvic health

Although a cesarean delivery does not require the baby to pass through the vaginal canal, the pelvic floor muscles, vaginal, and vulvar tissues can still sustain stress throughout the pregnancy that can cause issues with urinary, bowel, and sexual function. In addition to pelvic floor dysfunction, patients who have had a cesarean delivery can experience restriction of the tissue around their healing incision, leading to pain and limited function post pregnancy. Although many of these impairments are common, they are NOT normal, and pelvic PT can perform a thorough evaluation to assess the function of all these tissues. 

Tissue restriction from a cesarean scar 

Scar tissue restriction from an abdominal or cesarean scar can contribute to all of the below. Painful sex, incomplete bladder emptying, urinary leakage, constipation, scar pain, or a “shelf” after cesarean birth. All of which can be helped with pelvic floor physical therapy!

  • Cesarean shelf 
  • Painful sex
  • Back pain
  • Painful ovulation and menstruation
  • Straining during bowel movements
  • Unable to empty bladder
  • Section incision site feels numb, fuzzy, painful or sensitive

What is a cesarean shelf exactly? 

In many cases, these scar tissue adhesions can be so significant that they cause a “shelf.” A shelf occurs when the various layers of healing tissue along the incision adhere to one another, and, therefore, the scar becomes indented. Over time, the tissue just above the scar can puff out like a shelf. This can be both painful and a source of insecurity for many women. While there are severe cases that ultimately may require a consultation with a plastic surgeon for scar tissue revision, most patients can be treated conservatively with pelvic PT.

Causes of cesarean shelf

  • Giving birth via cesarean section 
  • Having an incision that is too tight 
  • Scar tissues, extra fat, and excess skin
  • Having loose skin 
  • Diastasis recti 

Things PFPT can do for a cesarean shelf

  • Test for DR (which might contribute to the cesarean shelf) 
  • Scar massage
  • Belly massage 
  • Core work / abdominal etc 
  • Diaphragmatic breathing 

What you can do to help your cesarean shelf

MASSAGE YOUR SCAR. Immediately after childbirth, this area will feel very numb, but you start massaging gently 2-3 inches around your scar to promote healing, blood flow, and sensation back to the area. After the initial six-week healing period, you can start massaging directly over the scar. Move it up and down, side to side, and spend extra time on the areas that feel tightest and hardest to move around. Doing this a few times a week for 2-3 minutes will help the scar be softer, flatter, and less purple-y. This also helps your scar from getting too tight, leading to the shelf, pain with sex, discomfort wearing pants, and peeing and pooping bladder problems. Whether your surgery was six weeks ago, six months ago, or six years ago, it’s never too late to start! 

If left untreated, the cesarean shelf can cause:

  • Belly pooch 
  • Pain with sex
  • Discomfort wearing pants
  • Bladder problems
  • Pooping difficulties

What to expect in a pelvic health assessment after a cesarean

One of the first places a pelvic PT will likely assess is the connective tissue of the abdomen. This is where cesarean mommas commonly experience pain, tightness, mobility restriction of the scar, difficulty activating the abdominal muscles, diastasis recti, and potentially numbness around the healing cesarean incision. The pain a patient may experience following a cesarean can vary from diffuse abdominal pain to local pain along the incision. In addition, it may present muscular pain or pull with activity, hypersensitivity to touch, and numbness along the scar. This variation in the type and location of the pain can often lead to discomfort wearing specific clothing, aversion to touching the scar, difficulty with daily activity (like lifting their child), and limitation with exercise. The pain and activity limitations are primarily due to scar tissue and myofascial restriction to the connective tissue surrounding the scar. 

Assessing for diastasis recti

In addition to assessing the mobility of the connective tissues of the lower abdomen, the pelvic PT will most likely evaluate you for potential diastasis recti. They will assess your ability to properly activate your transverse abdominis and correctly manage the pressure in your abdomen with daily activities. This is important because improper pressure management can lead to unwanted stress on the healing abdominal tissues, increased risk of diastasis recti, and increased risk of pelvic floor dysfunction.

diastasis recti check

Pelvic floor assessment via internal exam

Lastly, the pelvic floor PT will most likely do an internal vaginal exam (only once you have given consent). The purpose of this exam is to determine how well your pelvic floor is able to contract (kegel) and relax, and to determine if there are any areas of tightness (trigger points) in these muscles. This is important because we need full contraction of these muscles to hold in urine and poop, support our internal organs with daily activity and exercise, and for sexual function. Equally important is the ability for these muscles to relax. This relaxation is necessary to empty our bowel and bladder, and for sexual function. And yes, these muscles can be weak, tight, or both even if you did not have a vaginal delivery.

What does treatment look like?

Some of the things that can be done in pelvic PT for treatment of the above listed impairments include, but are not limited to:

  • Manual Therapy – Manual therapy and myofascial release to the scar itself and abdominal tissue surrounding the scar. These are techniques in which the therapist will perform hands on connective tissue release to reduce scar tissue adhesions and improve mobility. These techniques can also improve blood flow to the area to help promote healing.
  • Desensitization – Desensitization to the scar and tissue directly surrounding the scar with items of varying textures (tissue, towel, q-tip, makeup brush, etc). This technique can reduce hypersensitivity that may cause pain from clothing or touching the scar.
  • Dry Needling – Dry needling (once you are at least 30 days post delivery). This technique is used to improve blood flow to the area, promote healing, and reduce adhesions from scar tissue formation.


Had a c-section and wondering if you can have a vaginal birth for your next baby? Check this out!


Are you currently pregnant or planning to conceive? If so, make sure to download my FREE resource — How to Prepare Your Pelvic Floor & Core for Childbirth + 8 Must-Dos for C-Section and Vaginal Deliveries.

Some links may be affiliate links. The products we recommend are products we use or recommend to clients.

Join The V-Hive

Online pelvic floor fitness programs from a board-certified Women’s Health Physical Therapist. Your first week is free.

Free Pelvic Floor Guides

Download these free guides for some simple, do-able, totally-not-weird tips to take better care of your down there.

You might also like…

All About Postpartum Belly Binding

All About Postpartum Belly Binding

Have you ever heard of using postpartum belly binding during your immediate postpartum recovery? Over the course of your pregnancy, your body changes shape and makes room for your growing little one. Then, in postpartum, your muscles and organs literally shift around...

read more
Considering a Vaginal Birth After a C-Section? Here’s What You Need to Know

Considering a Vaginal Birth After a C-Section? Here’s What You Need to Know

What exactly is a VBAC? VBAC stands for vaginal birth after cesarean and is a delivery option for mothers who have had a cesarean delivery prior to their current pregnancy. While vaginal birth after cesarean was not always thought of as a safe option for moms, the most recent research shows that VBAC can be a great option when the patient is an appropriate candidate.

read more
Recovery after Cesarean Birth

Recovery after Cesarean Birth

April is Cesarean Awareness Month! You may be wondering, do I need pelvic floor therapy if I’ve had a cesarean birth? Do I need to massage my scar? Can I work on my scar even if it has been a few years? What about a VBAC?

read more

Join the V-Hive waitlist!

Enter your name and email below and you'll be the first to know when our new membership launches.

You have Successfully Subscribed!

How to Take Great Care of Your Pelvic Floor

6+ Simple Tips to Prevent or Overcome Pelvic Floor Problems

Pregnant? Postpartum? Struggling with peeing or pooping probs? Experiencing painful sex? Download this free guide for some simple, do-able, totally-not-weird tips to take better care of your down there.

Thank you! Check your inbox.

How to Take Great Care of Your Pelvic Floor

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

5 Myths We’ve Been Told About Pregnant Bodies

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

4 Signs of Pelvic Floor Muscle Tension

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

How to Prepare Your Pelvic Floor & Core for Childbirth

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!

6 Exercises To Strengthen Your Pelvic Floor and Core

Enter your name and email below and we'll send it right over.

You have Successfully Subscribed!