March 13, 2022

Importance of Pelvic Physical Therapy After C-Section

If you think a c-section means pelvic floor PT isn’t for you, get ready to change your mind. Learn how pelvic PT can be hugely beneficial in helping reduce pain, improve mobility, function, and quality of life no matter the type of delivery!

stomach massage

As a pelvic physical therapist, I often hear women say things like, “Well I had a cesarean so I don’t think pelvic PT would help me.”  However, this could not be further from the truth! 

While 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, improve mobility, function, and quality of life no matter the type of delivery. 

How A C-Section Affects Your Pelvic Health

You might be thinking, “Nothing happened to my vagina during my delivery so what in the world will a pelvic PT assess and treat on me?” The answer is LOTS! 

Although a cesarean delivery does not require the baby to pass through the vaginal canal, the pelvic floor muscles, vaginal, and vulvar tissues still can 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, which can lead to pain and limited function. 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. 

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 an area 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. It may present muscular pain or pulling with activity, hypersensitivity to touch, and/or numbness along the scar. This variation in the type and location of pain can often lead to discomfort wearing certain clothing, aversion to touching the scar, difficulty with daily activity (like lifting their child), and limitation with exercise. The pain and activity limitations occur in large part due to scar tissue, and myofascial restriction to the connective tissue surrounding the scar. 

Assessing for a Cesarean ”Shelf”

In many cases, these scar tissue adhesions can be so significant that they cause what is called a “shelf.” A shelf occurs when the various layers of healing tissue along the incision become adhered to one another and therefore the scar itself becomes indented. Over time, the tissue just above the scar can begin to 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 cases can be treated conservatively with pelvic PT.



Assessing for Diastasis Recti

In addition to assessing the mobility of the connective tissues of the lower abdomen, the pelvic PT will most likely assess you for potential diastasis recti. They will assess your ability to activate your transverse abdominis properly, and your ability to manage the pressure in your abdomen with daily activities correctly. 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.




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.


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After An Exam, What Might 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 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.


Interested in more tips on how to prevent or overcome Pelvic Floor Problems?
Download this free guide for some simple, do-able, totally-not-weird tips to take better care of your down there.


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