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.