I had a cesarean, do I really need pelvic floor physical therapy?

Cesarean Birth by Nick Youngson CC BY-SA 3.0 Alpha Stock Images

I get this question a lot so I wanted to answer it for all of you.

Loudly and clearly the answer is YES!

I know, your baby was delivered through your abdomen, not your vagina, so why would your vagina be affected?

Well, it turns out that most pregnancy related pelvic floor symptoms are due to pregnancy, not delivery. No matter how your baby exited your body, he or she grew inside of you for 9-10 months. The weight of this growing baby, amniotic fluid, placenta, and any additional weight you put on in pregnancy affect your pelvic floor. We know being overweight increases the risk of pelvic floor dysfunctions and it seems that quickly gaining weight (9-10 months is a short time to put on 35lbs in the grand scheme of things) which may or may not be lost quickly does too. Additional factors include hormonal changes, stretching muscles and ligaments beyond their normal level, and changes in activity level.

Now that we all understand that the baby and pregnancy as the factors putting the pelvic floor at risk, then let’s talk about the cesarean itself. I want you to watch this quick little video to visualize the cuts made in a cesarean delivery. This is a felt simulation no gore.

Now after watching that video I want you to consider the anatomy affected. The surgeon does not cut the skin and see a baby immediately. The abdominal muscles, the fascia and peritoneum, and the uterus are cut to get to your baby. As much as possible is sewn back together, but there is a scar at each layer. Usually these layers stick together once healed which does not allow each layer to move as freely as before surgery. The bladder usually adheres to the uterine scar which can cause a reduced capacity since the bladder cannot stretch as before. The muscles do not contract as strongly or with the right timing to be effective in stabilizing for lifting, carrying, and caring for baby.

What does that mean for you? It means that all pregnant women should have pelvic floor physical therapy, we all have that in common. Those who deliver by cesarean also have different needs for scar massage and reeducating the muscles because of the surgical procedure.

I use visceral mobilization to release adhesions and restrictions in the fascia to improve muscle and organ movement, but you can do superficial scar massage for yourself. Check out this video for info on cesarean scar massage:

https://www.youtube.com/watch?v=AbzABppHjLc

To recap, you should have pelvic floor physical therapy no matter how you deliver, but your full plan of care will be differ depending on how you delivered.

Feel free to reach out over email if you have any questions. I am always happy to help you find the care you need.