Pelvic Floor Dysfunction After C-section
Although some women believe a cesarean section (c-section) delivery spares their pelvic floor, this is an unfortunate misconception. During a c-section delivery, the baby does not pass through or by the pelvic floor muscles, however, a pregnancy alone causes stress to the pelvic floor and therefore can result in pelvic floor dysfunction, along with other factors that result from a c-section. In this blog we will seek to understand what pelvic floor dysfunction is, why a c-section can result in pelvic floor dysfunction, and how pelvic floor therapy can help.
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction is a catch-all term describing the changes that can happen to the pelvic floor muscles, ligaments, tissues, and nerves that support the bladder, bowel and uterus. Symptoms of pelvic floor dysfunction can include:
Urinary dysfunction
Urinary incontinence, urinary frequency, urinary urgency
Bowel dysfunction
Constipation, fecal incontinence, gas incontinence, fecal urgency, pain with bowel movements, fecal smearing
Pelvic pain
Pelvic pain encompasses a wide range of symptoms spanning anywhere between the belly button and the knees. Pelvic floor dysfunction can present as
Tailbone pain
Groin pain
Testicular or penile pain
Low back pain
Hip pain
Abdominal pain
Pain with intercourse
Pain during exercise such as running or lifting
Pain during menstruation
Pain during pregnancy or postpartum
Pelvic organ prolapse
Pelvic organ prolapse is when one or more of the pelvic organs descend further down into the pelvis than what is typical. If you have prolapse you may have a feeling of heaviness or “falling out” in the vagina.
Sexual dysfunction
Pain with intercourse, difficulty achieving orgasm or erection, pain with erection or ejaculation
For a more thorough look at what pelvic floor dysfunction is and if it may be right for you, refer to our previous post here.
Pelvic Floor Dysfunction After C-section
Although a baby does not pass by or through the pelvic floor muscles with a c-section delivery, the muscles are still impacted via pregnancy and indirectly through weakness of the surrounding areas. We will now explore how a c-section can contribute to pelvic floor dysfunction.
Impact of Pregnancy: A pregnancy alone causes added stress and pressure to be placed down onto the pelvic floor as the muscles as they work to support a growing baby. Pregnancy also causes stretching and weakening of the abdominal muscles, often resulting in a diastasis recti. Because the pelvic floor muscles and abdominal muscles work together as a unit, a pregnancy alone puts us at higher risk for pelvic floor dysfunction if we do not rehab appropriately.
Muscle imbalance: As mentioned previously, the pelvic floor and core muscles work together to help support our pelvic organs and for control of urination, bowel movements, and with exercise. When an area of our body is weak, oftentimes another area attempts to compensate for this. Due to the weakness of the abdomen after a c-section, this often leads to other areas such as the pelvic floor, hips, or back muscles compensating for the weakness and can cause a muscle imbalance within our body. If the pelvic floor and surrounding areas are not appropriately able to relax, contract and be coordinated properly with our other muscles, we are more likely to develop pelvic floor dysfunction.
Core Weakness: Any major abdominal surgery will result in abdominal or core weakness. A c-section is a major abdominal surgery, as muscles, fascia and the uterus are cut. After a surgery, we must allow these areas rest and time to recover. This further weakens the abdomen and if we aren’t purposeful about rehabbing our core muscles, the muscles often just stay weak. A weak core puts us at higher risk for pelvic floor dysfunction.
Scar tissue: All incisions form scar tissue, this is a normal process of healing. However, scar tissue can restrict muscles, fascia and organs from proper movement. When we have an abdominal scar after a c-section, it can limit the structures beneath the scar from proper movement which can contribute to development of pelvic floor dysfunction.
Posture Changes: Pregnancy often results in changes to our posture due to the change in weight distribution while carrying a baby. Furthermore, a c-section can result in posture changes due to the initial guarding and protection from discomfort at the incision. Optimal posture is key for prevention of pelvic floor dysfunction.
Abdominal pressure management: Our core system is a closed system meaning there is a set amount of pressure between the diaphragm, pelvic floor, and abdominal muscles that allows us to effectively support out pelvic organs, pelvic girdle, hips and low back. Oftentimes deep breaths are painful initially after a c-section. Proper movement of the diaphragm is key to proper strength of the pelvic floor and core muscles. Poor management of abdominal pressure puts us more at risk for pelvic floor dysfunction.
How Can Pelvic Floor Therapy Help Prevent Pelvic Floor Dysfunction After C-section?
Pain management: A c-section is often painful during the initial healing phase due to the fact that we use our abdominal muscles every single day with all types of movements. When there is a fresh incision through the muscles, this is often uncomfortable. Pelvic floor therapists are experts in guiding your through movement with everyday tasks and caring for your baby that will put less stress and pressure through your abdomen, allowing you to be more comfortable.
Management of scar tissue: Pelvic floor therapists are experts in management of scar tissue, especially at the abdomen. There are a number of manual therapy techniques used including scar massage, cupping and dry needling that helps to improve the mobility of the scar, therefore allowing the muscles, fascia, and organs beneath the scar to function as they need to.
Core retraining: Pelvic floor therapy after a c-section should include purposeful retraining of the abdominal muscles. Oftentimes the core muscles are difficult for the brain and body to access due to the numbness or discomfort from a scar or the severe weakness. Core retraining includes proper use of the diaphragm for optimal management of intraabdominal pressure.
Pelvic floor muscle rehab: Pelvic floor therapy after any type of delivery should include retraining the pelvic floor muscles how to function. This should include teaching the muscles to fully relax, contract and be coordinated when we are doing functional movement such as lifting our baby, household tasks, or exercise.
Posture retraining: When our posture is changed slowly over the 10 months of pregnancy and the initial postpartum period, we often do not even realize it. Pelvic floor therapists will help to retrain your posture which may include stretching of some areas, strengthening of some areas, and retraining the brain and nervous system to return to what is optimal.
Exercise progression: Pelvic floor rehab should include progressing you back to what exercise you like to do. Therapy should be aimed at your specific goals and desires for exercise. We must retrain our entire core system to properly support our body during exercise and functional movements.
Pelvic floor therapy is recommended for all women after pregnancy and delivery, regardless of vaginal or c-section delivery. Any type of pregnancy and delivery puts us at higher risk to develop pelvic floor dysfunction. It is never too late to begin pelvic floor therapy after delivery. Schedule with one of our Doctors of Physical Therapy and pelvic floor experts here. If you are not local to the Omaha area, refer to this post here to find a pelvic floor therapist that is well trained near you.
