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Maximizing Core Strength and Recovery after Cesarean Section

April is C-section Awareness Month. C-section is short for cesarean section, and is the delivery of a baby through an incision in the mother’s abdomen and uterus. According to the Obstetric Care Consensus from the American College of Obstetrics and Gynecology (ACOG), roughly 1 out of 3 women give birth by c-section. For many women, c-section isn’t a choice; it is the only safe way to deliver the baby but often requires a longer healing period and has more potential risks. During a c-section, the lower abdominal wall fascia is separated and stretched at the midline to allow access to the uterus. After the baby is birthed, the endopelvic fascia is repaired. Unfortunately, most postpartum women are not given much information regarding the healing of their core and incision beyond general wound care.

Whenever an incision is made, a scar forms as part of the natural healing process as the body lays down collagen, a fibrous protein. The healing time for wound closure takes 6-8 weeks. Scar tissue is not only what you see at the surface, but can extend into the deeper layers below the skin and fascia, down to muscle, organs and sometimes bones. When the scar extends to these deeper layers, adhesions may form and cause:

  • Pain and sensitivity at and around the scar or remote areas caused by nerve irritation and decreased blood flow

  • Reduced mobility and difficulty standing up straight due to fascial restrictions

  • Constipation or irritable bowel due to decrease organ mobility, causing a swollen or bloated abdomen

  • Myofascial pain/muscle guarding in the abdominals, diaphragm, pelvic floor, hips and even the jaw

  • Nausea, sometimes persisting for years

  • Disruption of the pelvic core piston function, causing core weakness and hip weakness and/or stiffness

  • Urinary urgency, increased frequency (including nighttime voiding) and/or urinary incontinence

  • Pain with sexual intercourse or altered sensation with intimacy

Postpartum pelvic floor rehabilitation is a big part of what we do at Healthy Core and healing from a c-section is often overlooked. Pain and dysfunction can be related to a former pregnancy or surgery, regardless of how many years have passed. Our typical postpartum evaluation includes assessment and treatment of muscle and fascial restrictions, diastasis recti (abdominal separation), rib and pelvic alignment, posture, strength and overall body mobility. We will assess scar mobility, especially as it relates to the underlying organs such as the bladder, bowel and ovaries. Our treatment approach addresses any restrictions with manual therapy including visceral mobilization (myofascial release of deep abdominal fascia), vacuum cupping therapy, dry needling and mobilization of joints and muscles. Individualized exercise prescription addresses mobility and strength/coordination deficits to achieve your specific functional goals, whether it be standing without pain, taking care of your family and home or returning to high intensity exercise.

We offer a free virtual consultation to answer any questions you have. For more information on postpartum exercise and restoring your core after baby, click here.

initially published April 2018; revised April 2024

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