Cesarean Section and Your Core

April is C-section Awareness Month.

  • Do you have discomfort at your c-section scar?

  • Do you feel disconnected to your core since your c-section?

  • Have you noticed a change in bowel or bladder habits since your c-section?

  • Have you had difficulty performing an exercise program after your c-section?

  • Have you noticed pelvic or pelvic floor pain since your c-section?

Postpartum pelvic floor rehabilitation is a big part of what we do at Healthy Core, and c-section scarring is a common issue that we treat. At Healthy Core, we commonly ask these questions during our intake of our postpartum women - at any age. Many times, we see women that have been postpartum for several years with pain, thinking it was normal after c-section. Our purpose is to educate women on issues that can be common (but not normal) and how they can help themselves.

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 most recent 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 their 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 baby is birthed, the endopelvic fascia is repaired. Unfortunately, most women post c-section are not given much information regarding the healing of their incision beyond general wound care.

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

  • Pain and sensitivity at and around the scar by nerve irritation and decreased blood flow -Sometimes the sensitivity is a distance from the scar.

  • Reduced mobility of your body 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 and even the pelvic floor

  • Nausea

  • Disruption of the pelvic core piston during general mobility, causing eventual core and hip weakness and low back/hip pain

  • Urinary urgency, increased frequency and urinary incontinence

  • Pain with sexual intercourse

How can physical therapy help? At Healthy Core, we are specialists in Pelvic Floor PT. Our assessment of a mom post c-section includes scar mobility (once the incision is closed), muscle and fascial restrictions, diastasis recti, posture, strength and body mobility. Our treatment may include individualized education in scar massage and manual therapy such as visceral mobilization (myofascial release of deep abdominal fascia), dry needling and mobilization of joints and muscles. Individualized exercise prescription is necessary to address mobility and strength/coordination deficits and to achieve your specific mobility goals whether it be standing without pain or returning to high intensity exercise.

If you have questions, we are here to help you restore your core, no matter how much time has passed! Click here for more information on exercising your core after baby.

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