Roughly 20% of United States pregnancies are delivered by an abdominal surgery known as a cesarean or ‘c-section’. Like many other surgeries, a c-section requires healing and rehabilitation. You may have seen our blog post a few weeks ago regarding physical therapy for non-orthopedic surgeries, and this week we are taking a deeper dive into physical therapy for post c-section recovery. Having a baby is a transformative time and recovering from a c-section on top of all the new changes can be challenging. Luckily, a trained physical therapist can provide assistance through the recovery process.

What is a C-section? 

If it is decided by the healthcare provider team and parents that a c-section is the best course of action for delivery, the doctor makes an incision either vertically or horizontally near the pubic bone through the abdominal wall (including the abdominal muscles), and through the uterus. Once the delivery is complete, sutures are placed at both the uterine level and abdominal level. In the weeks following, it is recommended to avoid heavy lifting and to generally take it easy in order to protect the incisions as they heal. Managing a surgical scar can be challenging with a newborn, but prioritizing self-care and rehabilitation in the early days can be especially helpful.

What are common symptoms that can occur after a C-section?

As time goes on and the incision begins to heal, scar tissue is formed at the skin level all the way down into the deep layers of the abdomen, including the uterus. This scar tissue can create sensitivity and pain around the incision. Other common symptoms after a c-section include decreased mobility especially of the hips and lower back; together, this can lead to pain, additional decreased mobility of the internal organs because of scar tissue, urinary issues, pelvic pain, pain with sexual activity, abdominal muscle weakness, as well as changes in bowel habits. These symptoms can be short- lived, but they may last for years if not addressed. Fortunately, a trained physical therapist can help you improve your symptoms and function.

How can physical therapy help after a c-section? 

A study by the University of Missouri found that women who received physical therapy after a c-section had significantly improved outcomes across all domains, compared to those who did not. In the early weeks after a c-section, a physical therapist can provide education on your care and help to adjust expectations as the incision heals. A physical therapist can also provide movement modifications to protect the incision, like the log roll technique for getting in and out of bed. After the acute stages of recovery, your physical therapist can perform manual treatments including soft tissue mobilization to improve the mobility of the scar and decrease pain. Additionally, your physical therapist can help restore the normal tone of your pelvic floor muscles through stretching and strengthening. Given nine months of pregnancy and a c-section scar that passes through the abdominal muscles, it is not surprising that these muscles get weak. A physical therapist can safely guide you through a progressive strengthening program to regain strength and return you to your optimal level of function.

Whether your c-section scar is new or from many years ago, it is never too late to address it! Here at Beacon Physical Therapy, we are here to support you and your postpartum body.

References:

1. Fan C, Guidolin D, Ragazzo S, Fede C, Pirri C, Gaudreault N, Porzionato A, Macchi V, De Caro R, Stecco C. Effects of Cesarean Section and Vaginal Delivery on Abdominal Muscles and Fasciae. Medicina. 2020; 56(6):260. https://doi.org/10.3390/medicina56060260
2. Osterman M. Vital Statistics Rapid Release Changes in Primary and Repeat Cesarean Delivery: United States, 2016-2021.; 2022. https://www.cdc.gov/nchs/data/vsrr/vsrr021.pdf
3. Wasserman JB, Abraham K, Massery M, Chu J, Farrow A, Marcoux BC. Soft Tissue Mobilization Techniques Are Effective in Treating Chronic Pain Following Cesarean Section. Journal of Womenʼs Health Physical Therapy. Published online June 2018:1. doi:10.1097/jwh.0000000000000103

4. Stone J, Skibiski K, Hwang S, Barnes C. Physical Therapy in Addition to Standard of Care Improves Patient Satisfaction and Recovery Post-cesarean Section. Journal of Women’s Health Physical Therapy. 2020;45(1):10-19. doi:10.1097/jwh.0000000000000187