Physical Therapy After a C-Section Delivery
Having a baby is a joyful, special event in the life of a mother. However, the process of delivery and recovery post-delivery can be challenging, particularly if a mother has undergone a c-section delivery. Women may experience pain at the caesarian-section (c-section) incision site, low back pain, urinary continence, and pelvic floor muscle weakness following a c-section. Physical therapists can provide women customized physical therapy treatment to address these issues, relieving incision pain through soft tissue mobilization techniques and strengthening the core, back, and pelvic floor muscles through a personalized exercise program.
What is a C-Section Delivery?
An estimated 1.3 million c-section deliveries are performed annually in the United States. A c-section is the delivery of a baby through incisions made in the abdomen or uterus, which can be transverse (horizontal) along the pubic hairline or vertical along the midline (rectus abdominis muscle). During a c-section, the abdominal wall is cut, which may have become overstretched and strained during pregnancy; the c-section can thus exacerbate a woman’s healing from diastasis recti post-delivery.
Abdominal surgical scars can cause pain due to their effect on the body’s fascia system. Fascia is thin connective tissue underneath the skin throughout the entire body, covering each blood vessel, nerve, and muscle. After surgery, as part of the healing process, scar tissue is formed from collagen, a tough, fibrous protein, that extends into deeper layers below the skin. Adhesions can also form, which are scar tissue in the underlying fascia (connective tissue) and myofascial layers that attach to other structures close by to it. The formation of scar tissue and adhesions can contribute to pain sensitivity around the scar, limited mobility, reduced blood flow to that area, and nerve irritation around the scar.
Common post-c-section symptoms include:
Scar pain and sensitivity
Reduced mobility and flexibility in hips and low back
Difficulty bending forward or lifting and standing upright
Low back pain from weakened core muscles
Myofascial trigger points in the abdomen
Urinary incontinence, frequency, and urgency
Pelvic pain during intercourse
Pelvic immobility
Physical Therapy for C-Section Scars
If you are experiencing pain after a c-section, physical therapy can help reduce incision site pain, normalize pelvic floor muscle tone, decrease tissue hypersensitivity, improve core and back muscle strength, and retrain muscles affected by pregnancy and delivery for optimal function. Physical therapy post-c-section involves manual therapy, scar tissue mobilization, myofascial release, and core, abdominal, and pelvic floor muscle stretching and strengthening.
For the c-section incision site, the physical therapist uses soft tissue mobilization techniques to soften and flatten the scar tissue around the incision about 6 to 8 weeks post-delivery. Gentle myofascial release can be done around four weeks post-delivery to the incision site. Scar tissue mobilization helps to reorganize the collagen fibers of the scar tissue into a similar pattern to normal tissues such that the scar moves and stretches more like the skin surrounding it. The manual therapy on the scar also helps to reduce adhesions in underlying connective tissues and myofascial layers. The manual techniques promote elasticity and improve the mobility of the body’s fascia, which lessens the pain around the incision.
A recent study by the University of Missouri showed that women who received physical therapy after a c-section had a higher satisfaction rate, significantly improved outcomes, and less pain. Seventy-two women who delivered c-section participated in the study, 39 who received the standard of care with a physical therapy consult and information about scar management and abdominal exercise. The other 33 women received six weeks of physical therapy that included scar therapy, mobilization of the low back, hip joint, and soft tissue, and stretching and core stabilization exercises. Those who received physical therapy achieved substantially lower pain levels than those who received the standard of care as well as higher patient satisfaction scores.
Whether you had a c-section recently or years ago, physical therapy can help you! Physical therapy can help to decrease pain and improve mobility, function, and strength in the abdominals, back, and pelvic floor.
