How Pelvic Floor Physical Therapy Aids in C-section Recovery
Cesarean births, also known as C-sections are major abdominal surgery in which 7 layers of tissue are involved to get to the baby. About 32% of births in the United States in 2021 were C-sections. That is over 1,000,000 C-sections! Whether planned or unplanned, tackling C-section recovery can be overwhelming, especially while simultaneously caring for a newborn. Don’t let anyone tell you that a C-section is the easy way out. Because it is not!
And YES, pelvic floor physical therapy is JUST as important for C-sections as it is for vaginal deliveries.
Like any major surgery, C-sections require appropriate rehabilitation, making an immediate referral to pelvic floor physical therapy essential. Just as patients are promptly prescribed physical therapy after significant procedures like hip, shoulder, or knee surgeries—often starting in the hospital the same day as their operation—new mothers deserve the same support after a C-section. Not only have you undergone major surgery, but you also have a tiny human to care for (but that’s a topic for another day!)
In this guide, we’ll explore what you can do from day one to enhance your C-section recovery, from your time in the hospital to your first pelvic floor PT appointment. While the pelvic floor may not have been directly injured during delivery, it has endured the pressure of carrying a baby for nine months and also needs focused rehabilitation.
Understanding Your C-Section Recovery
Because C-sections are major abdominal surgery, it’s normal to experience pain and discomfort in the days and weeks following the procedure. Approximately 25% of women will experience some level of C-section scar pain. This is expected in the first few weeks, but it should gradually subside as you heal. This is one of the many reasons why pelvic floor physical therapy is imperative after a C-section.
Prioritizing proper healing is crucial for a smooth recovery and can prevent long-term complications.
What to Expect Immediately After Your C-section:
Immediately after your C-section, you will be numb for a few hours while the medication from the spinal wears off. Once the spinal wears off, you may experience pain and soreness, which can be managed with pain medicine in the hospital.
You will also experience lochia, which is postpartum vaginal bleeding. This is normal and comes from where the placenta detached from the uterus. While the bleeding may not be as heavy compared to a vaginal delivery, it will still be present and last for about 2-6 weeks.
Caring for your Scar:
After your delivery, your scar will be covered with a bandage. During your hospital stay, your birth team will monitor your scar for signs of infection. These include:
redness
abnormal swelling
clear or colored discharge
abdominal discomfort
hot to touch
fever greater than 100.4
Redness and swelling are normal for the first couple of days post C-section, but this should subside after a few days. To reduce swelling, compression garments such as leggings, ice, gentle movement, and pelvic floor physical therapy for scar massage can help.
What Should I Do The First Few Days Post C-section?
Because a C-section is major abdominal surgery, steps should be taken early in the recovery process to ensure proper healing. These steps include managing pain, moving safely to avoid excessive strain on the abdomen, and using supportive measures.
Pain Management:
Stay ahead of your pain medicine, especially in the first two weeks postpartum. Taking your pain medicine before you feel pain can make a significant difference in managing discomfort. Icing the incision is another great way to help reduce pain and swelling.
Safe Movement Techniques:
When getting in and out of bed, use the "log roll" technique. This involves rolling your entire body as a unit, rather than twisting at the waist, to minimize strain on your incision.
When getting out of a chair, practice the “nose-over-toes” technique. This involves leaning forward and shifting your weight over your toes and using your hands to push yourself up to avoid straining your abdominal muscles.
Lifting your baby:
After a C-section, your provider will most likely tell you not to lift anything heavier than your baby for 6 weeks. This can be challenging, especially if you have a toddler at home or if you are alone with the baby. It’s important to not put too much pressure on your incision when lifting the baby. The best way to go about this is to BREATHE when you lift the baby. Holding your breath can put undue pressure outward on the incision and down on the pelvic floor which could lead to core and pelvic floor dysfunction. If you have to get a toddler in and out of a crib, using a step stool that they can stand on while you assist them is an option to reduce stress on the abdomen.
Supportive Measures:
Hug a pillow to your incision when you need to cough or sneeze to provide abdominal support and reduce discomfort.
Silicone scar strips:
Two weeks after your C-section, you can start using silicone scar strips which can help reduce the red appearance of the scar. These silicone strips help keep the scar hydrated and protect the area around the scar. You can cut the strips to the length and shape of your scar and can wear them all day.
What is the C-section Shelf and Does It Go Away?
The C-section shelf is excessive skin and abdominal fat that hangs over the incision. This is caused by multiple layers of tissue adhering down to each other or from restriction in the scar itself. The appearance of the shelf can be greatly reduced with scar tissue mobilization from a pelvic floor physical therapist.
Do I Need Pelvic Floor Physical Therapy After A C-Section?
YES, yes, A MILLION TIMES YES! After 7 layers of tissue are cut, each layer needs to be sewn back together. Scar tissue can cause these layers to get stuck to each other which can cause pelvic and abdominal pain as well as pelvic floor dysfunction, such as pain with sex or bladder leakage. A skilled pelvic floor physical therapist will be able to mobilize these tissues to prevent these issues.
Many people think that their pelvic floor is spared after a C-section (which in a way it is-there’s less instances of pelvic organ prolapse). But, there was still a fetus putting pressure on these muscles for 9 months. The core and pelvic floor are strongly connected and therfore it is vital to address both after a C-section.
What Does Pelvic Floor PT Look Like after a C-section?
At Cappuccino Physical Therapy, we can see you as early as two weeks post C-section. Our C-section recovery starts with scar desensitization and works up to core strengthening.
We will start with scar desensitization. If your scar feels numb, exposing it to different textures such as a pillowcase (early on) or towels (later on) can help decrease this numbness and sensitivity.
We don’t do any work directly on the C-section scar until you are cleared by your provider at 6 weeks, but we can start doing indirect scar mobilization by gently working the upper abdomen and the area above the scar. We will work on posture and body mechanics when holding and lifting the baby. Addressing posture early on can help reduce the appearance of the C-section shelf. We will also start very gentle breathing exercises to begin the process of reconnecting the core and the pelvic floor.
At the 6 week mark, we can begin working on the scar itself. Performing scar tissue mobilization can decrease pain and reduce the appearance of the shelf. Remember that 7 layers of tissue were cut to get to the baby, and these layers can adhere down to each other if not addressed. Scar tissue mobilization is VITAL to C-section recovery. We will also check your pelvic floor at this time. Your core and pelvic floor need to work together to maintain normal bodily functions and this harmonious relationship tends to be disrupted after child birth, regardless of how you delivered. Around the 12 week mark, we will add deeper scar massage and mobilization to further aid in scar healing.
In addition to scar mobilization, core and pelvic floor strengthening are imperative parts of C-section recovery. Diastasis recti is very common after a C-section and can lead to other pelvic floor dysfunction such as bladder leakage or low back pain. Learning how to properly connect the core and pelvic floor is the first part of the strengthening process. We will then guide you through a progressive rehabilitation program for core strengthening. This starts with basic core activation exercise and eventually progresses to the core exercises that you love, whether it be crunches or planks. Yes you can do those after a C-section, but only after you have been taken through a guided rehabilitation program.
Red Light Therapy for C-section Scars
Red light therapy (RLT), also known as low-level laser therapy (LLLT) or photobiomodulation, has gained attention for its potential benefits in wound healing for C-section scars. This non-invasive treatment uses specific wavelengths of red or near-infrared light to penetrate the skin, promoting cellular regeneration and reducing inflammation, which can be particularly helpful for C-section scars.
One of the primary benefits of red light therapy for C-section scars is its ability to accelerate tissue repair via collagen production. By enhancing collagen production, RLT helps to soften the scar tissue, reduce scar size, and improve skin texture, making the scar less noticeable over time.
Red light therapy also helps reduce inflammation and pain, which are common concerns during the healing process after a C-section. The therapy works by increasing blood circulation to the treated area, providing more oxygen and nutrients to the cells, which supports faster healing and reduces discomfort. Many people who have undergone C-sections report significant relief from pain and tightness around the incision site after consistent use of red light therapy.
When Can I Return to Exercise After a C-section?
Being cleared at 6 weeks postpartum does NOT mean you can immediately resume your normal exercise routine. Yes you can start doing some exercise, but it’s important to ease yourself into exercise to prevent core and pelvic floor injuries.
Each C-section recovery looks a little different and varies greatly depending on how you are feeling. This is a very general guide about returning to exercise, but we highly recommend consulting with a pelvic floor physical therapist after you have been cleared by your provider to make sure you are getting back into exercise the correct way.
How Long Does It Take to Recover From a C-section?
Healing from a C-section is a gradual process that can take 12 to 18 months for full recovery, both internally and externally. While the external incision may appear to heal within a few months, the deeper layers of tissue, including the muscles and fascia, take much longer to fully regenerate. During this time, scar tissue continues to remodel, and sensation in the area may return gradually as nerve endings repair. It is important to work with your pelvic floor physical therapist throughout this time to regain proper core and pelvic floor strength. Though the most noticeable healing occurs in the first few months, subtle changes in scar appearance, tightness, and sensitivity can continue for up to a year and a half.
At Cappuccino Physical Therapy, we like to see you through the first year postpartum. Our C-section recovery starts with either an in person or virtual visit at 2 weeks postpartum. We then see you for an in person visit at 4 weeks postpartum and at 6 weeks postpartum. From there we see you weekly or every other week depending on how you are healing.
It is never too late to seek help with recovery. Whether you are 3 weeks, 3 years, or 30 years postpartum.
C-section recovery does not happen in 6 weeks, and it doesn’t happen without help. At Cappuccino PT, we have curated recovery techniques for our C-section moms. We help with your entire recovery, from scar mobilization while still in the hospital, to standing with baby techniques, all the way to returning to exercise and beyond.
