Understanding the Impact of C-Sections on Pelvic Health

Have you ever experienced someone saying, "Having a C-section protects the pelvic floor" or "Pelvic floor therapy isn't necessary if you've had a C-section," and found these statements could really fire you up?

Before we dig a little deeper, it is almost 100% certain (I will rarely say an absolute because there will most likely be an outlier) that therapy will be consulted for total knee replacements, hip replacements, spinal fusions, total shoulder replacements, small bowel resections and so on post-surgery.

But isn’t a C-section considered a MAJOR abdominal surgery? You better believe it is. And don’t you have a new life to care for on top of that major surgery? You bet.

So let’s cover the basics of what a C-section is and explore the impact it has on the pelvic floor and the overall well-being of the mother.

Bringing new life into the world is a remarkable journey, and the method of delivery- with both (vaginal and cesarean section) being forms of trauma on the body, have a lasting effect on the mother’s health.

A C-section, is a surgical procedure in which a baby is delivered through an incision made in the mother's abdomen and uterus. This method is typically performed when a vaginal delivery is considered unsafe or not possible- emergent situations, breech positioning, stalled labor, large baby, multiples, placenta Previa or mother’s comorbidities. During a C-section, the incision is made above the pubic bone, and it can be either horizontal or vertical, although horizontal incisions are much more common. The procedure involves cutting through several layers, including the skin, fat, fascia, muscle, peritoneum, uterus, and amniotic sac, to reach the baby.

A second stage C-section, is performed during the second stage of labor, the pushing phase. During a second stage C-section the mother is typically fully dilated and the baby’s head is engaged in the pelvis. This might happen for various reasons, such as complications that arise during the pushing stage, fetal distress, or if it becomes apparent that a vaginal delivery would pose risks to the health of the mother or the baby. Performing a C-section during the second stage of labor is not the typical course of action, and it is usually reserved for situations where an emergency intervention is necessary.

Similar to a vaginal delivery, mothers can experience urinary incontinence, abdominal weakness, low back pain, pain with sex, constipation and pain during your daily caregiving duties.

So let’s break down the potential impact a C-section may have pelvic health:

Scar Tissue Restrictions

Scar tissue restrictions resulting from a C-section, are a common occurrence. When a surgical incision is made through the layers of the abdomen and uterus during a C-section, the body's natural healing process leads to the formation of scar tissue. This scar tissue can potentially cause restrictions or adhesions, impacting nearby tissues and structures. This may affect the mobility of muscles, fascia, and other structures around the incision site. Scar tissue near the bladder or bowel can lead to adhesions that affect their normal function. It could impact bladder function potentially causing urinary symptoms.  Scar tissue can sometimes become sensitive or painful. This sensitivity may be due to nerve involvement or hypersensitivity of the scar tissue. Proper scar tissue management, including mobilization techniques, can help address these issues. The sensitivity can have an impact with wearing certain materials or clothing touching the scar or limitations when playing with your kids (when they lay on your belly).

C-section Shelf

In some significant cases, scar adhesions can be severe and may cause a shelf like appearance. This is when the layers of the healing tissue adhere to one another creating a shelf over time. It can cause pain and insecurity for women. There are some factors that influence the shelf: excessive skin or fat, excessively tight skin, loose skin and diastasis recti.

Pelvic Floor Tension

Your pelvic floor muscles have been working hard for 40 weeks to support the weight of your growing body and lengthened abdominals. After working overtime for an excessive amount of time and without the natural lengthening of your pelvic floor muscles during a vaginal delivery, they can stay tense-resulting in weakness and pain. This tension can bring about an array of complaints including- pain with sex and insertion of tampon, urinary incontinence and urgency and constipation.

Abdominal Changes

Growing a baby is hard work! With pregnancy- comes stretching abdominals, a shift in center of gravity and decreased muscle activation. With a C-section- comes an incision causing disruption in muscle function and weakness. Women find themselves having a harder time engaging their deep core, activating their transverse abdominals and reconnecting muscular connection. A pelvic health clinician will allow you to reconnect to your body, feel strong and empowered to return to movement.

It's important for moms and healthcare providers to recognize that a C-section, despite not being a vaginal delivery, is a significant abdominal surgery that requires attention. Clarifying the misconception that pelvic floor therapy isn't necessary post-C-section is crucial, as these therapies can effectively address concerns like scar sensitivity, abdominal issues, and pelvic muscle imbalances. Each mother's childbirth experience is unique, emphasizing the importance of acknowledging both physical and emotional trauma, regardless of the delivery method. Prioritizing pelvic floor health empowers moms to regain pain-free movement, restore balance, and ensure a more comfortable postpartum experience. It is imperative to advocate for comprehensive post-C-section care- encouraging a holistic approach that supports the well-being of both mothers and their newborns.