C-section and pelvic floor muscle recovery

Congratulations!

C-section recovery is so much more than the scar. Not only is there the physical healing process but also an emotional healing journey to consider, especially if you’ve ended up with an emergency c-section. Read blog 2 of this 3 blog series about the important considerations when embarking on your c-section and pelvic floor recovery.

Click here to read blog 1- scar tissue healing.

WHAT IS A C-SECTION?

It is a procedure involving an incision to the lower abdominal region under general aesthetic or a spinal block to birth your baby. An incision is made through 5 layers including:

  • Skin
  • Fatty tissue
  • Rectus or abdominal sheath and
  • 2 layers of peritoneum

The bladder is moved aside to access the uterus, where the final incision is made. Baby is born, placenta follows, uterus is stitched up, bladder is put back in place and the remaining layers are sutured up again to varying degrees. There is a reason your incision is sore and you feel like the wind has been taken out of your sails.

IS THERE A DIFFERENCE BETWEEN PLANNED VS UNPLANNED C-SECTION?

Sometimes labour doesn’t go to plan and may require the need for an emergency c-section. Some mums may have laboured for hours before the decision is made and this is where the difference lies. Sustained downward pressure on the pelvic floor on top of the c-section incision can make things a little more challenging and may mean that your rehab journey is different to a stand alone c-section or vaginal delivery mummy. And let’s not underestimate the emotional trauma experience by the mummy (and daddy) during this process.

WHAT IS PELVIC FLOOR DYSFUNCTION?

Pelvic floor dysfunction (PFD) is the umbrella term used to describe changes to functioning of the pelvic floor structures: bladder, bowel or uterus and the ligaments, tissue and muscles that support them.

Signs of PFD include:

  • Incontinence
  • Urgency or frequency
  • Prolapse
  • Pelvic pain
  • Dyspareunia

Risk factors for pelvic floor dysfunction include:

  • Pregnancy
  • Childbirth- Vaginal Delivery
    • Quick 2nd stage
    • Long 2nd stage
    • > 4kg
    • Forceps/vacuum
  • Hormones/ageing
  • Hypermobility
  • Genetics
  • Increased downward pressure:
    • BMI > 25
    • Constipation/ straining
    • Persistent heavy lifting
    • Excessive coughing

WILL DELIVERING VIA C-SECTION PROTECT MY PELVIC FLOOR FROM PELVIC FLOOR DYSFUNCTION?

“Caesarean delivery is not associated with a significant reduction in long term pelvic floor morbidity compared with spontaneous vaginal delivery”. (Alastair H et al 2000)

A strong risk factor for post-partum urinary incontinence was in women who complained of urinary incontinence during pregnancy, regardless of mode of delivery. (Foldspang A et al 2004)

The EPINCONT study collected data from over 15000 women and it showed that regardless of mode of delivery, by the time we reach 50 years in age rates for urinary incontinence are the same for both vaginal delivery mums and c-section mums. (Rortveit G et al 2003). This was further supported by Cacciatore A et al 2010.

Did you know that it would take 8-9 c-sections to prevent 1 case of urinary incontinence (I’m amazed that they researched this!) (Gyhagen M et al 2013)

Episodes of feacal incontinence, dyspareunia and time to return sexual activity was favored by c-section births. (Cacciatore A et al 2010)

DO I NEED TO DO PELVIC FLOOR EXERCISES?

YES! Basically, C-sections don’t protect your pelvic floor from ageing or ‘wear and tear’.

What we know is that despite mode of delivery, we are all pregnant and our pelvic floors can weaken up to 25 % due to baby, uterus and body weight.

If you chose to have more babies, regardless of a c-section or a v-bac or choose to be physically active in the postnatal period and beyond, having the guidance on the right type of exercises to do, how heavy to lift and what you can do to optimise your recovery is a no brainer to me…me thinks.

WHEN SHOULD I START MY PELVIC FLOOR EXERCISES?

You can start pelvic floor exercises once the urinary catheter is removed and it is comfortable for you to do so. The aim is not for a personal best though, but rather about re-building the connection between the brain and the muscles- gentle pulses is all that is required early on. Then progress from here under the guidance of your Women’s Health Physio.

I’VE NOTICED THAT I GET THE SUDDEN URGE TO GO TO THE TOILET AND GO TO THE TOILET OFTEN…

Vaginal delivery mummies aren’t the only ones that may suffer from changes to their bladder habits. Falling short of being man-handled, the bladder needs to be repositioned to allow access to the uterus. This process can make the bladder sensitive and cause it to randomly send signals to the brain giving rise to urgency- the sudden need to have to do a wee that you can’t defer and/or frequency.

Sometimes this urgency and frequency can also arise from

  • the placement or removal of the urinary catheter (causing irritation of the urethra)
  • a UTI
  • being unable to completely empty your bladder leaving a bit of wee leftover in the bladder (post void residual (PVR) or
  • scar tissue can disrupt the nerves supplying the perineum causing irritation of the urethra or vulva
  • scar tissue extending down to the bladder wall can create a tugging effect sending off bladder signal

As you can see, symptoms of urgency and frequency can arise for a number of different reasons and it is best that you get it seen to sooner rather than later. No, it is not normal.

Management is dependent on the cause of your symptoms and may be as simple as allowing time to heal the irritability, antibiotics to clear the infection, optimising voiding function, bladder retraining, bladder calming strategies or pelvic floor muscle training to name a few.

HOW STRONG SHOULD MY PELVIC FLOOR BE BEFORE RETURNING TO EXERCISE?

I’ll cover more about returning to exercise in the next blog, but in line with the latest return to running/exercise guidelines, mummies should be able to do the following or near abouts:

  • 10 quick repetitions
  • 8-12 reps of 6-8 sec holds at 100% effort (max squeeze)
  • 1x 60 second hold at 30-50% effort (sub maximal squeeze)
  • With the correct technique…

WHEN SHOULD I SEE A PHYSIO?

Read this blog!

Mummies, this blog post is intended as general advice. You only get one chance to do it right, know better, do better 🙂

If you feel like you could benefit from specialised guidance and treatment for your c-section recovery or return to exercise, reach out by calling/whatsapp or email .

 

Reference:

Alastair H. MacLennan, Anne W. Taylor, David H. Wilson, and Don Wilson, The prevalence of pelvic floor disorders and their relationship to gender, age, parity and mode of delivery, BJOG: An International Journal of Obstetrics and Gynaecology, Vol. 107, Issue 12, December 2000, pp. 1460-1470.

Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120(2):144-151.

Foldspang A, Hvidman L, Mommsen S, Nielsen JB. Risk of postpartum urinary incontinence associated with pregnancy and mode of delivery. Acta Obstet Gynecol Scand. 2004;83(10):923-927.

Rortveit G, Daltveit AK, Hannestad YS, Hunskaar S. Vaginal delivery parameters and urinary incontinence: the Norwegian EPINCONT study. Am J Obstet Gynecol. 2003;189(5):1268-1274. doi:10.1067/s0002-9378(03)00588-x

Cacciatore A, Giordano R, Romano M, La Rosa B, Fonti I. Putative protective effects of cesarean section on pelvic floor disorders. J Prenat Med. 2010;4(1):1-4.

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