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Healing the Structures: C-section and Pelvic Floor Muscle Recovery

There is much more to a c-section recovery than the scars and the pain; it is also an emotional healing journey. Welcome to part two of the three-part blog series on this journey. Find the first part here.

WHAT IS A C-SECTION?

This is a procedure involving an incision to your lower abdomen to birth your baby. The incision cuts through five layers; the skin, fatty tissue, rectus or abdominal sheath, and two layers of peritoneum.

A lot happens in a c-section– the bladder is moved aside to access the uterus, then the baby is born, the placenta follows, the uterus is stitched up, the bladder is put back in place and the remaining layers are sutured up again to varying degrees.

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

Labour may not always go to plan and an emergency c-section may become necessary. Some mums may have laboured for hours before the decision is made and this is where the difference lies. The sustained downward pressure on the pelvic floor, combined with the incision, can make the rehabilitation journey distinct from that of planned c-section or vaginal delivery modes.

WHAT IS PELVIC FLOOR DYSFUNCTION?

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

Signs of PFD include:

  • Incontinence
  • Urgency or frequency to urinate
  • 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 or 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 PFD?

Not necessarily. ‘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)

Women who reported urinary incontinence during pregnancy, irrespective of the delivery mode, were found to have a higher risk of postpartum urinary incontinence (Foldspang A et al., 2004).

A comprehensive study involving over 15,000 women, known as the EPINCONT study, revealed that the tendency of urinary incontinence was similar for both vaginal delivery and c-section mothers by the age of 50 (Rortveit G et al., 2003; Cacciatore A et al., 2010). Similarly, it takes about eight to nine c-sections to prevent one case of urinary incontinence, which is interesting research! (Gyhagen M et al., 2013).

C-section births had more favourable outcomes in terms of faecal incontinence, dyspareunia, and the time to return to sexual activity (Cacciatore A et al., 2010).

DO I HAVE TO DO PELVIC FLOOR EXERCISES?

C-sections don’t protect the pelvic floor from the effects of ageing or the natural “wear and tear” it experiences over time.

Regardless of the delivery mode, pregnancy causes the pelvic floor to weaken by up to 25% due to the baby’s weight, the uterus, and overall body changes.

Whether you plan to have more children, opt for a vaginal birth after caesarean (VBAC), or engage in activities postnatally and beyond, guidance on the right exercises, lifting techniques, and strategies to optimise recovery is essential for long-term pelvic health.

You can start pelvic floor exercises once the urinary catheter is removed and when you feel comfortable. Your goal should be gradually rebuilding the connection of your brain and muscles for progress under the guidance of your women’s health physiotherapist.

I NOTICE THAT I GET THE SUDDEN URGE TO PEE OR GO MORE OFTEN…

It’s common for women who had c-sections to experience changes in bladder habits. The process of repositioning the bladder during the procedure can make it sensitive and lead to issues like urgency (a sudden need to urinate) and frequency (going often).

Several factors can contribute to this:

  • Catheter placement or removal
  • UTIs
  • Incomplete bladder emptying
  • Scar tissues: Scar tissue from the surgery can affect nerves supplying the perineum, leading to irritation of the urethra or vulva. Scar tissue extending to the bladder wall can also create a tugging effect, triggering bladder signals.

Make sure to address these symptoms promptly. Management may include allowing time for healing, antibiotics, proper bladder habits, or pelvic floor muscle training. These symptoms may be common, but they are not normal.

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

We’ll get deeper into postnatal exercise in the next blog, but some general guidelines for what new mums should be able to do with the correct technique are:

 

  • 10 quick repetitions
  • 8-12 reps of six to eight-second hold at 100% effort (max squeeze)
  • 60-second hold at 30-50% effort (sub-maximal squeeze)

 

 

WHEN SHOULD I SEE A PHYSIOTHERAPIST?

This is discussed here!

Mummies, this blog post is intended as general advice. You have a chance to do it right! So if you feel specialised guidance and treatment may help you with your c-section recovery or return to exercise, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg.

Feel free to look through our website, where you can learn about other health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as individual medical advice.

 

 

Reference:

  1. https://www.embracephysio.sg/recovering-from-your-c-section-scar-healing/
  2. https://www.embracephysio.sg/the-6-week-postnatal-appointment/
  3. 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.
  4. 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.
  5. 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.
  6. 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
  7. 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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I had a wonderful experience with Brenda throughout my post partum recovery. She is very friendly and experienced and it definitely shows as she is able to make me feel at ease and comfortable as she navigates me through the exercises and steps to get me back to where I want to be. Appreciate the help and for making it easy especially with motherhood alr being a challenge. Thanks 🙂

Liying Ho Avatar Liying Ho
March 31, 2022

Great service and superior expertise at Embrace Physio! From the moment that you walk in you're greeted with top notch service. Preet and her team of physiotherapists are warm and welcoming, and their knowledge has undoubtedly helped me to treat my post-natal symptoms. My only regret is not knowing about Embrace earlier!

Dione Mayuko Harrison Avatar Dione Mayuko Harrison
September 28, 2021

Years ago, I approached doctors and gynaecologists to find out why penetration was so difficult for me and how to resolve it, but they couldn't understand that it was a problem, possibly because I was young, not married and without children. I later heard about vaginismus, but didn't know what to do about it since I had already approached doctors. In late 2022 I found out from Embrace's social media page that women's health physiotherapy existed, and made an appointment. I worked with Brenda, then Preet. They were able to identify the different muscle groups in my pelvic area, and tell me what exercises I can use to release the tension. I was able to progress from an initial zero-tolerance to touch at the entrance, to the ability to self-insert a 3cm width dilator without issues. My body awareness has increased a lot, and a large mental block about sex and post-pregnancy recovery has cleared. I strongly encourage women facing similar issues to find out if women's health physiotherapy can help you too.

Fresna Lin Avatar Fresna Lin
February 11, 2024

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