I had a c-section, so my pelvic floor is totally fine. Probably not.

Patients who have undergone vaginal delivery and are working with me to eliminate postpartum symptoms such as urinary leakage, pain with intercourse at the site of tearing, or prolapse will sometimes say “I wish I would have just had a c-section, then I wouldn’t have all of these problems.” Well…yes and no. They may not have presented in exactly the same way, but I think, when it comes to coping with symptoms postpartum, the grass is always assumed greener on the other-method-of-delivery side.

For individuals who have undergone a cesarian section, sometimes I feel that postpartum recovery education is even less available (if that could be possible). There are many symptoms that we see in these moms that are very treatable, even years down the road but everyone seems to think that because they had a surgical procedure, they just have to deal with the aftermath. False.

Symptoms commonly reported

Problem: The scar itself may be painful and restricted or is unsightly.

Insight/Fix: We can perform scar massage to decrease restrictions and alleviate pain, while desensitizing the skin, sometimes even (as a bonus) getting clothing to fit better and get rid of that shelf-like appearance over the scar.

Problem: The individual feels like they have no abdominal strength, or they have back pain

Insight/Fix: Again, we’ll work through scar tissue while teaching the patient to properly activate abdominal musculature in the proper manner. Once abdominals can work as they were prior to surgery, those muscles can support the spine, thereby resulting in decreased back pain with activities and safe return to exercise.

Problem: Bladder frequency and urgency, leakage

Insight/Fix: This one is actually often overlooked as having anything to do with cesarian history. Very frequently, we find significant scar tissue deep to the visible scar. What you can see is really just the tip of the iceberg. Those deep aspects can become wrapped around the area of the bladder, limiting the bladder’s ability to fill well and causing bladder spasms. This can make it feel like you have to pee all the time or actually contribute to bladder leakage when it feels like you have to pee. Manual work to the scar and bladder can often make a huge impact in these symptoms.

Problem: Painful intercourse

Insight/Fix: If the uterus or deep aspect of vaginal canal are also restricted or have scar tissue wrapped around them, the scar can actually be a large contributing factor to painful intercourse. A mix of internal and external manual therapy can alleviate this pain.

Take home points: A cesarian is not a routine procedure. It involves lots of disruption of the musculature and tissue throughout the area and forms significant scarring that can cause numerous abdominal and pelvic symptoms. See a pelvic floor physical therapist to assess your scar and find out what can be done to help you heal fully.

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