Cesarean Scar Tissue Restriction
Condition Overview
Many postpartum people believe that if they had a cesarean delivery, they don’t or won’t need pelvic floor physical therapy. However, this is very far from the truth! Whether you had a vaginal or cesarean delivery, our pelvic floors (vagina, vulva, and surrounding myofascial system) sustain a huge change during the pregnancy and postpartum period, so it is necessary to retrain these muscles after any type of delivery.
How Does My Cesarean Scar Affect My Pelvic Floor?
The abdominal wall and pelvic floor muscles are closely connected and work together along with the diaphragm and deep low back muscles to strengthen the core, assist in postural control, and perform pelvic stability. If one of these areas is affected, it can cause compensation, tension, pain, or weakness to any or all of the other areas!
During a cesarean delivery, the surgeon makes a 4-6 inch incision through the abdominal skin, and then has to go through the subcutaneous tissue, fascia (dense connective tissue), move the rectus abdominus (6 pack muscle) out of the way, incise through the parietal peritoneum and the uterine wall to eventually birth the baby.
Wow! This is a ton of tissue that is being affected and if not treated appropriately has the potential to result in scar adhesion, abdominal or pelvic pain and reduced core strength during functional mobility and higher level activities.
Many women post- cesarean complain of an “abdominal shelf” at the scar, feelings of instability at the core, and diastasis recti abdominus (a separation at the midline of the abdominal wall). Other symptoms that can be related to a cesarean scar adhesion are urinary frequency and urgency, urinary incontinence, constipation, and dyspareunia. These may not show up immediately postpartum so you may not realize your scar is impacting these symptoms.
However, did you know that pelvic health physical therapy can manage and treat all of these issues?
We recommend starting your postpartum physical therapy journey at 4-6 weeks to gain the most insight into what you can begin working on. Even better is coming in prior to your delivery to learn strategies to perform right after birth prior to being seen by a medical provider.
What Can Therapy Do For Me Post Cesarean?
In physical therapy, we will discuss all pelvic health related symptoms including bladder, bowel, sexual health, and gynecological history (including previous births and pregnancies). We will then do a thorough muscle assessment of all muscles attached to the pelvic structure. This includes the abdominal wall, the glutes, the inner thighs, and the pelvic floor.
Depending on how far along you are postpartum, we will assess the scar and perform scar mobilization techniques as well as teach you how to do this at home at the appropriate times to allow for tissue healing to fully occur.
The first 1-3 weeks are focusing on desensitization to the scar. At week 4 we start focusing on mobilizing abdominal tissues around the scar and then around week 6 you can begin gently working over the scar as long as there are no signs of infection and things are healing well.
At this point, we will teach you how to progress your scar massage and ensure you have appropriate core activation to progress strength training routine at home. If you are post-cesarean delivery or have a cesarean delivery scheduled and would like more guidance through this process or ensure you are managing your scar and progressing your exercises appropriately, reach out to schedule an appointment today!