Pelvic Floor Therapy After C-section: The Key to Recovering From Pain, Healing Your Core, and Getting Back to Exercising
Hey mama! Congrats on your new baby. I hope these days are filled with delight and sweet snuggles.
As a pelvic floor physical therapist and mama of 2, I know you probably found my page in the thick of postpartum recovery.
If you gave birth by C-section, you may be wondering:
How to decrease pain and ongoing issues after surgery
How to make the most as you heal from your C-section
When you can start exercise after C-section
How to help your scar heal faster
If the C-section shelf will ever go away
No need to do a Google search during those middle of the night feeding sessions - I’ve got you!
In this blog post, I’m going to tell you everything you need to know about Cesarian birth recovery, and pelvic floor therapy after C-section, whether this is your first baby or you’ve delivered by C-section multiple times.
We’ll talk about:
Safe movement you can do NOW (from day 1 postpartum) to reconnect to your core after surgery
The best things you can do in the early postpartum recovery period to optimize your healing
Why you need pelvic floor therapy after C-section (and when is the best time to start)
Here we go!
Why Pelvic Floor Health After C-Section REALLY Matters (Even Though You Didn’t Birth Your Baby Vaginally)
You may have heard about pelvic floor therapy during your pregnancy (and maybe you went for a few sessions-good for you!), but figured you may not need it if you have a Cesarian birth.
As awareness of pelvic floor therapy for postpartum recovery is growing, C-section mamas are often missed. But Pelvic floor therapy for C-section is equally as important as it is for mamas who gave birth vaginally, and here is why:
If you delivered your baby by C-section, you still went through MONTHS of pregnancy; which stressed, stretched, and challenged your pelvic floor as your body stretched to accommodate your baby. Ignoring your pelvic floor after birth can result in similar complications to those who delivered vaginally. These complications may include: urinary incontinence, pain with intercourse, and back pain, to name a few.
During pregnancy, your body was under the influence of Relaxin hormone, which causes your joints - particularly your pelvis - to become more mobile. This hormone remains in your body postpartum as long as you continue to breastfeed. While it’s natural and good, it can cause Symphysis Pubis Dysfunction ( SPD ), SI joint pain, and back pain, if you aren’t doing an exercise program aimed at creating stability in the the core and pelvis .
A C-section is major abdominal surgery - cutting through 7 layers of tissue. It’s not JUST about mobilizing your C-section scar, it’s about preventing adhesions (sticky spots where scar tissue grounds down into the organs), improving your core muscle function (which are intimately connected to your pelvic floor muscles) to reduce injury risk, and decreasing ongoing complications like painful sex, urinary issues, and pain with exercise.
As you can see, Pelvic floor recovery after C-section is not just about the muscles “down-there” - it’s really about your WHOLE BODY health.
Understanding Pelvic Floor Therapy after C-Section
Pelvic floor physical therapy is a specialized sector of physical therapy that deals with issues of bowel, bladder, sexual health, and more.
Pelvic floor physical therapists are doctors of physical therapy who have specialty training in assessing the pelvic floor muscles, internal exams of the vagina and rectum, and the connection between your musculoskeletal system (think- how your body moves) AND the functions of your urinary, reproductive, digestive, and nervous systems.
Translation: Pelvic floor therapy is not JUST about the pelvic floor - it’s about connecting the dots with what’s happening in your WHOLE body.
When it comes to pregnancy and postpartum, Pelvic floor therapy is an essential part to your care - we are the professionals who can find the connection between your back pain and your leaking problem, pain with sex and jaw pain, and prolapse and SI joint pain.
Read: It’s ALLLLLL connected baby!
Common Postpartum Pelvic Floor Problems After C-Section
There is a wide range of symptoms I see in my pelvic PT practice after C-Section, but the most common are:
Urinary issues like urgency and frequency (feeling a strong urge suddenly and/or frequently), bladder pain, and even incontinence (leaking)
Pelvic and abdominal pain - This is a general term describing pain anywhere below the belly button to the hips, but typically manifests like:
Vaginal pain
Pain directly over the C-section scar
Abdominal cramping
Tailbone pain (does this surprise you? I see it all the time!)
Diastasis Rectus abdominus or DRA - this is the separation of the abdominal muscles that often happens after giving birth and impacts your core muscles
C-section shelf - where the abdominal tissue folds over your C-section scar.
Pain with sex after C-section is very common due to the scar tissue, but also if the experience was traumatic, you may have some tension in the pelvic floor muscles causing intercourse to be painful after C-section.
Lower back pain, SI Joint pain, or hip pain - the musculoskeletal changes from pregnancy, and the changes to your core muscle function from cutting through the abdominal wall can cause Lower back pain after C-section.
Although some say these things are “normal” after having a C-section, they really aren’t, and you don’t have to live in pain. A specialized pelvic floor physical therapist can help you with all of the above pelvic floor problems after C-section and get you back to feeling good in your body again.
Benefits of Pelvic Floor Therapy After C-Section (You Don’t Want to Skip it!)
Pelvic floor physical therapy can address all of these pelvic floor problems after C-section and more. As a pelvic floor physical therapist, I am always looking to connect the dots between the symptoms you are having and optimize both your recovery and your long-term health.
Pelvic floor therapy after C-Section can help you:
Get back to movement and exercise early and safely
Mobilize your C-section scar tissue to reduce pain and improve function
Improve mobility of your abdominal organs that can get “stuck” as scar tissue develops and binds itself into the connective tissue
Improve blood flow and lymphatic flow to ensure ongoing healing
Reconnect to your core muscles after C-section with a customized exercise plan (not just something you found on youtube)
Reduce scar tissue in the uterus itself to reduce pain and make way for healthy future pregnancies (and even prepare for a VBAC if desired)
Identify root causes of your lower back pain or pelvic pain
Diagnose and treat diastasis recti after C-section with a customized core exercise rehab plan
Address any sexual issues after C-section like pain with intercourse
Heal from any physical and/or emotional trauma by incorporating a trauma informed approach to your C-section healing (because it is ALL connected)
When to Start Pelvic Floor Therapy After C-Section
It’s ideal to start your postpartum recovery after C-section early - but it’s never too late (yes, even years after your C-section - though I hope you start sooner!)
As a pelvic floor physical therapist, I like to begin C-section recovery exercises as early as day 1 postpartum. My early postpartum recovery guide has exercises for C-section that you can begin in early postpartum to start reconnecting to your core and healing from the inside out.
After that, I recommend an evaluation with a pelvic floor physical therapist anywhere from two to six weeks postpartum. This is essential to develop an individualized treatment plan with exercise progressions, manual therapies, and self-care approaches you can begin early at home to optimize your recovery.
In pelvic floor physical therapy, expect that you’ll need weekly sessions for at least 6-10 visits for the most progress as you recover. Your pelvic floor therapist can guide you through this process and work with you on an individualized plan.
Your Long Term C-Section Recovery Plan
Alright mama- if you’re still reading this, know that there is so much support available for you, and you are deserving of the best care. If you feel like something is missing after visiting your OB at your 6 week postpartum visit, it’s probably because it is - your OB makes sure you’re healing and are medically safe to proceed with normal activity. But Pelvic floor physical therapy is your next stop in your C-section recovery.
But don’t forget - you just had a MAJOR abdominal surgery. For perspective, after knee surgery, many orthopedic surgeons recommend intensive rehab for 6 months before beginning running again. After a C-section, you’ve had 7 layers of tissue -from skin to muscle to organ- cut through- and that deserves an attentive rehab program too.
A c-section is a major abdominal surgery to recover from - while also caring for a newborn baby!
And if you have goals to get back to running, start lifting weights again, or simply being able to pick up your baby and chase your toddler without back pain, pelvic floor therapy is the best place to start.
Ready for more support?
Hi! I’m Dr. Jackie Roelofs - a doctor of physical therapy specializing in the pelvic floor in pregnancy, postpartum and beyond. My C-section recovery programs are available in person in New Orleans, and worldwide through my fully digital postpartum programs.
If you are craving support after undergoing one of the biggest transformations of your life, fill out a contact form and I’ll reach out to you within 2 business days.
If you are within the first 6 weeks postpartum, make sure you check out my E-Book, Rest, Breathe, Begin: a postpartum recovery guide for those first few weeks at home with baby. It includes exercises you can do from your own bed to reconnect to your core, reduce pain, and kickstart your recovery and return to exercise after C-section.
Are we friends on Instagram? Make sure you are following and shoot me a DM with any questions - I love to hear from you.
P.S. If you’re <6 weeks postpartum…I’ve got the perfect resource for you to start healing your pelvic floor and reconnecting to your core.
Make sure you check out my E-book: Rest, breathe, begin: a guide to early postpartum pelvic floor recovery
A guide to the first 2 weeks of postpartum recovery
Pelvic floor recovery tips to prevent complications and ACTIVELY heal your body
two weeks worth of core and pelvic floor exercises with video demos that you can start from DAY ONE postpartum (and it’s a great place to start even if you are a little farther out)
Begin rebuilding your core and pelvic floor from the ground up , whether you had a vaginal or a cesarian delivery
Sign up for the wait list to be the first to know about my 0-12 week Postpartum Recover and Rebuild program (which is a great place to start WHEREVER you are in your recovery). It’s launching soon and it’s going to be sooooo good! If you’re on the wait list you’ll have first dibs and access to early bird discounts, bonuses, and more!
Next on your reading list:
Postpartum pelvic floor physical therapy exercises - a few of my favorite exercises to get you started in your pelvic floor strengthening and return to exercise after baby
The Best Nursing and Pumping bras for breastfeeding mamas - a few of my tried and true favorites as a breastfeeding mom (x2)
Postpartum workout gear every mom needs - the 6 ESSENTIAL exercise equipment pieces I recommend starting with as you ease back into movement
If you want to stay connected, make sure to Follow me on Instagram @drjuicyjackie for more expert (and no-TMI) postpartum advice.
