Pelvic Floor Dysfunction After C-Section

YES, IT CAN STILL HAPPEN!

Having a C-section does not exclude pelvic floor dysfunction. The most common pelvic floor issues that arise post C-section are pelvic pain - typically with intercourse, as well as urinary frequency issues. We will cover these below! I have included information on other dysfunctions that may come up as well. If you experience any of these weeks-months after your surgery, it is recommended to see a pelvic floor physical therapist.

PELVIC PAIN

Pelvic pain is defined as any painful sensation in the lower abdomen and pelvis. This can include the discomfort of the vulva, perineum, vagina, organs, abdominals and more. 

Painful Intercourse

Intercourse can often be painful as a result of pelvic pain. Tissues have a tendency to guard and protect when there is pain present which makes it difficult to lengthen and relax those same tissues. Whenever anything is inserted into the vagina (tampon, IUD, speculum, penis, etc.), the pelvic floor muscles should be relaxed and lengthened. It is not normal to be painful. It is common post-cesarean to have some tightness in the lower abdomen and the pelvic floor. This can be due to scar tissue, recovery post-trauma (abdominal surgery), or just overall muscle guarding. If you do experience painful intercourse, it is highly likely it is due to the pelvic floor muscles being tight/guarded.

To treat this, work on pelvic floor lengthening exercises:

  • Diaphragmatic breaths into child’s pose

  • Knees to chest, adductor rockbacks, etc.

On your inhale, picture the pelvic floor expanding and “flowers blooming” from the vagina and the anus. Work to get out of the kegel or contracted position of the pelvic floor. This is a great indication to do some lower abdominal massage and scar mobilization as well.

Another common cause of painful intercourse is decreased lubrication due to hormonal changes with breastfeeding. Try using a water-based lubricant to help (I recommend Slippery Stuff). You can also talk to your OB-GYN about using an estrogen cream at the vaginal opening to decrease pain.

INCONTINENCE

Urge/Frequency Issues

Urinary urge and frequency issues are a common complaint post-cesarean. Tightness and scar tissue in the lower abdominals and around the scar can often restrict the bladder from stretching as it fills up. This mechanical restriction can lead to increased frequency. We treat this with:

  • Lower abdominal and scar massage to increase tissue mobility

  • Breath work and pelvic floor relaxation exercises to expand the area

  • Practicing healthy bladder habits

    • Drinking water

    • Avoiding irritants

    • Avoid peeing “just in case”

    • Frequency per day should be about 5-8x (going every 2-3 hours) and 0-1x at night 

Stress Incontinence

This is the type of leaking that occurs with increased pressure in the abdominal cavity: the result of sneezing, coughing, laughing, running, jumping, etc. Often in these activities, there is a rise of pressure in the abdomen and the tendency is to bear down and out into the pelvic floor.

There are other factors that contribute to this: posture/alignment, breath strategies, and altered pelvic floor coordination.

As you get back to exercise, if you are experiencing stress incontinence, it is important to see a pelvic floor therapist to get an individualized treatment plan (not a one-size fits all program!).

INCOMPLETE BLADDER EMPTYING

Another common issue post-op is difficulty with fully emptying the bladder. This is often due to pelvic floor tightness as well! You have a sphincter that surrounds the urethra, and this muscle group needs to relax and open as you void. If your muscles are having trouble finding the ability to relax, it can be difficult for your body to fully empty the bladder. 

To treat this, sit on the toilet and let go of any tension: feet flat on floor or squatty potty, relax your posture, relax your abs and pelvic floor. Take an inhale and imagine the flowers blooming from your urethra. You should feel some lengthening into those tissues. If it still feels difficult to finish, try doing some pelvic tilts forward and backwards. Avoid trying to push pee out.

If you have finished voiding but still feel like you haven’t emptied, sometimes it helps to stand up for a few moments and then sit back down and retry.

DIASTASIS RECTUS ABDOMINUS

This is defined as a gap of >2 cm between the rectus abdominus muscles. You’ll often see coning or doming along the midline of the abdomen. It can present differently in each person, but it is most common to see the gap widest/deepest around the umbilicus. This is a normal part of pregnancy but you want to treat postpartum.

There is a video in the ‘Core Foundations’ section that goes over how to check for DRA. The good thing is, is that all of the core rehab and breath strategies that you will perform in this program are exactly how we would treat diastasis, so you will kill two birds with one stone.

PELVIC ORGAN PROLAPSE

Pelvic organ prolapse (POP) is the downward descent of one or more internal organs including the bladder, uterus, rectum, and more. Those experiencing prolapse often complain of sensations of pelvic floor heaviness, bulging, or something feeling like it’s falling out. POP is less common with cesarean births. However, since some cesareans are often the result after prolonged labor and pushing phases, it is important to address and see a PT if you experience these symptoms.