It’s a common misconception that having a c-section “saves” the pelvic floor. Although there is typically less direct impact on those muscles, cesarean birth is a major abdominal surgery that has a big impact on the entire core and pelvis. Here are three ways it can affect your pelvic floor muscles postpartum:
1. Scar Tissue Restrictions
In the human body, everything is connected to everything else. Our muscles, organs, nerves, blood vessels, and skin are all stuck to each other through a spider-web-like connective tissue called fascia.
Like a spider web, ripple effects are felt throughout the body when one part of the fascia is disturbed. A thickening within a spider web would affect the mobility and elasticity of the entire web. This is precisely what happens with a scar.
The fascia in our body is organized into longitudinal sheets, so the effects of a c-section scar will be seen in some areas more than others, including the pelvic floor. There are 7 layers of tissue cut during a c-section, and one of those layers is the Superficial Abdominal Fascia. This layer directly connects to the supportive connective tissue around the urethra (the tube your pee comes out of) and restrictions can lead to urinary issues such as incontinence and pain. It also anchors into a thickening in the pelvic floor called the perineal body, and tension can lead to tightness and pain with sex.
2. Pelvic Floor Tension
One of the jobs of your pelvic floor is to support the weight of your organs. During pregnancy, the pelvic floor muscles naturally accommodate the growing weight of the baby and will start working harder. It’s similar to how your arm muscles automatically adjust to the growing heaviness of an empty cup being filled up with water. At the end of pregnancy, those muscles work overtime, and without the natural stretch of vaginal birth, they can stay tight.
The pelvic floor muscles also tense up to guard when you’re in pain. The pain of a c-section on top of nine months of gradual tension can lead to an overly tight pelvic floor. Tight muscles not only can cause pain, but they are also weak.
The tightness can lead to painful sex, urinary incontinence (leaking pee), difficulty with starting to pee, a stop-and-go stream, feeling of urinary urgency and more.
One thing to note: Painful sex is common postpartum because of hormonal changes that lead to vaginal dryness. This is true for a vaginal or c-section birth. If you’re not sure whether your pain is hormone or pelvic-floor-related, try using lube. Here are postpartum-friendly lube options we recommend
3. Second Stage C-Section
With the total number of cesareans on the rise in the West, second-stage c-sections are also increasing. Although typically uncommon, second-stage c-sections account for 2% of births (excluding elective c-sections). The second stage of labor is when the cervix is fully dilated and the mom has transitioned into pushing. Pushing produces a high amount of stress on the pelvic floor and can lead to pelvic floor issues postpartum, even if the outcome is a c-section.
How to Reduce the Impact of a C-Section
Respect Healing Time
You’ll typically start feeling a lot better 2-3 weeks postpartum but healing takes 6-8 weeks! Scale back activities that increase scar pain.
Movement is key to recovery and can help improve scar healing. This can include gentle pain-free movements and short walks. Start with short, easy walks and slowly build up over 6-8 weeks.
Breathing is key for waking up your core and lengthening the scar from the inside out. Gentle breath exercises, like the ones taught in Chelsea’s Foundation Challenge, help reconnect you to your body and are the first step in deep core and pelvic floor strengthening.
Restrictions are common and can limit movement in the surrounding areas, including your pelvis, hips, trunk, and ribcage. Scar massage can help release tension and pain.
Lifting anything heavier than your baby immediately after isn’t recommended but progressive strengthening is important! Start with gentle pelvic floor, core, and hip stability exercises—low impact, low load. If you need some guidance, join our Foundation Challenge to get started on the right foot.