✨Did you know 1/3 babies are born via cesarean section in Canada and they are the most frequently performed surgery in Canada?
✨Did you know that BC has the highest rate of C-sections in all of Canada?
✨Did you know there's lots you can do to help prep and recover from a C-section and that a pelvic floor physiotherapist can help with this?
A C-section is considered a major abdominal surgery, and they are often performed in an emergency setting, especially for first deliveries. This can leave women feeling unprepared for what to do next and how to go about recovering from surgery. It is so common to hear "wait 6 weeks, and then you are cleared for exercise!" What does this even mean, what type of exercise? Here are some things that I find interesting about C-sections:
The incision consists of cutting through multiple layers of skin, connective tissue, fat and uterus but does NOT cut through muscle tissue. The abdominal muscles are separated to the sides and not cut in two. Check out this cool playdough video to see all the layers!
Overall, women who have had C-sections have less risk for urinary incontinence, fecal incontinence, pelvic organ prolapse, and have stronger pelvic floor muscular strength than women who have vaginal deliveries
However, these women can experience hypertonic pelvic floor muscles, constipation, abdominal pain, painful intercourse, decreased abdominal strength and higher risk of DRA (ab separation)
C-sections can lead to uterine and abdominal adhesions, in a study by Moro et al (2015), 45% of women had evidence of adhesions, mostly commonly in the vesico-uterine pouch
Pelvic floor physio can help prep for a c-section by educating on early post op strategies, scar care and appropriate exercises.
Early post op strategies may include:
encouraging early ambulation
education on bed mobility and transfers
coughing education and splinting to protect incision
advice on if ab wrapping is appropriate for you (I would recommend the ab wrap from Bellies Inc)
constipation and toileting posture education (hello, squatty potty!)
breastfeeding positions to help decrease upper body aches and pains
Ok, so when can I return to exercise?
A surgeon wouldn't tell an ACL rehab patient to "wait for 6 weeks, and then you can exercise." That would never happen! Why is this happening with c-sections? A gradual rehab program is important and very helpful in returning to previous levels of activity. What does this mean? It is different for everyone, but starting slowly and easing into walking, pelvic floor and deep core exercises, light resistance and body weight exercises. Here are some general guidelines and ideas:
0-2 weeks: The goal is to rest, recover, manage pain and protect the incision. Low intensity walking (10-15 min), pelvic floor muscle recruitment (kegels) linked with breathing and gentle movements to restore mobility.
2-4 weeks: The goal is to gradually increase walking tolerance and mobility. Functional strengthening (think lifting car seats and sitting on the toilet!) can start, using body weight only, such as squats and lunges.
4-6 weeks: Continue to increase body awareness, increase cardio intensity/duration and functional body weight strength.
If you've had a c-section, there is lots you can do early on before the 6 week check up to help with recovery. This is an awesome time for telehealth (zoom, etc) physio appointments because we can tailor the exercises directly to you at this early stage without even leaving the house!
What about scar massage?
This can begin as early as 6 weeks, once the incision is completely healed over and you have gotten approval from your doctor or physiotherapist. There are lots of different techniques, stay tuned for another blog post on this!
Any questions or want to chat? Shoot me a message or book online!
Claire McDonald
Registered Physiotherapist
Squamish, BC
Email: clairemcdonaldpt@gmail.com
