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The Long-Term Impact of a C-Sections to Know & 2 Essential Fixes

Have you had a c-section? C-sections can cause a lot of trauma in our bodies for many years to come. 

I’m going to go over exactly what you need to know in order to truly heal from your c-section.

This will be true even if you had the c-section five to 20 years ago, you’re going to know signs to look out for that your c-section scar maybe didn’t get fully healed and things that you can do now to start the healing process. 

I’m Dr. Allison, owner of Body Motion Physical Therapy in Edmonds, Washington. I am here to help women get the care that they deserve and help them through the fertility, pregnancy and postpartum journey all the way through menopause. So many times I have people come in with lingering sciatica or low back pain that just doesn’t go away with normal physical therapy. They’ve done all the exercises, they did everything that they were instructed to do to help heal the pain. But that provider never got to the root cause of what was causing that pain in the first place. 

Oftentimes it’s because we don’t heal our c-section scars completely. I am really glad that you’re reading this because I’m going to review how the core and the pelvic floor are connected and how having a c-section is going to impact your healing process and what needs to happen for you to truly heal. 

Okay, so first things first, when you have a C section, the abdominal wall is cut, they cut through seven layers of tissue, all the way from the skin, the muscles, the fascia down to the uterus, the fascia is like Saran Wrap that covers everything. So if you imagine that you’re wearing a one piece swimsuit, and you have a cut in that swimsuit, when that tissue heals, the scar tissue builds and it bounds down and that’s what healing is for the scar tissue. That’s the scar tissue that’s created, you have temporary stability in that tissue, so you can get back to your normal exercises and start doing things. The issue becomes that because so many layers of scar tissue exist, we have things like the muscles don’t work normally anymore. Because when we have a scar in an abdominal muscle it limits the amount of contraction and relaxation that can occur.

 That muscle becomes really weak. The front ab muscles, especially the transverse abdominus muscle is going to get a lot weaker. In order to truly heal that we need to break up that scar tissue and then retrain that muscle. So who can do that for you? Well, a skilled Pelvic Expert physical therapist can absolutely help break up that tissue and then teach you how to use it again, if you’ve done online fitness programs or you feel like you’ve never been able to get back into your fitness routine after you’ve had a c-section. 

A lot of times we see women who have had c-sections get injured when they return to their favorite workout routines. This is the missing link here, that your c-section scar hasn’t really been healed. When we have tissue that bounds down over the years to come,  it’s not only going to pull down from exactly where the c-section was, but it’s going to pull from the arm, it’s going to pull up from the pelvic floor, it’s going to pull in from all sides including the legs and the back. 

So it’s really important that we get this tissue moving. So how do we do this? I am a Pelvic Expert physical therapist, and we use our hands to start to break up this tissue. A lot of programs that you’re going to find online or videos are going to show you what scar mobilization looks like. 

Maybe they’ll have you cross friction, the scar if this was the scar line here that have you crossed friction, the scar, they’ll have you pick up the scar and move it around. But because we’re talking about the scar, and all these different layers of scar tissue, we need to get the entire scar moving. So it’s not just this first layer, it’s the second layer, the third layer all the way down to the seventh layer, we need all of that scar tissue moving. We do that through our hands. We also have a really cool technology called Shockwave Therapy. We use this in the clinic. We just brought it in house in order to help break up and  dissolve the final bits of the scar that we can’t quite get with our fingers. 

This has helped tremendously with the tissue that commonly protrudes above the scar or the “shelving” that you’ll get over your c-section scar. Obviously, that’s more cosmetic in nature. To truly have this healthy, happy core. We need the core to be able to contract and relax and just do that automatically without thinking of it. But you can never really adequately change the core and start building the core without addressing the scar tissue. So I see so many people heal after having their baby and they do some exercises to get their core back and they don’t actually heal or strengthen all of the tissue. 

It’s not normalized because there’s still those deep, deep layers of scar tissue. Another facet of this is that the organs itself because the uterus was cut open, the uterus has to move within the body. That is called visceral motility. The uterus just moves. The Lupien tubes move your colon, it moves in your body. So when you contract your core, the organs get squeezed in, when you relax it, they go out and then they move within the body without you  breathing or contracting your core, they just naturally should move.

 But when we have scar tissue and this is from any abdominal surgery, it doesn’t just have to be a c-section scar. But when we have any abdominal scar tissue, that will freeze the organs. So that what covers the uterus itself is called no pelvic fascia. What covers the colon is called peritoneum. And when when those structures freeze, because the scar tissue has become so dense that the organs now can’t move fully, then we have more problems and the body can’t flex in bend over that scar tissue as easily. That leads us to develop compensation patterns. We have to restore the scar tissue, we have to restore the visceral motility. Then we have to then retrain the abdominal muscles. Okay, so that is the process of healing with scar tissue. This is super important. Because oftentimes, we see women in their 40’s and 50’s. They have hip pain, knee pain, sciatica and they have these issues, because they never healed their core postpartum after their c-section. This isn’t common practice especially 10 years ago, postpartum physical therapy and rehab was not that common. Now we have this resource. I will tell you, even if you’ve had a c-section 20 years ago, it is not too late to start healing the tissue and unpeeling the layers of compensation that your body has developed. An example of a compensation is say your right hip is wearing out because the core isn’t functioning and because that hip isn’t as strong as it needs to be, the knee on the left side is trying to compensate and will develop pain and start to wear out as well. 

 Usually, when you have those areas, you will maybe go to physical therapy. They’ll treat the knee or they’ll treat the hip. They’re not looking at the entirety of the core or the entirety of the abdominal wall, or of the pelvic floor. So it’s really important that you see a Pelvic Expert, because if we start replacing the joints because traditional physical therapy didn’t work and the injections stop providing relief we just start chasing these pain patterns. Okay? 

These “solutions” aren’t actually healing the true root cause, which is the scar tissue and the abdominal wall and the fact that we never got the belly and the core retrained. Anytime there’s that scar tissue, it’s going to limit the natural function of the muscle and that’s just on the belly front. If we dive deeper to the pelvic floor, so the belly is on the front, the abdominal muscles that are cut are on the front of the skin, that’s what is on the front, but the pelvic floor is very much affected. The pelvic floor is three layers deep. The second layer is more of a fascial layer and that layer connects up towards the fascia and the abdominal wall. So when the fascia and the abdominal wall is cut open, then stitched back together, it’s going to pull up and elevate the pelvic floor. 

It’s really common after cesarean births to have painful intercourse, painful penetration. Urinary Incontinence is very common post Cesarean birth. People are commonly like “how is that even possible my pelvic floor wasn’t affected”, or they opted to have a cesarean birth because they wanted to preserve their vagina and their pelvic floor. But the pelvic floor and the pelvic organs are very much affected when we have the Cesarean belly birth.

 I want to tell you how to start to heal these pelvic organs and the A pelvic floor itself, okay? So a healthy pelvic floor is going to be able to relax fully, and contract fully and also overstretch fully. So every time that our foot hits the ground, we have this shock absorption, which is like a spring mechanism, that we get this recoil when our foot hits the ground. Well, if your pelvic floor becomes very tightened and fibrotic and shortened due to having a c-section or maybe you’ve just always had a tight, contracted pelvic floor that is shortened in nature and that’s just how you’ve lived, maybe you’ve had a stressful life, the pelvic floor gets shorter. 

When we have stress in our life, it doesn’t always just naturally relax. It’s really important that we train the muscles to relax and that you have what’s called an intravaginal assessment during your pelvic floor physical therapy, recovery or rehabbing of the core itself. So even though the baby came out of your belly, whether that was six months ago, 18 months ago, 20 years ago, it doesn’t matter. You should definitely have your pelvic floor looked at to make sure that your muscles have that ability to fully relax over extend and contract so that when your foot hits the ground, you get that natural force absorption. Now, if we don’t have that, what happens is the pelvic floor turns to more concrete and you just don’t have a lot of dynamic movement and you don’t get the spring effect. So you start to wear out your joints, so your hips start to hurt, your knees start to hurt. Okay, so all of these facets play together after we have a cesarean. When I see women after they have cesarean, usually about 10 years later, there’s possibly some form of sciatica going on very frequently. They have uterine abrasions or a history of uterine abrasions. That’s where they go and limit the menstrual cycle essentially. So they ablate the inside of the uterus to help prevent bleeding, usually, because a lot of times when you have that scar tissue through the uterus, it’s, you know, 10 years old, that scar tissue actually hardens and gets more hard. So those women tend to have very, very heavy, heavy periods.

 I really do believe it’s because that scar tissue is that deep in the uterus, that the uterus over contracts, probably to compensate for that scar. Which leads to really heavy, heavy bleeding. In order to combat that the medical procedure is to ablate the inside of the uterus. We can help avoid that by really healing and getting to the root of the scar tissue and breaking up the scar tissue and helping the organs move more freely, so that the menstrual cycle can be a lot better and easier to have and the bleeding and cramps can be reduced. We also see that women about 15 years post cesarean can be more susceptible to bowel blockage, because the scar tissue can go and cut off some of the bowel, leading to bowel resections. Healing that scar tissue before that happens can really help improve the outcomes of women’s health.

I fully believe that every single person who’s had a cesarean needs to get their belly looked at and needs to get their pelvic floor assessed  and treated and spend time on the scar tissue and spend time on these muscles, helping them release the scar tissue, dissolve the adhesions that come about because of the scar tissue and help reduce the tightness that comes because of the scar tissue. So that then we can retrain the muscles which includes exercises and movements that you can do at home with different breathing exercises, different core moves that can truly help retrain the tissue and cause full healing so that you’re not the person that has all these issues post c-section when they’re in their 20’s or 20 years post cesarean so I hope this was helpful. 

Find yourself a Pelvic Expert physical therapist or come see us for our travel program. And we will help you dissolve the scar tissue and retrain your core. Take care!

AUTHOR

Allison Feldt

Body Motion Physical Therapy

"We Help Women Through Fertility, Pregnancy, Birth, Postpartum and Beyond So They Can Live Active, Confident, Healthy Lives Without The Need For Medication Or Surgery"
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