Pelvic Floor Physical Therapy Part 3: Cesarean section recovery

After Cesarean section delivery of a baby, most women are told that they can return to exercise and most activities after 6 weeks.  Is there something magical about the 6-week mark after baby?  How accurate is that timeframe in safely returning to exercise?   

A c-section delivery involves an incision through the uterus and the fascial layers of the abdomen and the movement of the abdominal muscles to deliver a baby.  This is a major abdominal surgery that requires not only recovery from pregnancy but also recovery from surgical incision through several layers of the abdominal wall.  It is important to consider healing times for this tissue as you return to activities around the house and return to exercise. 

Scar tissue takes time to form and for the fascial tissue to regain tensile strength equal to that before the surgery.  At the 6-week mark, scar tissue has about 50% of the original tensile strength.  Even if the scar appears healed, the scar tissue continues to need more time to heal.  

A general timeline for returning to activity can be broken into general phases: 

Rest and Recover: Weeks 0-6 to 8 depending on scar healing.  The cesarean scar should not be red, irritated, or leaking fluid.  This is a good time to practice pelvic floor activations, diaphragmatic breathing, and slow walks.  It is important to take this time to bond with your baby, learn how your body is moving through space after pregnancy and delivery, and take the time to nourish your body with good food and sleep.   

Rehabilitation: Weeks 8 to 20: This time starts when the cesarean scar is well healed and after your follow up visit with your gynecologist for clearance to return to exercise.  When the skin is well healed, we can start working on scar massage to help break up any restrictions in the healing tissue.  This is also a great time to see your pelvic floor physical therapist to ensure the pelvic floor muscles are firing and working in the best way possible.  Even if you didn’t have a vaginal delivery, pregnancy itself puts a lot of strain on the pelvis and surrounding tissues.  Pelvic floor physical therapy should check your scar, assess for diastasis rectus abdominus, and help you return to exercise safely.  As you add exercises into your routine, it is important to keep a few things in mind.  Exercises should not cause pain, incontinence (leaking urine or stool), sensations of heaviness in your pelvis, or bulging in your abdomen.  

Return to exercise: Weeks 20 onward:  This is the time to build strength of the abdominal wall and pelvic floor, return to aerobic and strength training.  This is all case by case as everyone’s body heals at a different pace.  This can be another good time to check in with your pelvic floor PT if you are struggling to return to a specific exercise or activity.  Your therapist should have a checklist to determine readiness for activities like running, lifting, cross fit or other training.

Recovering from a c-section requires time for tissues to complete the healing process. Returning to your previous activities may take time and effort. The most important part of the process is individualizing it to your body. Setting up appointments with a pelvic floor physical therapist can help in your journey to recovery. Many times just a few visits sets you up for success and give you the power of knowledge about how to exercise and stay active.

We offer a free, 15-minute phone consultation to answer any questions you may have and to ensure you are in the best place for your post-partum recovery.