How Does a Cesarean Birth Impact The Pelvic Floor?

There is a myth that having a Cesarean birth means that your pelvic floor was not affected and that you don’t have to worry about the common issues a mom who had a vaginal birth may experience. This myth is an important one to debunk because many women are experiencing issues in the pelvic floor that are related to their C-Section and they are unaware of the relationship.

First, I need to define the two different extremes on the pelvic floor dysfunction spectrum.

Like all muscles, the pelvis floor muscles need to move through their full range of motion to be efficient and dysfunction is present when they are not able to fully relax and contract. On one end of the spectrum is someone who has a pelvic floor that is lengthened/weak/not very active. This is called a low tone dysfunction. This person usually doesn’t have pelvic floor pain but may have leaking, prolapse and/or lack of sensation during sex as well as various orthopedic issues due to the lack of pelvic joint stability. On the other end of the spectrum is someone who has pelvic floor musculature which is overactive/tense/in spasm. This person may have pelvic pain, intolerance of penetration, urine leakage and reoccurring tightness in back, pelvis and hips. This is called a high tone dysfunction. Now let me get into the reasons this might occur even if you had a Cesarean.

Being pregnant affects your pelvic floor because it is supporting the weight of the baby, placenta and fluids for 9 months. This can cause the pelvic floor to lengthen and weaken under the load which may lead to a low tone issue, causing the signs and symptoms listed above. Or the pelvic floor may also respond to the load of pregnancy in an opposite fashion and may tighten up to counter the downward pressure, resulting in a high tone issue.

It is more obvious that if a women goes through any pushing phase of labor prior to a C-Section that the pelvic floor is directly affected. But even if a woman does not go through any pushing, due to the close proximity of the pelvic floor to the uterus and to the abdominals, the surgical procedure can result in some pelvic floor issues. There is a natural reaction of the body to shut down the muscles around a surgical site to allow for tissue healing. This is helpful at first but when it is prolonged, problems occur due to lack of functional muscle action. Since the abdominals shut down due to the direct tissue trauma of surgery and because the pelvic floor and deep abdominals are best friends, the pelvic floor may also go on a vacation along with the abdominals. I’ve worked with many cesarean birth moms who are shocked how weak and disconnected their pelvic floor is.

The pelvic floor may also respond by tensing up post-cesarean due to the pain from the procedure. Muscle tensing is a natural response to pain, as well as to anxiety, stress and fear….all of which might be present from a birth experience. This pelvic floor may stay tensed up which will result in inefficient muscle activity and a woman might experience the signs and symptoms listed above with a high tone dysfunction.

One study in 2006 found that at six months postpartum, 22.9% of women delivered by cesarean reported urinary incontinence. And many times the signs and symptoms of a pelvic floor dysfunction are not present immediately postpartum and might not show up until a woman increases her activity level or years later. Obstet Gynecol. 2006 Oct;108(4):863-72.

I hope this blog helps you understand the relationship with the pelvic floor for all moms. All women should have a postpartum evaluation from a women’s health physical therapist and especially when surgical procedures are involved. Would we ever let a professional athlete return to sport after a procedure that cuts through the tissues that hold the pelvis and spine together without physical therapy? So why are we accepting less for mothers? I’ll leave you with that thought to ponder.