Introduction:
A cesarean section is a major surgery that requires recovery and rehab. Although a c-section is an abdominal surgery, pelvic pain may be present due to the demand pregnancy puts on the core, pelvic floor, hips, and low back stabilizers.
Pelvic pain is actually very common even after c-section. Due to tissue healing times, if it’s lasting longer than 6 weeks, seeking out help may be warranted.
In this blog post, we will cover the 5 common causes of pelvic pain after c-section, what pelvic pain may feel like, how long it should typically last, and how pelvic floor physical therapy may be the relief you are looking for.
Is Pelvic Pain Normal After a C-Section?
Pelvic pain is normal and somewhat expected in the early stages of healing. For the first 2-4 weeks, you may have pressure or heaviness in the pelvis along with discomfort.
Symptoms should improve over time as the tissues heal. At 6 weeks, typically the scar should be closed and remodeling of the scar is heightened.
After the 6 week window, if your scar is bleeding, open, or irritated, reach out to your medical provider. Occasional pelvic pain may be present with specific movements, but each week further postpartum should decrease in intensity.
Being cleared at your 6 week postpartum appointment does not mean you’re fully healed. There’s still a lot of recovery below the surface of your scar that is occurring that can impact your pelvic pain.
5 Common Causes of Pelvic Pain After C-Section
1. Pelvic Floor Muscle Tension
Pregnancy and the postures from pregnancy can impact pelvic floor and core muscle coordination and strength. Those same muscles commonly become overactive or have trouble relaxing after a c-section.
Common symptoms that show up as pelvic floor muscle tension:
Pain with sex
Urinary urgency
UTI-like sensations
Lower back pain
2. C-Section Scar Tissue and Sensitivity
It’s important to remember that scars take a long time to fully heal and can impact fascial mobility, nerve mobility, and overall muscle guarding and tension.
As the scar heals, you may notice burning, aching, or sharp irritation with sudden movements. Scar tissue massage is a great treatment to begin around 6 weeks postpartum to improve mobility, decrease scar tissue adhering, and decrease pain. The more mobility we can get in your scar, the less it sticks to the layers underneath and the less healing it disrupts.
3. Abdominal Muscle Weakness and Coordination Changes
During a c-section, the abdominal wall is cut through. Abs work best when able to pull and tighten from all directions to create pressure. Any surgical opening in the abdominal wall will naturally decrease strength and coordination of the abs.
The pelvic floor and abdominal wall have a partnership, so when one is compromised (like during a c-section), the other supporting structures have to take up the slack. This is a natural protective response by the body, but can still lead to pelvic pain and dysfunction.
BUT, don’t worry. Slow and steady strengthening of the abs can reduce pelvic pain by helping the partnership. That surgical opening doesn’t stay open forever and targeted exercise and manual work can get your core and pelvic floor balance back in order!
4. Nerve Irritation After Surgery
Irritation of the ilioinguinal, iliohypogastric, or other nearby nerves can cause irritation to the pelvis and surrounding areas. We don’t expect anyone else to know specifics like this, but we will always ask about nerve pain.
Nerve pain symptoms are commonly:
Sharp
Shooting
Tingling sensations
Nerve pain that is persistent deserves attention and is not something that should be ignored. Most often there is scar tightness or muscle tension that is causing the nerve irritation, and that’s fixable!
5. Changes in Posture and Movement Patterns
As you recover from a major abdominal surgery like a c-section, movement patterns are altered to protect the scar. Often the hips, lower back, and pelvic floor are affected because of abnormal movement patterns. Slowly moving into normal movement patterns can help relieve pelvic pain after c-section.
What Does Pelvic Pain After a C-Section Feel Like?
Pelvic pain can vary in severity. One may experience:
A deep ache in the pelvis or vagina
Vaginal or rectal pressure
Pain during sex or during intimacy
A pulling or tension along the abdominal scar
Pain that is present with activity such as walking, running, or workouts
Discomfort in the bony pelvis including: pubic bone, tailbone, or hips
The location and type of pain happening can often give us clues as to what is causing the pain.
How Long Does Pelvic Pain Last After a C-Section?
Typically pelvic pain should last no longer than 8-12 weeks postpartum. The first 6 weeks, pelvic pain is normalized due to the demand placed on the pelvic floor muscles with c-section recovery. If pain persists outside of 6-12 weeks postpartum and is affecting your daily activities, further help is recommended.
True tissue healing and scar remodeling that is not present to the eye still occurs from 6 months to 1 year postpartum, so everyone’s healing journey varies depending on tissue recovery, sleep, diet, and exercise. There is no “one-size-fits-all” when it comes to postpartum recovery from a c-section scar.
If you have heavy drainage, a foul smell, or discharge present in your scar, medical intervention is required. Reach out to your medical team for further help.
How Can Pelvic Floor Physical Therapy Help After a C-Section?
Pelvic floor PT is helpful postpartum in various ways. Here are 4 ways pelvic pain after a c-section can be improved with PT:
Addressing Pelvic Floor Muscle Tension
Manual therapy for the pelvic floor musculature
Addressing pelvic floor coordination and mobility
Improving awareness of pelvic floor with daily activities
Improving C-Section Scar Mobility
Addressing scar mobility with specific stretches
Desensitization of the scar with various textures
Scar massage starting around 6 weeks
Rebuilding Core Strength
Core strengthening program focused on c-section support
Addressing the coordination between pelvic floor and core
Building up to activities such as running, lifting, and activities
Returning to Movement With Confidence
A home program based on your goals and needs
Building up strength for walking, running, lifting, and exercise
Getting you confident to return to the things you love
What Can You Do at Home for Pelvic Pain After a C-Section?
Here are a few simple exercises to start early after your c-section. Remember to let pain be your guide if you are pushing too far, the first few weeks are meant to focus on healing.
Practice belly breathing for 2 min: with hands on belly, slowly inhale into your belly and lower abdominal wall.
Gradually build up walking distance: research shows early walking after a c-section can decrease pain and improve mental health.
Coordinate your deep core: start lying on your back and slowly turning your abs on by thinking about lightly firming up your belly (as if a small child was going to sit on your stomach).
Gentle scar tissue mobility work for 2 minute daily starting at 6 weeks can improve pelvic pain after c-section. Check out our FREE guide below for a detailed resource on how to incorporate scar tissue work at home.
Make sure to follow c-section activity restrictions and make sure to consult your medical provider if you have an increase in pain, redness, or bleeding.
When Should You See a Pelvic Floor Physical Therapist After a C-Section?
Sharp pain with movement (like getting in/out of the car)
Consistent pelvic pain or pressure
Pain with sex
Increased sensitivity or pain into the scar
Having difficulty isolating your lower abs or pelvic floor
Pain or difficulty with returning to exercise
Urinary leakage or urinary urgency
Whether you’re 6 weeks postpartum or 6 years postpartum, pelvic floor PT after a c-section can resolve many issues that you may have been experiencing.
Find Relief From Pelvic Pain After C-Section in Columbia, MO
If you’re wondering how “pelvic pain after c-section” can be resolved, you are definitely not alone.
Pelvic floor physical therapy can help you get back to the things you love after baby without pelvic pain limiting you.
Revive Rehab in Columbia, Missouri, is a pelvic health practice that specializes in pregnancy and postpartum care.
If you are in the Columbia, Jefferson City, Fulton, Boonville, or mid-Missouri area, we’d love to work with you! Click here to learn more about our in-person services.
We offer hour-long, one-on-one, individualized appointments with a physical therapist to get to the root cause of your concerns. We provide a holistic approach for your care. Click the link below if you’d like to book an appointment with us, we’d love to help you on your postpartum journey!
Written by: Dr. Sarah Miller, PT, DPT
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