Why Women with C-sections Need Pelvic Floor Physical Therapy, Too

By Erica Mitchell, PT, DPT

One of the most common things I hear from friends when they find out I treat pelvic floor dysfunction is “I’m so glad I had a c-section; I’ve saved my pelvic floor!” It’s my favorite time to ruin the party and educate them on how they need pelvic floor therapy just as much as someone who has had a vaginal delivery.

Your body has carried a baby for 9-10 months. There are a lot of musculoskeletal, hormonal, and visceral changes that happen when growing a baby. As your belly grows, your center of gravity often shifts posteriorly, your pelvis shifts anteriorly, your hips externally rotate, organs move up (or down), and you go through a rollercoaster of hormonal changes that can affect your body in the peri and postpartum period.

A majority of cesareans result from failed vaginal delivery. Typically that means a prolonged period of attempting to push the baby through the birth canal and ultimately having to go the cesarean route. The prolonged pressure on vaginal tissues and bearing down in an attempt to deliver a baby can have lasting effects on the pelvic floor – even if you ultimately don’t deliver vaginally. In this case you have the prolonged pressure and strain on vaginal tissues in addition to the abdominal musculature compromisation from the cesarean.

Your abdominal wall is compromised by c-section, so pressure management is key! After c-sections it’s important to learn how to effectively, safely, and appropriately engage your core to prevent excessive pressure through the abdominal wall or pelvic floor. Sometimes the weakness of the abdominals causes increased force down onto the pelvic floor with lifting or straining causing symptoms of heaviness, leakage, etc. The deep core muscles and pelvic floor muscles act as best friends; these muscles need to be firing together, something that needs to be retrained after pregnancy and delivery.

Post c-section, you’ll still go through postpartum changes, too. Examples of postpartum changes include laxity of tissues, thoracic pain from breastfeeding and pumping, lingering hip and back pain from pregnancy, postural changes, etc.

All of these issues are common but can be addressed and relieved with appropriate treatment and attention! Pelvic floor therapy can help with SI joint dysfunction, diastasis recti (separation of abdominal muscles from pregnancy), and general laxity of tissues from downward force of a whole human on your pelvic floor. Pelvic Floor Therapy can help retrain muscles that have been stretched and weakened, help to improve posture and decrease aches and pains, decrease (or prevent) unwanted bladder and bowel dysfunction, and improve your overall level of function. None of that has to do with method of delivery!

If any of this sounds familiar to you or if you’re wondering if you could benefit from pelvic floor physical therapy, contact us! We see women in the peri and postpartum period in the Birmingham, AL, area. Our clinic is conveniently located in Hoover, AL, near the Galleria.

Senior Urinary Incontinence

Urinary incontinence is a condition where an individual experiences involuntary leakage of urine. It is a common problem among seniors, with a prevalence rate of up to 50% among older adults. Bladder leakage can significantly impact the quality of life, leading to embarrassment, social isolation, and decreased independence. Fortunately, having a Pelvic Floor Therapist can help teach you several strategies that can manage urinary incontinence and improve bladder control in seniors.

There are different types of urinary incontinence, and the treatment approach depends on the underlying cause. The most common types of urinary incontinence among seniors are stress incontinence, urge incontinence, and mixed incontinence. Stress incontinence occurs when pressure is exerted on the bladder, such as during coughing, sneezing, or physical activity. Urge incontinence, on the other hand, is characterized by a sudden urge to urinate that is difficult to control. Mixed incontinence involves a combination of stress and urge incontinence.

One effective strategy for managing urinary incontinence among seniors is bladder training. Bladder training involves gradually increasing the time between bathroom breaks to help the bladder hold more urine. It can be an effective strategy for seniors who experience urge incontinence or mixed incontinence. Bladder training works by retraining the bladder to hold more urine and reducing the frequency of bathroom breaks. It can also help reduce the number of accidents and increase confidence and independence. Bladder training begins by keeping a bladder diary, which involves tracking when and how much urine is passed throughout the day. This helps seniors understand their patterns and identify times when accidents are more likely to occur. Using this information, a Pelvic Floor Therapist can develop a personalized bladder training plan that gradually increases the time between bathroom breaks.

For example, if a senior currently goes to the bathroom every hour, the plan may start by increasing the time between bathroom breaks by 15 minutes. Over time, the interval between bathroom breaks is gradually increased until the senior can comfortably hold urine for longer periods. It is important to note that this process may take several weeks or months to see significant improvement.

General strengthening exercises are another effective strategy for managing urinary incontinence among seniors. Think about it… if a senior cannot make it to the bathroom without ease, they are more likely to have urinary accidents. Improving strength and mobility will assist seniors being able to make it to the bathroom in time. Pelvic floor muscle exercises, also known as Kegels, can help improve bladder control and reduce nocturia. However, It’s not just about kegels! The pelvic floor muscles need to be able to contract and relax just like any other muscle in the body. These muscles should be coordinated with your deep abdominal muscles, spinal muscles, hip muscles, and work of breathing. A pelvic floor therapist can work with you to develop an exercise program that is tailored to your specific needs and goals.

Lifestyle changes can also help manage urinary incontinence among seniors. Seniors should limit their intake of bladder irritants which can irritate the bladder and increase the urge to go to the bathroom. Seniors need to maintain adequate overall hydration and try to drink 50% of their body weight in fluid ounces of mostly water per day. A good guide to hydration is to look at urine color; it should be clear to pale yellow and not dark yellow! Maintaining a healthy weight and avoiding constipation can also help reduce bladder leakage. Engaging in regular exercise can also help improve bladder control and reduce the risk of urinary incontinence.

It is important for seniors to talk to their healthcare provider about their urinary incontinence and bladder leakage. A healthcare provider can help diagnose the problem and recommend a Pelvic floor Therapist. Seniors should not feel embarrassed or ashamed to discuss their symptoms with their doctor, as urinary incontinence is a common medical issue that can be effectively managed.

Our clinic is conveniently located in Hoover, Alabama, near The Galleria. We have experienced clinicians with advanced training in the treatment of Pelvic Floor disorders. Contact us to schedule an appointment!

Pelvic Floor Misconceptions

The pelvic floor is the base of a collective group of muscles referred to as your ‘core’. The pelvic floor muscles are located in your pelvis and stretch like a hammock from the pubic bone (at the front) to the coccyx or tail-bone (at the back) and from side to side.

The pelvic floor muscles work with your deep abdominal (stomach) muscles, deep back muscles, hip muscles, and diaphragm to stabilize and support your spine. They also help control the pressure inside your abdomen to minimize the downward force when you lift or strain, such as during exercise

Since the pelvic floor has a lot of responsibilities in the body, that brings some confusion and misconceptions. Let’s try to clear up some of these misconceptions!

Running DOES Affect the Pelvic Floor

The high-impact nature of running adds increased stress to the pelvic floor muscles. Ground reaction force is the force your body absorbs every time your foot hits the ground.

Gravity pulls down and ground reaction force is coming up, and they meet at the midpoint in the pelvic area. Pelvic floor muscles are absorbing a ton of impact, and when you have these forces combining at once, leakage can occur when there is pelvic floor dysfunction. There are other aspects of the body that can assist in decreasing this impact, such as midfoot mobility, diaphragm excursion, and posture. A highly trained pelvic floor therapist can evaluate potential causes of urinary leakage while running; it is likely NOT just that your pelvic floor muscles are weak!

This is why medical professionals, pelvic floor therapists included, recommend women who have recently given birth ease back into running and other high impact activities. A pelvic floor therapist can help these postpartum women recover from childbirth, build back core strength, and safely return to a high impact exercise routine without negative side effects such as urinary or fecal leakage, prolapse, or pain.

Squats DO NOT only strengthen leg and buttocks muscles

Squats can promote a stronger pelvic floor and core when performed correctly. Pelvic Floor therapists coach clients to perform squats with ribs stacked over a neutral pelvis. They coach proper breathwork and footwork to optimally engage the pelvic floor and deep core. Oftentimes women present with a “mom butt”, or a flattened rear, due to weaknesss and inhibition of the glutes following pregnancy; this can cause the pelvic floor muscles to work in overdrive. Increasing glute strength can help to decrease pressure and tension placed on the pelvic floor.

Men DO Have a Pelvic Floor

Men can experience symptoms related to pelvic floor dysfunction: urinary and fecal incontinence, overactive bladder, painful intercourse, core weakness and diastasis recti, pelvic pain, and erectile dysfunction.

Symptoms of pelvic floor dysfunction often occur in men with prostate dysfunction. Those symptoms might be dribbling after urination, getting up more frequently at night to use the bathroom, and a slow stream of urination. Men may also struggle with erectile dysfunction or incontinence after a prostatectomy to treat prostate cancer.

Men who work in strenuous jobs or engage in heavy exercise may experience bladder and bowel dysfunction. Excessive straining can cause rectal prolapse in men, hernias, and abdominal muscle separation.

Pelvic floor therapists can treat men as well! Men do not have to live with these unwanted symptoms of pelvic floor dysfunction.

Everyone Should NOT Be Doing Kegel Exercises

The kegel exercise is an important tool in strengthening your pelvic floor, but only if it’s done correctly.

Quick squeezes of the pelvic-floor muscle can strengthen the fast-twitch muscle that prevents leaking while sneezing, coughing, laughing, and jumping. Longer endurance holds focus on recruiting slow-twitch muscle fibers that are required for prolonged activity as well as decreasing urinary frequency and urgency.

To properly do a kegel exercise that focuses on those slow-twitch muscles: Breathe normally as you tighten your pelvic floor muscles for 10 seconds, then relax them for 10 seconds. Perform three sets of 10 repetitions daily.

All muscles need to be able to contract and relax, even the pelvic floor. Most people we see in the clinic need to be relaxing their pelvic floor before they learn to contract it. If you are habitually doing kegels or strengthening your pelvic floor without lengthening or relaxing it, this can lead to pelvic floor dysfunction (urinary and fecal leakage, urinary urgency/ frequency, nocturia, pain, prolapse, sexual dysfunction).

Squeezing can make a tight pelvic floor problem worse. For these people, many of whom present with feelings of pain in the pelvic floor, kegel exercises are not an appropriate form of treatment. Pelvic floor therapy is about strength and tone, as well as being able to relax those muscles.

Urinary Leakage is NOT Normal

Pelvic floor therapists want everyone to understand that any amount of Bladder Leakage is common but NOT normal. Bladder leakage can be an embarrassing symptom and some people may not want to divulge this information to their medical provider. Bladder leakage will be easier to treat if it are addressed when symptoms are mild versus waiting till it gets worse.

Pregnancy, prostate disease, and aging may be risk factors for leaking, but leakage can be addressed through pelvic floor therapy. The key is acknowledging your problem and seeking treatment (ideally through conservative treatment in Pelvic Floor Therapy)!

Don’t be afraid to seek treatment if something is off or seems off with your pelvic floor muscles. You do not have to live with leakage, prolapse, or pain!

Interested in Pelvic Floor Therapy? We see men and women of all ages in the Birmingham, AL, region. Our clinic is located in Hoover, AL, near the Galleria. Contact us to schedule!