How Does a C-Section Impact the Pelvic Floor - and Why Is Pelvic Floor Physiotherapy Needed Postpartum?
When we think of pelvic floor challenges after birth, we often assume they only apply to those who’ve had a vaginal delivery. But that’s one of the biggest misconceptions I come across in my practice.
Even if you had a planned or emergency C-section, your pelvic floor still plays a major role in both your pregnancy and recovery and it can be impacted in ways you might not expect.
Let’s break down exactly how a C-section affects your pelvic floor, and why pelvic floor physiotherapy is still a crucial part of postpartum healing.
1. Pregnancy Alone Stretches and Challenges the Pelvic Floor
Whether you gave birth vaginally or by cesarean, your pelvic floor muscles supported the weight of your growing baby, uterus, placenta, and amniotic fluid for approximately 9 months. That’s a lot of work!
This pressure gradually stretches the pelvic floor and can lead to:
Muscle weakening or overcompensation of the pelvic floor and abdominal/back muscles
Increased intra-abdominal pressure
Changes in bladder and bowel control
Risk of pelvic organ prolapse
So even before delivery, the pelvic floor is under strain and often needs help recovering.
2. C-Section Surgery Affects the Deep Core (Which Works with the Pelvic Floor)
A C-section is major abdominal surgery, involving incisions through skin, fat, fascia, muscle, and the uterus. These structures are part of your deep core system, which also includes the diaphragm and pelvic floor. More specifically layer 2 of your pelvic floor is fascially and functionally connected to your deep core. Layer 2 muscles of the pelvic floor include: external urethral sphincter, deep transverse perineal muscles, urethrovaginalis and the compressor urethra. This layer of muscle is vital for urinary control and supporting the perineal body. Issues in this layer can lead to urinary frequency and urgency or difficulty with fully emptying the bladder.
Moreover, when the abdominal muscles are disrupted by surgery, the pelvic floor often has to "pick up the slack". This can lead to:
Tension or tightness in the pelvic floor
Imbalance between the core and pelvic muscles
Poor pressure management during movement or lifting
Changes in posture and breath patterns
All these dysfunctional can then lead to urinary urgency, frequency, difficulty emptying the bladder and pain during periods, intercourse or with every day activities.
If you are still not convinced that pelvic floor physiotherapy is needed post c-section, let’s continue to reason number 3…
3. Scar Tissue and Adhesions Can Affect Pelvic Mobility
After a C-section, the body naturally forms scar tissue to help with healing. While some scar tissue is normal, excessive buildup or adhesions (tissues sticking together) can cause issues like:
Pain or discomfort in the pelvis or abdomen
Restricted mobility
Pulling sensations with movement, intimacy, or even during menstruation
Altered organ function in the pelvic region
These restrictions can also influence the nerve pathways and fascial lines that connect to the pelvic floor, further contributing to dysfunction.
4. Posture, Breathing, and Movement Patterns Change
After surgery, it’s common to adopt a protective posture — hunching forward, shallow breathing, avoiding full core engagement — all of which can impact how the diaphragm and pelvic floor communicate.
Shallow breathing and bracing behaviours can create tension and reduce pelvic floor mobility. Over time, this can lead to:
Core and pelvic floor disconnection
Persistent tightness
Difficulty with bowel movements or urination
Delayed return to movement and exercise
So, Why Pelvic Floor Physiotherapy After a C-Section?
Because C-section recovery is more than just letting your incision heal. It’s about:
Restoring deep core strength and coordination
Improving bladder, bowel, and sexual function
Addressing scar tissue restrictions
Preventing or treating pain and dysfunction that may arise later
As a pelvic floor physiotherapist, I work with many moms who are surprised to learn that their lingering symptoms — back pain, incontinence, heaviness, or tightness — are linked to their C-section recovery.
And the good news? With the right guidance and care, you can heal and feel strong again.
💛 You deserve support 💛
Whether you had a planned C-section or an emergency one, your birth story is valid — and your recovery matters. Pelvic floor therapy isn’t just for those who delivered vaginally. It’s for anyone who has gone through pregnancy and birth.
If you’ve had a C-section and want to feel more confident in your body again, book a pelvic health assessment. Let’s get you back to feeling like you.
Wishing you all the best in your recovery!
Leila Awada, PT
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