A Q&A on C-Section Recovery and Diastasis Recti with Allison Romero, doctor of physical therapy and pelvic floor specialist
According to the CDC, close to 32% of women deliver by C-section. Whether planned or due to complications during delivery, a c-section can be a common birthing experience. C-section recovery, however, requires unique patience and a different level of care than you may be familiar with due to its surgical nature. This inspired the Every Mother team to create a Surgical Recovery Path, designed for mothers looking for expert guidance and support in the earliest days following a cesarean delivery.
How does having a C-section impact diastasis recti, and does it make healing more difficult?
A C-section delivery is a major surgery in which an incision is made into the uterus and abdomen along the anterior oblique sling where all of our deep abdominal core muscles insert. The nature of a C-section delivery can prolong the healing process from diastasis recti because of the additional injury incurred in the abdominal core with the surgery, leaving the muscles less functional and more hypertonic which can lead to longer downtime for recovery (anywhere from 6-12+ weeks). In addition, women often experience discomfort around the incision site and temporary feelings of numbness postpartum, making it difficult to connect to their core and pelvic floor musculature.
All of this is to say, you can fully restore core strength and function postpartum, regardless of the delivery method. With a C-section recovery, we may need to take a different approach for incorporating safe and therapeutic exercises to heal, recover, and regain strength.
When recovering from a C-Section, when can I begin working out?
When it comes to resuming exercise following a C-section, it's essential to go at your own pace and only begin once you have received care provider approval. Once you have received medical provider (MD or PT) approval and you feel ready, you can start introducing therapeutic exercises that gently engage the breath and deep inner core to begin to reawaken the abdominal core, pelvic floor and diaphragm. In the first several weeks postpartum, bleeding may play a role in the rate of returning to exercise. It should lessen in the weeks following delivery, but if you feel uncomfortable or see an increase in bleeding, take a break and give yourself longer to heal. It is important to listen to your body while recovering from a C-section.
Our EMbody Surgical Recovery Path supports women during the earliest days after a C-section birth (less than 6 weeks postpartum) through healing core activation, stretches, and movements recommended by OB-GYNs. Learn more about Every Mother programming, here.
What exercises should I avoid during C-section recovery?
We want to avoid anything that causes abdominal coning or doming, pain (anywhere), leaking, or downward pressure into the vaginal or rectal canals. Any moves that lift your shoulders or both of your legs off the floor from a back-lying position are exercises to wait on until the linea alba has had more time to fortify. Instead, focus on therapeutic deep core exercises like the EMbody Program’s foundational Core Compressions that build stability and muscle endurance and safely engage the transverse abdominis, your natural corset, and your pelvic floor.
Learn more about the exercises to avoid following a C-section here.
How do I know if I have scar tissue adhesions, and what can I do about the numbness and discomfort?
After a C-section there will be scar tissue adhesions on and around the incision site. This is an absolutely necessary and important part of healing AND after the initial healing stages are completed (typically 2-6 weeks post-op), it can be therapeutic to begin to mobilize this tissue for improved healing and circulation, which will lead to improved core muscle function. Scar tissue can cause feelings of discomfort, including numbness, pain, tingling, and itchiness. Sometimes scar adhesions can cause skin puckering or puffiness or a C-section shelf-like appearance. C-section scar adhesions are not only cosmetic; they can also affect the deeper tissue layers of fascia, muscle, and viscera which can lead to functional issues including, but not limited to:
- Back pain
- Urinary urgency, frequency, and incontinence
- Pain during intercourse
- Diastasis recti
The good news is that you can hugely improve new and even decades-old adhesions with scar tissue massage techniques and neuromuscular re-education which we include in our programs.
Numbness typically takes about 1 year to see the full extent of healing. Superficial nerves can get injured in the surgical procedure and typically heal at about 1 mm per day for the year following. Any scar tissue mobilization and activation of the deep core will help with freeing the nerves and increasing circulation which helps them flush with new blood and nutrients and can increase the healing capacity in this area. Sometimes as sensation returns we can feel new itchiness or lower level pain and that can be a good sign of nerve regrowth!
Does massage really help with C-sections scars? How about old ones?
Short answer: Yes - 100%. And there is no time limit-so feel free to jump in wherever you are in your healing timeline!
Long answer: It requires consistent and daily care to loosen and soften adhesions. Typically we want to be addressing our c-section scars a minimum of 2-4x/week for at least 2 minutes. The more consistently we mobilize this tissue the more we will see the desired results on both a cosmetic and functional level.
Learn more about scar tissue massage and how to administer a common C-section scar tissue massage technique, here.
How can I get rid of my C-section shelf?
C-section shelves can appear more exaggerated when suffering from diastasis recti. Over 60% of people who have pregnancies that go to full term will experience some degree of abdominal separation postpartum, which can contribute to a host of symptoms, including back pain, incontinence, pelvic floor dysfunction, and a persistent abdominal pooch that doesn't respond to diet or exercise. This is why it's important to self-check for DR after delivery (around week 4-6 postpartum) and throughout your C-section recovery.
If you do find that you present with a diastasis recti following a C-section, we recommend joining the Every Mother Program to resolve diastasis recti and restore core strength and function. That therapeutic exercise program paired with scar tissue massage will help to reduce the appearance of scar puckering, or C-section shelves caused by scar tissue adhesions.
How do I reduce postpartum swelling following my C-section?
Postpartum swelling is quite common following a C-section due to the IV administered during surgery. This can result in far more dramatic swelling than pregnancy alone, but thankfully it is temporary. Gentle movement like walking, in addition to drinking water, eating fresh fruits and vegetables, and massage are a few simple strategies to help reduce swelling. Gentle lymphatic mobilization techniques can be started right away post-op and can make a huge difference in the absorption of postpartum/post surgical swelling. These techniques are included in the Every Mother Early Surgical Recovery and Reclaim paths.
Check out this article and in-depth guide on tips to reduce swelling following a C-section.
Should I wear a waist trainer during my C-section recovery? What do I need to know about them?
Corsets, belly binders, and splints are powerful tools that can augment C-section recovery and accelerate healing of diastasis recti, but keep reading for a few important precautions. The science behind how they work is simple: they draw together the abdominal musculature and take chronic stress off the linea alba so that the healing is potentially accelerated. However, something like this used alone will not fully heal our core. It must be combined with daily core activation such as Every Mother’s Core Compressions.
When choosing to wear supportive apparel post C-section:
- Choose a soft support for the early weeks post surgery while the incision is healing (the hospital provided ones are great).
- Once the incision is healed make sure to select one that provides firm support, stays in place throughout the day, follows the natural curve of the body, and is adjustable.We recommend our EMbody Core Support garment.
- If you are healing diastasis recti, feel free to wear the support garment as much as is comfortable. Take it off anytime it begins to feel bothersome.
- It is extremely important to don the support garment from bottom to top to ensure that any increased pressure is not affecting the pelvic organs. If you continue to feel downward pressure into the pelvic floor despite loosening the garment and properly wearing it, pause and set the garment aside for a few weeks (2-4) while you focus on strengthening your deep core with Every Mother Core Compressions. Come back and try the garment again if you wish once your core and pelvic floor muscles are more fully recovered and able to withstand the increase in abdominal pressure that is brought on by support garments.
Learn more about corsets, binders, and baby-wearing here.
In the end, recovering from a C-section and returning to daily activities following birth may seem daunting. But with support, guidance, and therapeutic exercise, you’ll be on your way to restoring core strength & function and feeling confident and empowered in your own skin. Check out our EMbody Surgical Recovery Path to get started.
Every Mother’s app-based exercise program delivers personalized exercise protocols for every stage of motherhood. Whether you’re training to build strength for birth, to enhance postpartum recovery, to heal diastasis recti, to address symptoms of pelvic floor dysfunction, or to improve health during perimenopause and beyond, our clinically proven online program offers evidence-based coaching and support from pelvic floor physical therapists each step of the way. Get started today.
