How Pelvic Floor Therapy Helps After A C-Section

Hi friends! It’s April which means it’s Cesarean Section (C-section) awareness month!  C-sections are the most commonly performed inpatient surgical procedure in the United States (Stone, 2021).  A C-section is more than just a surgical delivery—it's a layered experience, both physically and emotionally. Recovery often extends well beyond the six-week postpartum period, and doesn’t stop after you last checkup with your birth provider.

What Gets Cut (and Heals) During a C-Section

A C-section is an intricate procedure that involves carefully opening and closing multiple layers of tissue to reach the uterus and the baby. These layers include:

1. Skin

2. Subcutaneous fat (fatty tissue)

3. Fascia (connective tissue over the abdominal muscles)

4. Rectus abdominis muscles (typically separated rather than cut)

5. Transversalis fascia and peritoneum

6. Uterus

   
   

While the abdominal muscles are not actually cut, they are often stretched and retracted, which can impact core strength, posture, and mobility.  Depending on the obstetricians surgical technique, they may stitch one or more of these layers back together after the cesarean section is completed (Cintesun, 2021).

What Should Activity Look Like Post-C-Section?

0–6 Weeks: Gentle, Restorative Movement

In the early weeks, the goal is healing—not intense workouts. While rest is essential, complete rest and immobility isn't helpful either. Safe, gentle movement supports circulation, reduces stiffness, and lays the groundwork for core recovery.

Focus on:

• Short walks (around the house, gradually increasing duration)

• Deep breathing with light core engagement (diaphragmatic breathing)

• Posture awareness (especially when feeding or lifting your baby)

• Pelvic floor awareness (gentle contractions, as tolerated)

  
  

Avoid:

• Lifting anything heavier than your baby

• Crunches, planks, or high-impact movement (like running or jumping)

• Twisting or aggressive stretching around the incision site

  
  

Listen to your body, and don’t push through pain. If something feels like too. much, it probably is.  Watch out for headahces,  If you have questions if something is safe, be sure to contact your birth provider or a pelvic floor therapist.

What Recovery Should Look Like After 6 Weeks: Building Strength and Mobility

At this stage, many are cleared by their birth provider for "normal activity," but that doesn't mean your body is fully healed. In pelvic floor therapy therapy, we start gradually reintroducing targeted movement that restores function and builds a foundation for higher level activities or exercises. Remember, you’ve just spent the last six or more weeks recovered with less activity.  Our bodies become deconditioned in that time, but that doesn’t mean there’s no hope.

Recovery typically includes:

• Core and pelvic floor retraining (especially to address diastasis recti or coordination issues)

• Scar mobilization (to reduce pulling, tightness, and adhesions)

• Progressive strength training (using breath and form as a guide)

• Posture, lifting, and baby-carrying mechanics

• Low-impact cardio, such as walking or cycling, based on comfort

  
  

If your goal is to return to running, hiking, or lifting weights, a pelvic floor therapist can help design a phased program that prevents injury and supports long-term success while avoiding injury and other complications.

Why Pelvic Floor Therapy Matters After a C-Section

There are several common complications in the period after a C-section including back pain, pelvic pain, bowel and bladder issues, and scar tissue/adhesions (Stone, 2021).  The risks of these issues are higher with C-sections when compared with spontaneous vaginal deliveries (Stone, 2021).

The layered nature of a C-section means that postpartum discomfort or dysfunction can show up in a variety of ways:

• Core weakness or abdominal separation (diastasis recti)

• Pelvic floor dysfunction (yes, even with a C-section)

• Hip or lower back pain

• Scar sensitivity or pulling

• Difficulty returning to exercise safely

  
  

With pelvic floor therapy therapy, recovery becomes more intentional—addressing not just healing, but performance and comfort in your daily life.  A pelvic floor therapist can help retrain the muscles of the pelvis, hips, and back; use hands on techniques to decrease pain and improve movement patterns; and manage the scar.

Even if you’re reading this and you’ve had a vaginal delivery, you may still have abdominal separation or core weakness.  One study found that all postpartum women were weaker and their muscles tired more quickly compared with women who had not been pregnant (Deering, 2018).

Scar Massage: Reconnecting with Your Core

After a C-section a scar can be numb, sensitive, painful, or a combination of these.  Scar massage and scar desensitization techniques can start once your incision is fully healed (usually around 6–8 weeks) and help improve any of those feelings. A pelvic health therapist can guide you through techniques that:

• Improve tissue mobility

• Reduce adhesions and sensitivity

• Help reconnect to core muscles through tactile feedback

• Support more fluid, pain-free movement

  
  

Even if your C-section is older (more than 6 months ago), research still shows that techniques can help address pain (Wasserman, 2018).

You Deserve a Supported Recovery

Your postpartum healing is just as important as the birth itself.  A pelvic floor therapist can help you navigate scar tissue, movement, and strength so you can get back to living fully and comfortably. Whether you’re newly postpartum or years out, they can help you heal—layer by layer.

The physical healing doesn’t stop there.  Women who had pelvic girdle pain postpartum were more likely to have postpartum depression (Simonds, 2018).

Regardless of your delivery, you deserve to heal well. There is hope and help out there--you just have to look for it!

To learn more about your pelvic floor muscles, check out these great resources:

• Find a Therapist near you at www.mypfm.com/find-a-pt

• Watch our YouTube playlist on Postpartum and Your Pelvic Floor

• Support heaviness/pressure with myPelvic Bra

• Learn more about your pelvic floor on our Instagram

• Visit our Amazon store for our favorite pelvic health products

• Sign up for our email newsletter

For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources.

Written by Emily Reul, PT, DPT

References

1. Cintenseun E et al.  Effect of closure of anterior abdominal wall layers on early postoperative findings at cesarean section: a prospective cross-sectional study.  Rev Bras Ginecol Obstet. 2021;43(4):250-255.

2. Deering RE et al.  Fatiguability of the lumbopelvic stabilizing muscles in women 8 and 26 week postpartum. J Womens Health Phys Therap. 2018;42(3):128-138.

3. Simonds AH et al.  Disability, pelvic girdle pain, and depressive symptoms in the first 3 months postpartum.  J Womens Health Phys Therap. 2018;42(3):139-147.

4. Stone J, Skibiski K, Hwang S, Barnes C.  Physical therapy in addition to standard of care improves patient satisfaction and recovery post-cesarean section. J Womens Health Phys Therap. 2021;45(1):10-19.

5. Wasserman JB et al.  Soft tissue mobilization techniques are effective in treating chronic pain following cesarean section: a multicenter randomized control trial.  J Womens Health Phys Therap. 2018;42(3):112-119.