By Emily Quinn PT

Approximately one third of all births in Canada are delivered by cesarean sections (c-section or c-birth).  Some of the many factors that healthcare providers take into consideration when planning for a c-section include the position of the fetus (for eg. breech), labor dystocia (i.e difficulty with cervical dilation) and abnormal fetal heart rate during labor. Multiple gestations, maternal age, obesity and individual requests may also influence the method of delivery. But how does a cesarean birth affect the pelvic floor?

If I deliver by a c-section, my pelvic floor will be unaffected, right?

Method of delivery can have a unique impact on the pelvic floor and adjacent structures. To understand these differences, it is first important to review what the pelvic floor is. Our pelvic floor is a network of muscle, connective tissue, vascular and neural structures that are located at the base of our pelvis below our pelvic organs. These structures are involved in many important functions including bowel and bladder function, sexual function, lymphatic function and core function. In addition, they provide support to our pelvic organs.  It is normal for these structures to experience some changes throughout pregnancy, delivery and the postpartum period. For many people, this may result in changes to bowel and bladder function such as urinary and/or fecal leakage, heaviness and/or pressure in the pelvis, pain in the genital, low back and/or abdominal regions. Changes to sexual function including pain with intercourse can also occur.

Individuals who have had a c-section tend to experience less loss of pelvic floor strength compared to those who have had a vaginal delivery. As a result, individuals who deliver vaginally are more likely to experience urinary incontinence than those who deliver by a c-section. Additionally, the risk of pelvic organ prolapse, which is characterized by the lowering of one or more of the pelvic organs, is also higher for women who have had a vaginal delivery. Interestingly, although the risk of fecal incontinence (i.e involuntary stool leakage) in the first 3 months postpartum is higher for individuals who deliver vaginally, some research indicates that the long-term risk of fecal leakage is similar in both groups. 

To perform a c-section, an incision is made through several layers of tissue, including connective tissue and muscle and can impact nerves in the area as well. As such, individuals who deliver by c-section may experience pain and other sensations including numbness, tingling or burning around the incision site. Trunk strength may also be impacted. Individuals who deliver by a c-section are at risk of developing fibrous adhesions around the site of their scar. Depending on the nature and location of these adhesions, this can influence the synergistic relationship between abdominal and pelvic floor musculature. Overtime, these fibrous structures can contribute to a variety of different symptoms including pelvic pain, pain with intercourse and in some cases bladder urgency. 

Although the method of delivery is important to consider with regards to pelvic floor integrity, it is also important to consider how hormonal changes, sleep, stress and other lifestyle factors throughout pregnancy and postpartum can impact the function of the pelvic floor. 

How can pelvic floor physiotherapy help?

Pelvic floor physiotherapists assist individuals to continue with or return to their activities of daily living throughout pregnancy and the postpartum period. We utilize a combination of strengthening, stretching and deep breathing exercises, scar massage and education around symptom prevention and management. In addition, we provide guidance on returning to physical activity and intimacy postpartum. If you are planning for a c-section or have questions and concerns about your recovery, know that pelvic floor physiotherapy can help! 

References: 

Blomquist, J. L., Carroll, M., Muñoz, A., & Handa, V. L. (2020). Pelvic floor muscle strength  and the incidence of pelvic floor disorders after vaginal and cesarean delivery. American Journal of Obstetrics and Gynecology, 222(1), 62.e1-62.e8. https://doi.org/10.1016/ j.ajog.2019.08.003

Blomquist, J. L., Muñoz, A., Carroll, M., & Handa, V. L. (2018). Association of Delivery Mode With Pelvic Floor Disorders After Childbirth. JAMA, 320(23), 2438. https://doi.org/ 10.1001/jama.2018.18315

Brown, S. J., Gartland, D., Donath, S., & MacArthur, C. (2012). Fecal Incontinence During the  First 12 Months Postpartum. Obstetrics & Gynecology, 119(2, Part 1), 240–249.https:// doi.org/10.1097/aog.0b013e318242b1f7

Canadian Institute for Health Information (CIHI) Snapshot.  (2019). Inpatient Hospitalization, Surgery, Newborn, Alternate Level of Care and Childbirth Statistics, 2017 – 2018. Retrieved on May 20th, 2021.

Gregory, K., Jackson, S., Korst, L., & Fridman, M. (2011). Cesarean versus Vaginal Delivery:Whose Risks? Whose Benefits? American Journal of Perinatology, 29(01), 07–18. https://doi.org/10.1055/s-0031-1285829

Gu, J., Karmakar-Hore, S., Hogan, M. E., Azzam, H. M., Barrett, J. F., Brown, A., Cook, J. L., Jain, V., Melamed, N., Smith, G. N., Zaltz, A., & Gurevich, Y. (2020). Examining Cesarean Section Rates in Canada Using the Modified Robson Classification. Journal of Obstetrics and Gynaecology Canada, 42(6), 757–765. https://doi.org/10.1016/j.jogc.2019.09.009

Moro, F., Mavrelos, D., Pateman, K., Holland, T., Hoo, W. L., & Jurkovic, D. (2014). Prevalence of pelvic adhesions on ultrasound examination in women with a history of Cesarean section. Ultrasound in Obstetrics & Gynecology, 45(2), 223–228. https://doi.org/10.1002/uog.14628