Why pelvic PT should be standard after a Cesarean birth

When preparing for a baby, most birth plans focus heavily on labor, delivery, and immediate postpartum care. I certainly spend a good chunk of our time in PT talking about all of this. But if your baby arrives via C-section, recovery often gets simplified into two basic instructions: rest for six weeks and don't lift anything heavier than your baby. Good luck. 

Once you get cleared at that 6-week postpartum checkup, it can feel like you're expected to jump right back into normal life. However, a C-section is major abdominal surgery, and true recovery goes far beyond just waiting for an incision to close. Really, none of us are healed after birth at 6 weeks no matter how baby gets here but CERTAINLY not after a major surgery. 

Whether your C-section was planned or emergency, pelvic floor physical therapy (PFPT) is one of the most effective, yet underutilized, tools to help you heal fully, move without pain, and regain your core strength. While it should be standard of care it is still something that many providers don't recommend to us after birth. 

Why C-Section Recovery Requires Pelvic PT

It’s a common misconception that pelvic floor issues only happen after a vaginal birth. In reality, your pelvic floor carries the weight of a growing baby for nine months regardless of how you deliver. Combine that pressure with a surgical incision through multiple layers of tissue, and your core system undergoes significant stress.

Here is how pelvic PT supports your recovery:

1. C-Section Scar Care & Mobility

During a C-section, the surgeon cuts through skin, fascia, and abdominal tissues to reach the uterus. As these layers heal, scar tissue forms. If that scar tissue grows rigid, it can restrict movement, pull on surrounding muscles, and cause pain far beyond the incision line.

• How PT helps: Pelvic physical therapists perform targeted scar tissue mobilization to break up adhesions. This improves skin mobility, reduces numbness or hypersensitivity around the scar, and prevents pulling sensations when you stand, stretch, or exercise.

2. Reconnecting Your "Core Canister"

Your deep core functions like a cylinder: your diaphragm is the top, your abdominal muscles wrap around the middle, and your pelvic floor forms the base. A C-section disrupts the abdominal wall, which can cause the pelvic floor to compensate by overworking or contracting too tightly.

• How PT helps: Rather than just telling you to do "crunches" or "kegels" (which can sometimes make tightness worse), a pelvic PT helps you retrain the deep transverse abdominis and pelvic floor muscles to work together in harmony again. It's all about the coordination and breathing!!

3. Resolving "Invisible" Postpartum Symptoms

Many C-section parents are surprised to experience symptoms commonly associated with vaginal delivery. You don't have to accept these issues as your "new normal":

• Pain during intimacy

• Urinary urgency, frequency, or accidental leaking when laughing or sneezing

• Lower back, hip, or tailbone pain

• A feeling of pressure or heaviness in the pelvis

That's where your Pelvic PT comes in - we look for the root cause and figure out how to make these symptoms better. 

4. Safely Returning to Exercise and Daily Life

Lifting a heavy infant seat, carrying groceries, or returning to workouts like running or weightlifting puts significant demand on your core and pelvic floor. Returning to heavy activity too quickly without proper core rehabilitation can lead to feeling pressure in your abdominal separation (diastasis recti), leaking, symptoms of prolapse and more. 

• How PT helps: Your therapist will assess your functional movement, check for diastasis recti, prolapse, weakness, etc.  and guide you through progressive exercises tailored to your specific fitness goals.

What to Expect at a Pelvic PT Appointment

If you've never been to pelvic PT, it's natural to feel uncertain about what happens. I have a blog post about this if you want more detail but a typical session includes:

1. A Detailed History: Discussing your pregnancy, birth story, current pain points, bladder/bowel health, and personal goals.

2. External Assessment: Evaluating your posture, breathing patterns, core strength, hip mobility, and scar flexibility.

3. Internal Assessment (Optional): With your consent, an internal examination (via the vagina) may be performed to assess pelvic floor muscle tone, endurance, and strength.

4. Customized Treatment Plan: A mix of manual therapy, guided movement, breathing techniques, and targeted home exercises.

When Should You Start?

• Early Weeks (0–6 Weeks): Gentle diaphragmatic breathing, light walking, and gentle scar desensitization (lightly touching the surrounding skin) can begin early on.

• Post-Clearance (6+ Weeks): Once your OB-GYN or midwife clears you at your post-op visit, you can begin formal pelvic physical therapy.

Note: It is never "too soon" or 'too late" to start. Whether you had a C-section six weeks ago or six years ago, scar tissue and pelvic floor dysfunction can still be successfully treated.

Give Your Body the Recovery It Deserves

You wouldn't be expected to run a marathon right after knee surgery without rehabilitation—and recovering from a C-section should be treated no differently. Pelvic floor PT isn't just about fixing problems; it’s about restoring confidence in your body’s ability to move, heal, and thrive in parenthood.

 

Why Pelvic Floor Physical Therapy Is Helpful During Pregnancy

Pregnancy is an incredible experience, but let’s be honest… your body goes through A LOT.

As your baby grows, your body adapts in ways that can affect your posture, breathing, core strength, pelvic floor, and overall comfort. While some discomforts are considered common during pregnancy, that doesn’t mean you have to simply accept them as something you have to live with.

This is where pelvic floor physical therapy can make a meaningful difference.

Pelvic floor PT during pregnancy isn’t just about addressing problems after they happen. It’s about preparing your body, helping you feel more comfortable, and giving you the tools you need to navigate pregnancy, birth, and recovery with confidence.

What Exactly Is Pelvic Floor Physical Therapy?

I've covered this in other blog posts and on social media but we are the experts in all things pelvis. - specifically the muscles that support your pelvic organs, contribute to bladder and bowel control, assist with sexual function, and work together with your deep core and breathing muscles.

During pregnancy, your pelvic floor is adapting to:

• Increased weight and pressure from your growing baby

• Hormonal changes that affect your connective tissues

• Changes in posture and movement

• The physical demands of labor and delivery

• The recovery process after birth

Pelvic floor physical therapy focuses on how these muscles and surrounding areas are functioning—not simply whether they are strong.

Your pelvic floor needs to be able to contract, relax, lengthen, and coordinate with the rest of your body.

And every person’s needs during pregnancy are different. That's why a one-size-fits-all online class is NOT going to be the best thing for YOUR specific needs!

5 Ways Pelvic Floor PT Can Help During Pregnancy

1. Reduce Pelvic and Low Back Pain

Pelvic girdle pain, low back pain, hip discomfort, and pubic symphysis pain can make everyday activities challenging. Getting in and out of the car, rolling over in bed, walking, exercising, or putting on your pants can suddenly feel much harder than it used to and can often cause pain. While it's common, it's not something you have to live with.

A pelvic floor physical therapist can assess how your pelvis, hips, core, breathing, and movement patterns are working together. Treatment may include:

• Personalized exercises to improve strength and coordination

• Movement modifications for daily activities

• Recommendations on supports or belts that can be helpful

• Hands-on techniques when appropriate

• Strategies to reduce strain during transitions and exercise

The goal is to help you move more comfortably and confidently throughout your pregnancy.

You don’t have to wait until pain is severe to seek help. In fact, it's a LOT easier if you come in sooner!!!

2. Prepare Your Pelvic Floor for Birth

One of the most common misconceptions about the pelvic floor is that pregnancy preparation is all about strengthening it.

But here’s the thing: your pelvic floor needs to know how to relax, too. This is actually what we focus on in pelvic PT during pregnancy for the most part.

During a vaginal birth, the pelvic floor needs to lengthen and allow your baby to pass through the birth canal. Learning how to recognize tension, coordinate your breathing, and practice pelvic floor relaxation can be valuable skills.

We talk about better ways to push, positions for labor and delivery, movements to practice before and during labor and more. Pelvic floor therapy does not guarantee a specific birth outcome, but it can help you develop a better understanding of your body and prepare for the demands of delivery.

3. Address Bladder Leakage and Pelvic Pressure

Leaking when you cough, sneeze, laugh, change position can occur during pregnancy, but they deserve attention—not dismissal. While pregnancy places additional demands on the pelvic floor, leakage and pelvic pressure are not something you simply have to tolerate without support.

Sometimes there is a pressure management issue, other times it's tight muscles. Sometimes it is weakness. That's the beauty of having an actual human assess you instead of some of the online advice and classes out there - you don't know what you'll need until someone actually takes a look.

4. Keep You Moving and Exercising Safely

If you were active before pregnancy, you may want to continue doing the activities you enjoy. If you weren’t active, pregnancy can also be an opportunity to build a movement routine that feels good for your body.

Pelvic floor PT can help you adapt your exercise routine as your pregnancy progresses.

We talking things like:

• Strength training modifications

• Walking and other forms of exercise

• Core exercises and pressure management

• Managing symptoms during workouts

• Returning to movement after periods of discomfort

Your plan should be based on your symptoms, goals, stage of pregnancy, and medical considerations. You don’t have to stop moving just because your body is changing. You may simply need a different approach.

5. Prepare for Postpartum Recovery

One of my favorite things about seeing pregnant patients is the opportunity to start the conversation about postpartum recovery before the baby arrives.

Many women spend their entire pregnancy preparing for birth but have little guidance about what happens to their bodies afterward.

Pelvic floor PT can help you understand:

• What to expect during the early postpartum period

• How to gradually return to exercise

• How to manage changes in bladder and bowel function

• How to recognize symptoms that deserve additional support

• How to rebuild strength and coordination over time

The earlier you understand your body and have a plan, the more prepared you may feel to navigate the changes ahead.

When Should You Start Pelvic Floor PT During Pregnancy?

There is no single “perfect” week to begin.

Some women benefit from an evaluation early in pregnancy, while others seek care when symptoms develop or as they prepare for birth.

You may consider pelvic floor PT if you are experiencing:

• Pelvic or low back pain

• Pain with walking, rolling in bed, or changing positions

• Urinary leakage

• Pelvic pressure or heaviness

• Pain with sexual activity

• Difficulty relaxing your pelvic floor

• Concerns about birth preparation

• Questions about exercise during pregnancy

Even if you aren’t experiencing symptoms, a preventative evaluation can help you understand your body and identify strategies that may support you throughout pregnancy and postpartum. I love getting to do PT sessions before birth even if it's just once. It can be SO helpful!!

Always discuss new, severe, or concerning symptoms with your OB or midwife. Pelvic floor PT complements your prenatal medical care; it doesn’t replace it.

What Makes My Approach to Pelvic Floor PT Different?

I believe you deserve care that is individualized, unrushed, and centered around you. In my practice, I don’t believe in handing every pregnant woman the same exercise sheet and sending her on her way.

Your body, your pregnancy, your symptoms, and your goals are unique. Your treatment should reflect that. Because I run my practice a little differently I have the flexibility to focus on your individual concerns and spend time getting to know the whole picture—not just a diagnosis or a checklist of symptoms.

You Don’t Have to Wait Until Something Is Wrong

Pregnancy comes with enough uncertainty. You shouldn’t have to wonder whether pelvic pain, leakage, or discomfort is something you just have to push through.

Pelvic floor physical therapy can be a valuable part of your pregnancy journey, helping you prepare for birth, manage symptoms, and build a foundation for postpartum recovery.

You deserve to feel supported throughout every stage of pregnancy—not just after your baby arrives.

If you’re pregnant and wondering whether pelvic floor PT could be helpful for you, I’d love to help you explore your options!

What to expect on your first day at Pelvic PT

 

What to Expect on Your First Day of Pelvic Physical Therapy

I hear from a lot of friends and patients that they have no clue what Pelvic PT entails. It's a big barrier to people getting the help they need when they are scared to even try it. Here's an idea of what to expect when you walk into my clinic. 

First, We Talk

We sit down and have a chat about your symptoms, your medical history, and how your concerns are affecting your everyday life. We talk about your goals, your worries, your life, your schedule, your body... all the things. 

Depending on what's going on I'll ask you about:

• Pelvic or abdominal pain
• Urinary frequency, urgency, or leakage
• Constipation or bowel symptoms
• Pain with intimacy
• Pregnancy or postpartum recovery
• Menstrual or pelvic symptoms
• Hip, back, or tailbone pain
• Pelvic pressure or heaviness
• Previous surgeries, injuries, or treatments

Some of these questions can feel personal. That’s completely normal. 

You don’t have to feel embarrassed. Pelvic health is a physical-health issue, and these questions help your therapist understand the bigger picture. It's always up to you about how much you want to tell me, especially on day one!

The Assessment

After talking through your concerns, I will do a PT exam. 

This can include looking at your posture, breathing, movement, hips, abdomen, back, or other areas that may be contributing to your symptoms. This all starts with external things! An internal exam is not automatically required. If your therapist makes you feel like you HAVE to have this done, find a new therapist. Your therapist should explain why they recommend it, what it involves, and what you can expect before doing anything.

You have the right to ask questions, pause, or say no.

Your comfort and consent matter throughout the appointment. I ask permission MULTIPLE times. 

What About the Pelvic Floor Exam?

If an internal examination is appropriate for you and you agree to it, we talk through it beforehand. The goals of an internal exam are to assess things like muscle coordination, tension, strength, relaxation, tenderness, or how the pelvic floor muscles respond to movement and pressure.

And here's something important:

Pelvic PT isn't just about doing more Kegels.

For some people, the pelvic floor muscles may actually be too tense or have difficulty relaxing. In those cases, learning how to release and coordinate the muscles may be more important than strengthening them.

Treatment

My goal is always to have to you leave feeling better than when you walked in. My initial sessions are 1.5 hours so we have all the time to get to know each other, figure out what's going on, and give me time to start your treatment! 

Treatment could include:

• Manual therapy like soft tissue mobilization
• Cupping
• Graston
• Dry Needling
• Visceral mobilization
• Education on anatomy and function
• Movement and exercise

You’ll Leave With a Plan

By the end of your first appointment, I will know what direction to move toward. 

You might be given a few simple things to work on at home, such as:

• Breathing exercises
• Relaxation techniques
• Mobility exercises
• Posture or movement changes
• Bladder or bowel habits to track
• Pelvic floor coordination exercises
• Gentle strengthening

I see a lot of busy moms in my practice so I'm not one to send my patients home with a million exercises. Instead I try and carefully choose a few that would be the MOST beneficial for the time you have in your life. I work your routine into our plan, discuss how to make your gym time more efficient, and talk about what to be working on in your day to day. 

Your first visit is often about establishing a baseline and creating a treatment plan that makes sense for your body and your goals.

What Should You Wear?

Wear something comfortable that allows you to move easily.

You generally don't need to dress differently just because you're going to pelvic PT. If a pelvic exam is something we do I'll provide you with a sheet (NOT a piece of paper) to cover up with!

A Few Things You Can Do Before Your Appointment

It can help to think about what you want to get out of pelvic PT.

Before you go, consider:

What symptoms are bothering me the most?

When did they start?

What makes them better or worse?

What activities am I avoiding because of them?

What would I love to be able to do without worrying about my symptoms?

Writing down a few notes can make the conversation easier—especially if you're nervous or tend to forget things when you're in an appointment.

Most Importantly: You’re in Control

You can ask questions.

You can request an explanation.

You can tell me if something hurts.

You can ask to stop.

And you can say no to an examination or technique.

A good pelvic physical therapist will work with you, not just on you.

So if you're walking into your first appointment feeling nervous, take a breath. You don't need to know anything about pelvic PT beforehand.

Your job is simply to show up, share what you're experiencing, and start the conversation. You won't be sorry!! 

Check out what all the buzz is about! 

https://www.fayettevillepelvichealth.com/appointments/

The dreaded Postpartum Poop

                                                 

The First Poop. 

We all know what I'm talking about right? That first poop after you give birth. It's terrifying. It's horrifying. It makes you sweaty with fear and dread that you are going to poop out your insides or rip open every stitch they just put in you. Or was this just me??

Maybe that was a little too much information for you but I'm just being honest. I'm pretty sure I was more traumatized by the idea of pooping after I delivered my first baby than I was from the actual delivery. I was so scared, in fact, that I had the nurse come in multiple times and talk me off the ledge over it. She didn't actually come into the bathroom with me while I did it or anything, but she had to give me some pep talks. And all the stool softener.

Reality was not as scary as my imagination. I took the stool softeners they gave me and tried to go as soon as I had the urge. I think I was still taking Tylenol so it didn't hurt that much, but the anticipation was rough.

Had I been a practicing Pelvic Health PT back in the day, I would have been on my game and been psyched about my first poop. However, I knew nothing. If you aren't sure what exactly that is, click here for more info.

My friend and I are both really into pelvic health and
have taught some fun yoga workshops about digestive health.
We are also very good at pooping now. Just saying. 

Here's what pooping should be like:

• No pain with pooping
• Soft but fully formed easy to pass stool
• No straining or "bracing" needed
• Pooping between 3 times a day to 3 times a week (basically enough so that you don't feel icky in your belly but not so much that it's consuming your day)

Here are some tips on how to make that first poop less scary for you than it was for me: 

1. Stay hydrated: Stay on top of your water intake (you'll be doing that anyway if you choose to breastfeed). Hydration is key to helping your poops move properly and be solid. Soft but solid is ideal!!
2. Take the stool softeners: If you are able, take the pills y'all. It helps soften your stool to make it easier to pass and therefore less painful. 
3. Practice your breathing: If you follow me at all on Facebook or Instagram you'll know I'm big on breathing. Breathing deeply using your diaphragm is key to pelvic floor health. Breathing in the bed after you deliver will help relax your nervous system. This will then relax your muscles. Your pelvic floor is made of muscles. See how it works? So breathe. In the bed, while sitting up on the edge of the bed, and especially while on the toilet. Just slow down, close your eyes, and take some good belly breaths to relax the pelvic floor.
4. Exhale, huff, blow out the candles: If you're confused, let me put it this way - don't strain! Straining on the toilet can make things like prolapse, diastasis recti (abdominal separation), pain, or swelling worse. You can avoid this by making sure you are breathing instead of holding your breath on the toilet. Imagine blowing out candles across the hospital room or make "huff" sounds with your mouth. That will help increase the pressure in your belly while also avoiding the strain.
5. Use a trashcan: Again, that sounds confusing. Have you heard of the squatty potty? Well, most hospitals don't have one in the room which means you have to get creative. Take the trashcan in the bathroom and turn it on its side, then put your feet on top of it. You've just made a squatty potty for free!
   
   There is science behind this. In a nutshell, it helps relax your pelvic floor muscles so your rectum is nice and straight. Stool can just head straight on out this way instead of having to move around a curve. It's much easier. Trust me. Here's a video if you want a visual. Don't worry I'm not actually pooping in the video I swear. 
6. Go when you feel it: When you feel the urge, go. Don't hold your poop. I know how it is with a newborn, I do, but holding your poop only confuses your sphincters and your brain and it makes it harder to go the next time. Plus, the longer it sits in there the more water gets absorbed and the harder your stool gets. Not ideal. Often you'll be most likely to poop after your first meal of the day so have breakfast, a glass of lemon water, and then try and poop!

Every body is different. As in, your body is different from my body and my body is different from my BFF's body. Every birth is different. Every postpartum experience is different. I know these tips won't work for everyone. Then again, not everyone is terrified of the first poop. But if you are, be mindful of these things to minimize discomfort. Better yet, see a Pelvic PT before you give birth. And then after you give birth. Go here to find one near you or come check out my website here for more information about Pelvic Health in Fayetteville, NC! 

Lacy Kells PT, DPT  

Owner of Fayetteville Pelvic Health & Wellness

http://www.fayettevillepelvichealth.com

lacykells@fayettevillepelvichealth.comFollow me on Facebook: Lacy Kells PT, DPT orInstagram @lacykellspt and on YouTube at Fayetteville Pelvic Health

Maternity Leave in Real Life

This blog is a guest post that I got permission to adapt from Instagram. My best friend Ashley is currently on maternity leave with her second son and shared some thoughts as she is home working hard to keep baby boy happy and healthy. I love her real talk and her thoughts as processes going back to work. Enjoy! 

Maternity Leave. What does it look like? Is it a vacation? 

It’s such a weird thing, you go to school working toward a career for so many years, you bust your butt to grow within that career and then before you know it it's time to expand your family. As a mom, a lot of that initial change falls to you. When you find out you’re pregnant, everything changes.

You may not be telling people about the pregnancy yet, but it’s consuming all of your thoughts and plans. You wonder how this will change your family, yourself, your career progression. It’s a bittersweet source of anxiety at first.  Then you share your news, and somehow anything that happens in your career has a filter over it. Is this because I’m pregnant? Will my coworkers be mad at me for not pulling my weight? Will I lose out on opportunities because I chose to have a family??

Then you have the baby and it’s time for maternity leave. It’s a weird place to be, having worked so many years to be able to work every day in your field. Now you are at home, focused 24/7 on this tiny little person that has turned your life upside down. In so many ways it is SO. MUCH. HARDER. than daily work and in other ways it feels like you haven’t (can’t—sleep deprivation is real) use your brain anymore. 

We all know that maternity leave here in the US is pretty dreadful, I’m lucky that I can chose to take 3 months off, albeit unpaid. For me, I got only a super small percentage of my pay by filing short term disability (though can we all agree that having a baby is not a disability?!!?)

Lately,I’ve been thinking about this transition into motherhood. It’s so different the second time around. I love the newborn phase. Yes, it’s hard as hell. I’m tired, like super tired. And yet, my main responsibility and to-do list everyday is to take care of me and to take care of the baby. I can shift all my resources and energy to those goals.

I think the hardest part about motherhood for me was with my transition back to work. If I’m doing something, I’m going at it 100%, so with my return to work I didn’t want to halfway do it. I wanted to be just as on top of it as I was pre babies. And now I have this new focus of being a great mom whenever I’m home, which is hard when you are awake every 45 minutes the night before (yup, that's what my firstborn did for a while when I first went back to work). Nighttimes get more stressful because I’m always thinking about how it’s going to affect my performance at work the next day.  I’m short with my kid and my husband because of this stress and because I’m just. so. tired. By the end of the week I remember laying on my kitchen floor, staring at the ceiling too tired to make dinner, yet arguing with my husband because I didn’t want to order food in (it would mess up the budget (#realtalk here)).

What about you guys? What was easier for you? The early newborn days or later in the game when life got busier (like the return to work or other obligations??)

#momlife #realtalk #fourthtrimester #newborn #womeninhealthcare #momsinhealthcare #workingmom #sleeptraining #sleepdeprivation

Dr. Ashley Chandler is a Physical Therapist currently on maternity leave after the birth of her second son. She is a Certified Oncology Specialist and Certified Manual Therapist who is passionate about Oncology rehab and Lymphedema management. She is a wife and a mom to two awesome boys and a very fluffy Golden Doodle. Find her on Instagram @ashleychandleryoga or on Facebook at Ashley Chandler PT, DPT, CLT

I am a Lacy Kells, a Pelvic Health Physical Therapist with a passion for informing women (and men) on the completely amazing subject of Pelvic Health.

Owner, Fayetteville Pelvic Health and Wellness

http://www.fayettevillepelvichealth.com
lacykells@fayettevillepelvichealth.com

Follow me on Facebook: Lacy Kells PT, DPT or Instagram @lacykellspt and on YouTube  at Fayetteville Pelvic Health and Wellness. 

Exhale on the Effort! Why?? Watch to find out.

I often see women who are very active but are dealing with some pelvic floor issues despite feeling pretty strong. Very often, they are exercising regularly, lifting weights, doing things that they feel like should keep them from having pelvic floor issues yet they find themselves in the clinic for help.

Well, here's the thing. We can be strong and powerful yet still be compensating with our movements in a way that causes some dysfunction. Often, it's about pressure management through our core. Breathing properly can be such a big help in managing pressures through our abdomen so that we can prevent things like prolapse or leaking! While it's always more complicated that simply exhaling, sometimes it can be a good first step in getting yourself on track to stop leaking or prevent prolapse or worsening of your diastasis! I hope this video helps you get started and as always, find a pelvic PT asap to take a look and get you on track!




Lacy Kells PT, DPT
http://www.fayettevillepelvichealth.com


Owner of Fayetteville Pelvic Health & Wellness
lacykells@fayettevillepelvichealth.com

Follow me on Facebook: Lacy Kells PT, DPT or
Instagram @lacykellspt and on YouTube