The Importance of Physical Therapy post Cesarean and Vaginal Birth

Not everyone gets Physical Therapy after a Cesarean or Vaginal birth but as a Physical Therapist Assistant and Licensed Massage Therapist I highly recommend it. If your doctor or midwife does not give you a prescription for Physical Therapy you can request it.

Even though your doctor or midwife clears you for exercise after 6 weeks, this means LIGHT exercise. You may have exercised throughout your whole pregnancy or may have been a marathon runner prior but things change during delivery. Your body has been through a lot and you need to ease back into it no matter what fitness level you were at prior to delivery. Too much too soon can lead to complications and injury. It’s best to seek a Physical Therapist for assistance to get things started again safely.

YOUR PELVIC FLOOR

Functions of the pelvic floor muscles:

• Support your organs (including the bladder) as well as your pelvis and spine. They act like a posture muscle working all day and night.

• Assist in the stopping and starting of the flow of urine and the passage of gas and stool.

• Help with your sexual response and orgasm.

• Provide stability to the spine and pelvis during movement.

Possible Postpartum Problems:

• A sense of heaviness or pressure in the vagina or rectum

• leakage of urine

• Difficulty holding back gas

• Pain with sex

Exercise and caring for your pelvic floor muscles:

You should begin exercising the pelvic floor muscles immediately after childbirth. Exercising can help you recover from your delivery now, and can help prevent problems from developing later in your life.

Finding your pelvic floor muscles:

Do’s:

• Squeeze and lift the muscles around the vagina and anus together, as if you are trying to hold in gas. Tighten the

muscles you would use to hold the gas in. no one should be able to tell you are doing this. Try to keep your buttocks

and thighs as relaxed as possible.

• Insert your finger into the vagina and squeeze.

• Test your urinary sphincter by trying to stop the flow of your urine mid-stream. Then let it go again. If you can not completely stop the stream, it means that your pelvic floor muscles are weak.

Don’ts:

• Avoid the above exercise when you have a full bladder.

• once you have control of these muscles, do not continue practicing while urinating. It could lead to urinary tract infections.

Light postpartum exercise:

• Squeeze and lift the pelvic floor muscles by squeezing the muscles that you use to hold in gas. Try to hold the contraction for a count of 5. Count out loud to make sure you don’t hold your breath. Then relax for at least 10 seconds. letting the muscles relax is very important.

• Try contracting your pelvic floor muscles as you begin to exhale, this may make it easier.

– Work up to 10 second holds and 10 contractions at a time. Repeat 5 to 6 sets of 10 holds a day. – You can do these lying on your back, sitting or standing.

• You should not feel the buttock or inner thigh muscles working too much when you exercise your pelvic floor.

• Practice doing a quick and strong squeeze before you sneeze, cough, laugh or lift your baby or heavy objects.

• A good way to remember to exercise is to do them every time you wash your hands, feed or change your baby.

YOUR ABDOMINALS

Abdominal strengthening:

Strengthening your abdominal muscles will not only help you lose your “pooch,” it will aid in getting stronger.

The abdominal muscles:

• Become stretched and/or weak during pregnancy.

• Aid in breathing, coughing, sneezing and bowel movements.

• Help prevent problems such as back pain, incontinence (can’t control your urine) and constipation.

General exercise guidelines:

Always remember:

• Quality is more important than quantity.

• It may be weeks before you see any change and several months before the muscles become short and strong.

• no sit-ups, curl-ups or crunches for at least 4 weeks, or at least 6 weeks if you had a Cesarean birth.

*Please refrain from all exercise until cleared by your doctor or midwife.

*Ask your physical therapist for more advanced exercises when you are ready.

Watch out for separation of abdominal muscles:

During pregnancy, the abdominal muscles can become stretched enough to result in separation. This separation is known in medical terms as diastasis recti. When the muscles are separated, they cannot work efficiently. This can contribute to low back and pelvic pain and a flabby appearance.

To check yourself for diastasis recti:

• lie on your back, place your fingers in the center of your belly just above the belly button.

• Slowly lift your head until your shoulder blades are off the bed while feeling how many fingers you can insert

between the belly muscles.

• If you have a separation of 2 or more fingers, ask your doctor if you would benefit from a referral to a physical

therapist or use of a belly binder for support.

Exercise Basics:

Pelvic Tilt or Tummy Tuck

Begin 1 week after delivery:

• Take a deep breath.

• As you exhale, pull your belly muscles inward as if you are trying to zip a pair of tight jeans.

• Hold this contraction for 3-5 seconds. Work up to holding this contraction for 1-2 minutes at a time.

• Don’t hold your breath or flatten your back.

• Practice holding this contraction for longer periods. Try holding it while washing dishes, driving the car or standing

in the grocery line.

Heel slides:

Begin 2 weeks after delivery.

• lie on the floor with your knees bent with both feet flat on the floor and pull your belly muscles inward. • Hold the belly contraction while slowly sliding one leg along the floor until the leg is straight.

• Slowly slide your leg back to the bent position.

• Keep your belly muscles pulled inward while your leg is moving and don’t let your back arch or move. • Relax and repeat with your other leg.

FOR MORE RECOMMENDED SAFE EXERCISES AND STRETCHES POST CESAREAN AND VAGINAL BIRTH PLEASE BE ADVISED BY YOUR LOCAL PHYSICAL THERAPIST.

CESAREAN SCAR MANAGEMENT

Scar management will improve the healing of a scar. It reduces infection, aids skin and tissue motion and stretches the fully healed scar tissue. Scar massage will actually reduce the amount of scar tissue.

Scar massage:

Scar massage should not be started until the incision is fully healed. This is usually 4 to 6 weeks post surgery. Check with your healthcare provider if you are not sure if your scar is fully healed. Massaging the incision area is important to prevent the scar tissue from attaching to the deeper muscle layers. Scar tissue can be quite deep, depending on the type of surgery. If a scar is thick and deep, it can limit movement and add to your pain.

The massage should be done 2 to 3 times a day for 5-10 minutes at a time to get the most benefit. The more the scar is massaged, the more pliable, soft, and thin it will become. The goal is to have a smooth, flat, and pain-free scar.

Management of the scar should continue until it is mature. This can take from 6 months to 2 years. A mature scar is usually a light pink or white color that is paler than normal skin color. Ask your pharmacist for products, such as lotions and gels, that help with scar healing. Talk to your healthcare provider about these options.

Self Scar Massage:

Warm your hands by rubbing them together. natural oils or warm compresses can be used, but are not necessary. • Massage the scar by working it with a rubbing motion along the line of the scar.

• Stroke back and forth across the scar.

• Roll the scar between your thumb and your forefinger.

• Pick up and lift the fully healed scar to prevent it from attaching.

Decreasing sensitivity at the surgical site:

Some women experience sensitive skin in the surgical area. After surgery, even clothing may be painful if it touches the incision. The nerves are sometimes overly sensitive. Try “desensitization” on a daily basis to decrease the pain and tenderness.

How to Desensitize Your Incision:

Massage or rub the area with a soft material such as a cotton ball. later try using a rougher material like a towel. Patting and tapping along the sensitive area is also used to desensitize.

• Massage the sensitive area of skin with hand lotion and rub in circles with gradually increasing pressure.

• Gently rub and tap the sensitive areas starting with soft materials and gradually work up to rougher materials. Some

materials to try are cotton balls, silk, cotton fabric, terry cloth (towel), paper towels, soft velcro and corduroy.

• Rub for 5-10 minutes, 3 times per day.

Pregnancy and childbirth can strain and sometimes injure these muscles. Any problems with pelvic floor and/or abdominal muscles should be resolved by 4 to 6 weeks postpartum. If you continue to have problems a er 6 weeks, you should let your health professional know.

Patient Education Information from: http://www.womenshealthapta.org

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