Featured Post

Wednesday Women's Health in the News: Most Frequently Asked Questions On MonaLisa Touch Vaginal Therapy

MonaLisa Touch: The Issue of Vaginal Symptoms Even with the passage of time, many women still retain their youthful energy and enthusi...

Menopause: Making Peace With Change

Monday, June 13, 2011

Abdominal Muscles Before and After A C-Section


Did you wonder what is going to happen to your abdominal muscles after you have a c-section? The abdominal muscles are separated to remove the baby at the time of a C-section. In some cases they are actually cut, but most often, the natural elongation of the rectus muscles (the long muscles running down either side of the midline of your abdomen) can be used to just cut their middle joining ligament and then spread apart to allow for room for the baby. This muscle's blood supple and some of the nerve supply is now divided from this technique. The muscle itself has blood supply and nerve supply per segments, so it's unlikely to ever damage the entire muscle's supply. However, the lack of blood and nerve function, even to a segment, can lead to poor healing of that section, sometimes a bit more pain, and occasionally less function that before (not as flat a tummy!). Any time a muscle has been cut, there is a chance of a hernia developing in the region after a surgery. In midline incisions (up and down, not the traditional pfannenstiel) with older studies they used to quote about a 7% chance of a hernia developing at some future date in that surgical incision. We know the hernia rates from pfannenstiel incisions are much less, but persistent pain, distended abdomens, and inability to strengthen those muscles might all be a sign of a small hernia even if one is not obvious. There are other important layers that have to heal as well, so this is not a complete discussion of the healing after a C-section. Most women who have had a C-section may have a stitch or two placed in their muscles to close the separation that was created when entering to get the baby delivered. These stitches are typically of a resorbable nature, some of delayed absorption. It would be rare for an obstetrician to have used permanent suture, but we are encountering more permanent suture in repairs done for tummy tucks. The absorption of the suture material occurs over time, the stitches for the ones usually used at C-section are weakened to about 50% of their strength at about 2 weeks, and it takes much longer to completely dissolve. So minor nerve entrapment around the muscle usually begins to  resolve as the sutures weaken, so at about 2 weeks, barring infection or any more dramatic swelling. So when we say “the muscles” as usual, we mean a whole lot more: the pregnancy, the surgery, the healing, the care we have taken of our bodies, and the shape we get into afterward. It’s a great subject to gab with your gyno about.

47 comments:

  1. Is there a way to workout the AB muscles back to pre-pregnancy strength/appearance or are they ruined permanently?

    ReplyDelete
  2. All muscles can be strengthened by 1)proper nutrition, 2)proper care and 3)exercise. After a pregnancy the muscles, like other parts of the body, will go through an involution process that occurs over 6 weeks. At that point your obstetrician/gynecologist can give you a consultation regarding the current shape your muscles are in, and what specifically needs to be done to enhance your abdominal musculature. There are some abdominal muscular conditions that cannot be exercised back into shape after a pregnancy, but most can be. We encourage consultation, www.womenshealthpractice.com

    ReplyDelete
  3. I have felt some spasms that are reminiscent of kicks in my lower abdomen. What would cause this? My daughter is almost 1 and I still feel these occasionally.

    ReplyDelete
  4. Phantom uterine pains and fetal movement pains are common in pregnancy. We have discussed this in the context of pseudocyesis (patients who believe they are pregnant when they are not, http://www.gynogab.com/2013/06/could-this-pregnancy-befake.html)but it occurs in many other situations as well. Women who have had to have hysterectomies at the time of childbirth report after pains, and many times women who have breastfed will report after pains long after breastfeeding has ended. It is possible to have actual muscle spasms, gas pains, or other gynecologic conditions that feel like movements, and those can be treated, so if the pains are bothersome do see a gynecologic provider.

    ReplyDelete
    Replies
    1. Thank you. I had a c section and was guessing these were some kind spasms due to the repairing and healing of the muscle. I would have though that repair was completed by now. It is so much like those first little kicks you feel when pregnant its a bit unnerving. But I know I am not. Again, thanks for your fast response!

      Delete
  5. Is it possible for spasms to be painless, like movement Kari described? I had my second section in June and about 3 weeks in if I used my abdominal muscles to get up, I felt like some by my groin sort if popped out painlessly. I also felt involuntary twitching from time to time in the same area. I keep thinking hernia but have never heard it described in this way. I know at the same time a ball near the area inside my body showed up that feels like scar tissue though I don't know that it's related. Anyone have any ideas? I'm afraid my ob won't have any idea with such a vague description. Thanks.

    ReplyDelete
  6. When women report groin strains, and difficulty with sitting after a c-section they need to see their obstetrician to determine the cause. It is going to be the examination and any additional tests that will determine the cause, and the obstetrician will not likely be making a diagnosis on the verbal description. C-sections can cause scar tissue, but the way they are performed the large uterus usually forms a natural barrier from the bowel and intra-abdominal adhesions are not very common even in women who have had multiple c-sections, although scarring around the bladder is common.

    ReplyDelete
  7. This comment has been removed by a blog administrator.

    ReplyDelete
  8. I had my c section almost 5 years ago and have been in the gym since but almost all of the time if I do abs in any form I will get abdominal cramps sometimes pretty severe. Is there anything I can do to eliminate these cramps so that I can get through my training sessions at the gym?

    ReplyDelete
    Replies
    1. Gradually work into it, when your body adjust do a little more. It took me sometime to be able to workout my abs. I'm just getting use to squats it has has been 3 years post for me

      Delete
  9. For women who specifically get cramping they think may be related to prior surgeries we suggest first a visit to your gynecologist to review exactly what symptoms and to check your abdominal muscles and the incision. Maneuvers can be done to see if abdominal work is exaggerating the midline split of the muscles or if you actually have a small hernia. Without an exam specific recommendations are difficult, but commonly scar tissue makes for less elasticity to the abdominal wall and slower and more directed stretching can help. We suggest yoga to determine what positions are tolerated better and to better direct the focus to strengthen so as to support weaker muscles.

    ReplyDelete
  10. I am two years out from my c-section and still get a spasm in the upper left just under my rib cage whenever doing abdominal exercises. It is so annoying. Do you recommend any specific exercises or stretches to help with this?

    ReplyDelete
  11. Exercise and strength can always help support back and abdominal muscles and make chronic aches and pains easier to deal with. To the extent that any pain with stretching is due to internal scaring, there is no credible medical evidence that this can be directly improved by exercise. Internal scaring around the bowel is managed by increasing the movement of stool through your intestinal track. Exercise does help your bowels move and thus those pains may be minimized.

    ReplyDelete
  12. It's been 8 weeks since I had a csection I'm sacared I'm might have an hernia because I feel some kicks in my lower abdomen close to where I have the csection cut ! How can I know if it is a hernia ??

    ReplyDelete
  13. Hernias are more likely if one has a bulge or what can feel like an indentation around an incision; but have to be diagnosed by your physician on exam. Sensations of soreness, burning, swelling, itching, and general feelings of irritation can be very common for many weeks after surgery without anything being specifically wrong. See your physician for evaluation of hernia or other issues.

    ReplyDelete
  14. After a burst ovarian cyst, and hemorrhaging out, my midsection was cut vertically and horizontally to remove the ovary and explore for other damage after fainting. Subsequently, due to the disfigurement, I had scar revision surgery, also called a mini tuck. The ab muscles spasms, the sutures tore out, were redone, and then the area hemorrhaged. Since then I have been plagued with the tightness and pulling, and occasional small bowel blockages. It is over 10 years passed, a multitude of PT, and stretching, and currently having a neuromuscular massage therapist release the adhesions. I had norovirus week ago, bad enough to visit the ER, and the area has twitched since then. It is very uncomfortable, and is creating a nauseous feeling. Any suggestions? I now have bound the area using a back brace. Do I do nothing or have it worked on?

    ReplyDelete
  15. Scaring and tugging that is due to external scars are more easily treated than internal adhesions. Both can occur together or separately. Successful treatment depends upon the extent and nature of the scaring. For external scaring the extent and nature has to be determined by clinical examination. Laser therapies, injection therapies, radiofrequency therapies and heat treatments are all possible solutions for both pain and disfigurement. www.womenshealthpractice.com

    ReplyDelete
  16. Does muscle pain by my pelvic area get worse before it gets better. My baby is one month old and in the last 2 days my muscle pain feels like the day I had her...should I be concerned or because this was major surgery and I can't always take it easy as some do who don't have a newborn, it just takes longer?

    ReplyDelete
  17. For those healing after delivery rest, nutrition, appropriate exercise, and healthy lifestyle (no smoking) typically find that muscle pains in the pelvis or abdomen improve. Lifting too much, lifting improperly, coupled with other factors noted above can make you get more sore before you finally heal. Only an examination can tell if there has been appropriate healing after surgery or delivery. Some women will need nutritional supplements to help heal their muscles.

    ReplyDelete
  18. Hi what can cause the insison line to re-open after 3 years?

    ReplyDelete
  19. Hi what can cause the insison line to re-open after 3 years?

    ReplyDelete
  20. Localized disruptions of incisions, whether soon or in the distant future after a surgery can be caused by a variety of skin and abdominal layer issues. There are hernias, infections, pockets of endometriosis, localized rashes, allergies to materials in the incisions as well as many other causes. It is important to have ongoing medical care to do your pest to insure that one doesn't have medical conditions that are treatable. In some cases it's just a mater of maintaining cosmetic results. www.womenshealthpractice.com

    ReplyDelete
  21. Hi I'm 5 weeks pp and Everytime I wake up for
    Feedings or in the morning I feel this uncontrollable urge to stretch my abdomen, legs, and back after I stretch slowly I feel pulling and like something moving underneath my incision. It doesn't hurt but it's really unconftarble is this normal? it's my 3rd c section and didn't have this before. :(

    ReplyDelete
  22. Incision closure after surgery can cause a variety of transient conditions including collections of fluid, entrapping a nerve, or a small amount of inflammation. And all these can create a tugging sensation. In most cases it's a matter of sensations that will resolve, but be sure to mention the symptoms to your surgeon at your check up.

    ReplyDelete
  23. Love the way you respond aptly. Kudos to you. How soon can I wear a pant-girdle after a cs?

    ReplyDelete
  24. After surgery restrictive garments that are not too tight are usually permissible. Wound pain, drainage, redness or other questions of infection or healing must be referred to the gynecologic surgeon who performed your surgery.

    ReplyDelete
  25. Hi, it has been over 8 months since I had my 3rd c section and ever since the surgery I can't move my arm above my head without feeling tired and with trouble breathing, I can't lift weight without feeling tired or my hand is giving out and I have a sharp pain across my left rib cage when I get up or cough......etc. I didn't have any issues with my first two surgery, can you advice

    ReplyDelete
  26. For women who after a c-section have either upper abdominal symptoms or upper body concerns like arm pain it's not very likely that the c-section itself would cause these. Taking care of a baby, alternations in diet causing abdominal distress. Trouble breathing that occurs many months post surgery, again, would not be an expected outcome. We offer primary care consultation and can see women with similar complaints. www.womenshealthpractice.com

    ReplyDelete
    Replies
    1. Thanks for the reply, I been having breathing and arm pain since discharge with baby and it's been 8 months and still having the issues and doctors are puzzled. Advice if possible

      Delete
  27. I have had 2 c sections about 6 months after last c section (which was a 10 pound baby so it was a lot of strain on my stomach) I started getting pains on the right side of my scar and goes up my side about 6 inches. This pain has started like clock work every month for the last 2 years. It starts 4 days after I start my period and last for 10 to 15 days. The pain feel like a bad sunburn that is being sawed on and it comes and goes in those 10 to 15 and then on the last day it quits and does not come back again until I start my next period. I have sen my gyno and she found a small cyst on my that ovary and changed my Birth Control and the cyst went away but the pain never did (the pain feel more like tendons or muscle)I have a pap every year and they come back normal. Since changing my birth control I am having extremely light periods (hardly bleed at all mainly just small clots of dark blood, which I have always had clotty periods). Sorry for the life story but I am ready to be rid of this pain and feel like I am getting no answers.

    ReplyDelete
  28. hi there, hope you can help,9 weeks ago I was 34weeks pregnant when they discovered i had placenta acreta.Due to this i hadvto stay in hospital and bd monitored before surgery. i had to stay awake for the firstbpart of surgery which was fitting balloons into my groin to reach pelvis, incase of a bleed out. I was then put under general anaesthetic for the surgeon to carry out an abdominal c section, which then followed by hysterectomy,This is caused when my placenta had stuck to my previous c-section burying itself into my womb. I lost 5litres of blood when I had to receive a full blood transfusion. Surgeons saved or lives.My soon was born 4lbs5oz and he is perfect.
    Can any of you advise me when I can exercise? And what kind of exercises we ok to do?

    ReplyDelete
  29. I had my 3Rd C-section more than 5 months ago. My incision area has healed without any pain. But I have a small swollen node in my stomach just close to my nerve. I had first noticed it immediately after my surgery before I was discharged from the hospital I called the attention of my Dr to it send he said is muscle that I just had surgery that it will ease out after some time. Then it was very painful after some time the pain stopped just about the time the pain on my abdomen stopped. But the swollen is still there. Now is more than 5months and the swollen is still there and sometimes very painful that I can even touch it. Pls what might be the cause of this swollen as my Dr says is muscle. Thank you.

    ReplyDelete
  30. Typically pain and swelling from a well healed C-section resolves after 6-8 weeks. The detection of a swollen node after abdominal surgery could mean an infection, a collection of fluid, or a hernia. Pain after a surgery needs to be evaluated by a physician and this should not be delayed.

    ReplyDelete
  31. Only the direct health care provider can release a woman back to routine care and activity after a delivery, a c-section, or after any medical condition. The patients who lose the most blood are the slowest to recover. Acute blood loss can have other medical consequences, and may need an endocrinology evaluation.

    ReplyDelete
  32. I feel that my surgeon saved my life too! I was 39 weeks with a 10lb breech baby and they found my placenta percreda (placenta through all layers of uterus). My doctor did an emergency hysterectomy while I was awake. I'm thankful to be alive. I was weak and bloated for a long time after, and still 18mos later have a distended belly. I've been doing pelvic tilts to heal the abdominal diastasis. I hope you are doing great!

    ReplyDelete
  33. Hi, my twins are 13 months now and I delivered through C-section. I randomly have this pulling sensation to the right of my belly button and downwards in a diagonal towards my vaginal area every so often for the past several months. This past week it has been pretty constant and I also just found out I have an umbilical hernia and rectus diastasis of about 2-3 cm. What could this pulling, sometimes moving hot liquid like feeling sensation be?

    ReplyDelete
  34. Patients who have been diagnosed with a hernia and/or a rectus diastasis should consult their provider and have and examination to help determine if their odd sensations are due to these conditions. Since bowel moves, movement against the hernia or muscle split can be described in the way you are describing your sensations.

    ReplyDelete
  35. Hello!!! I am a 32 Y/O female, who has had a ruptured ectopic pregnancy back on Mother's Day... more than a year ago. I had been bleeding internally for days, while giving myself blood thinning injections in the stomach. I was hospitalized over night being told my pregnancy was still healthy, until they found blood in my Chest CT pushing my diaphragm up. Because of the urgency, I underwent emergency cesarean section and had my right Fallopian tube removed as well as the ectopic pregnancy.
    It has been a long time since this surgery, and I am still having Major stomach discomfort! I have tried PT, colonoscopies, endoscopy, and all imaging options to search for a hernia, etc. nothing was found aside for a very tiny umbilical hernia.
    I am a very healthy person. I goto the gym and I juice an assortment of fruits and vegetables daily! My work outs are a 30 minute cardio, and hour of weight training, and then a hot tub or sweat room for 15. This routine has helped with my pain, although I am having major bloating/digestion issues! I can NOT eat pasta, nuts, or anything bulky. I go days with out being able to have a BM, and my lower right quadrant has a string of palpable masses that are painful to touch. They have been ruled out for being a hernia....! I can only feel them when I flex my muscles.
    My PT, when asked me to stand and flex to find this lump with my shirt raised, looked at my structure and immediately asked if I have scoliosis, becaue of how high my right hip is compared to my left- after measuring both legs, she determined that my muscles are compensating for pain enough that I am unbalanced.
    I also can not get any tone of muscle back above my incision or below my belly button after months of working out!! :(
    I get most pain to touch when my stomach is tapped- like for instance with a lanyard hanging on my neck and dangling keys- if they hit my stomach it is very painful!!

    Could I have damaged nerves??? That aid in digestion???? This is one doctors idea-

    I appreciate ANY help anyone could give me!!! Thank you very much!!!

    Jennifer

    ReplyDelete
  36. I just had a c section with my first baby 3 weeks ago. My inscision has been healing well but I'm having other strange symptoms the OB had never heard of. When I sleep at night and wake in the morning my legs feel like they are paralyzed when I try to get out of bed. It takes forever to get my legs moving (not a tingly asleep feeling, they feel heavy and hard to move) to run and pick up my baby but they
    eventually do and during the day when I'm sitting or waking they are fine. Along with that when I try to move my legs I get muscle spasms all over me abdominal sometime taking over my back to from halfway down also shooting down my legs. I saw the primary care doctor who referred me to a neurologists and waiting for approval from insurance on an approach 20 days from now. Help! This scares me that it might worse and I'm really paralyzed. The muscles don't hurt but cramp up so suddenly and strongly I feel like they are going to break open my inscision.

    ReplyDelete
  37. Chronic pelvic pain can be due to a wide range of conditions, I would suggest seeking the advice of a gynecologic chronic pain specialist or pelvic floor specialist. In the US the pelvic floor specialists this is usually a urogynecologist. First would be to get a diagnosis, then suggest therapy.

    ReplyDelete
  38. Hi
    I had my c section 8 years ago.
    I get frequent switching on the scar exactly like when you get a twitch in your eye.
    Me and my daughter sit here and watch it you can physically see the scar moving and twitching.
    it's quite uncomfortable and very annoying and can go on for days sometimes.
    Any ideas?

    ReplyDelete
  39. In 2011 my daughter kicked me in my right ribs while in the womb-I had a bruise and my ribs look buckled-I ended up being induced an then having an emergency csection 12 days early due to cellulitis in my leg-I hemmoraged after having my daughter. Months later I started having a catching feeling when I bent down or if I am in awkward position-feels like my diaphragm is coming up through my esophagus and when it releases it feels like a balloon letting air out-I Had my gallbladder checked and it was non functioning so they took it out in 2014 thinking this was the problem-not- I still have the same problem and it is getting worse Last night I went to the ER I was laying on the bed talking to my daughter and it catched it usually stops after I stand and move around but it lasted longer and happened 6 more times-my ribs are sore now-they did another ct and found nothing- said if it is scar tissue or muscles they wouldn't be able to see it but to follow up w my primary Dr. Help-is scar tissue under my ribs from having a csection or is it from her kicking me-or hemorrhaging or something else-

    ReplyDelete
  40. I had a c section 5 days ago. Three days ago, I started having a burning/pulling sensation about an inch and a half or so below my incision on the left side. I only have pain when walking, not sitting/laying down. My actual incision looks good and I've had minimal pain (so far). The burning/pulling sensation is limiting my mobility and I fear it will never go away.

    ReplyDelete
  41. I had a c section 5 days ago. Three days ago, I started having a burning/pulling sensation about an inch and a half or so below my incision on the left side. I only have pain when walking, not sitting/laying down. My actual incision looks good and I've had minimal pain (so far). The burning/pulling sensation is limiting my mobility and I fear it will never go away.

    ReplyDelete
  42. I had a c-section 14 years ago. Since then I've worked out with yoga, Pilates & crossfit. My stomach has never been the same but neither has my back. I have constant back issues and I'm wondering if it's because my abdominal muscles were never repaired after the c-section. Could it be that Since the abdominal muscles can't fully engage the muscles in my back are trying to compensate and therefor giving me back pain?

    ReplyDelete
  43. I am 42 and i had a c-section about 9 years ago, i have been doing an exercise programme for 4 months now which consists of cardio, pilates, plyo, abs,lower and upper exercises. There are weights and resistance bands involved in the programme.This week i have noticed a swelling just above my incision scar and it feels slightly sensative and painful to the touch.I dont feel the pain during or after the exercises there just when i touch that area, is this normal or should i be concerned. Where i had the incision the scar has always sort of had the numb sensation feel when i run my finger along it.I had no complications with my c-section my stiches were the type that dissolve and i healed very well no real pain, infact i was going up and down stairs at home three days later without discomfort as such.

    ReplyDelete
  44. I have pain in abdominal muscles sometimes.Is there any way to get relief from this pain? Can you suggest some exercise or anything else for this pain?
    back spasms in the middle back

    ReplyDelete

Thank you for your comments and questions. This blog is not intended to replace medical care, but is informational only. We hope you will become a follower or visit Womens Health Practice. We offer a variety of unique services including MonaLisa Touch, Coolsculpting, Labiaplasty, and Gynecoloigic Clinical Research Trials. For more information on menopause see http://www.amazon.com/Menopause-Make-Peace-Change

Follow on Twitter

Follow GynoGab on Twitter

Vaginal Contraceptive Ring

If you are a female between the ages of 18 and 35 you may be eligible for a contraceptive ring investigational contraceptive medication study. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

There was an error in this gadget

Gab ON!

Ciao, from Gyno Gab Gal! Send me questions and thoughts and let me know what is important to you! Hope to hear from you often.

Join one of our studies, become a patient at Women's Health Practice, come for an event, or visit any one of my websites our FB https://www.facebook.com/pages/Womens-Health-Practice/149858581724556?ref=hl

Women's Health Practice
Hada Cosmetic Medicine

Follow Women's Health Practice and Hada Cosmetic Medicine on Facebook https://www.facebook.com/pages/Hada-Cosmetic-Medicine/68631517372?fre!

Follow GynoGab on Twitter!

Adult Vaccination Recommendations