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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.

34 comments:

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

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  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

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  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.

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  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.

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    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!

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  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.

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  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.

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

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  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?

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  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.

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  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?

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  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.

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  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 ??

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  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.

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  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?

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  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

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  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?

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  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.

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

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

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  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

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  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. :(

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  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.

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

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  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.

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  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

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  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

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    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

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  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.

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  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?

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  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.

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  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.

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  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.

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  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!

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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

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