C-Section Scars: How They Cause Lower Back Pain

Authored by the Bodyful PT Team

• Are you experiencing back pain after C section?

• Do you have a “bad back after C section?”

• Do you experience burning pain during sex after C section?

At Bodyful PT and Wellness, we specialize in caring for you after a cesarean delivery.

What is a cesarean section?

Caesarean section is a surgical intervention for delivering the baby through the abdomen by cutting into the uterus. Like any surgical intervention, you may experience complications such as pain in the short or long term. Long term causes may be due to limited mobility of the scar, lumbar and pelvic pain, and intestinal obstruction and ectopic pregnancies.

Studies show physical therapy interventions for a determined duration and frequency, can improve function. Clients have shown improvements in pain, activities of daily living, comfort level, joint ranges and reduction in the use of pain medications.

Do you experience a “bad back” after C section?

In a RCT study published in 2021, they concluded that “Supervised core stability exercise program was more effective in reducing pain and disability, and improved core muscle activation than unsupervised, home-based core exercise program” for patients with low back pain after cesarean section.

Supervised core stability exercise can be explored with Telehealth services or in person physical therapy services. It can also include one-to-one private Pilates Reformer sessions or somatic wellness.

Low back pain is a very common complaint during and after pregnancy and after a cesarean delivery. There are many reasons this pain can exist and one source can come from scar tissue in the abdomen.

What is scar tissue?

Scar tissue lays down differently compared to the original tissue. It often expresses less mobility overall and therefore less blood flow. Mobility and movement in our connective tissue is key to having easeful and joyous experiences in our body. 

When scar tissue mobility is not cared for, some of the important areas that support the low back and pelvic joints may be affected.

Also, scar tissue in the abdomen also affects the internal organs and their fascial structure. Many internal organs, including the uterus, lay in front of the SIJ. When these organs lose their full range of motion due to scar tissue, they can pull on the sacrum and sensitize the joint further. At Bodyful, we are trained in visceral fascial mobilization techniques that can care for this type of scar tissue and guide your ability to move it.

Treating scar tissue does not mean we are “breaking up adhesions” or “making the scar tissue go away”. Rather, it means we are working with the fascia around the scar tissue and how the nervous system has developed holding patterns around it. At Bodyful, we are working with your body to introduce new possibilities of movement and blood flow through slow and targeted hands on work in addition to individualized movement that reinforces these new possibilities.

The abdominal muscles are traumatized after a cesarean delivery. With a C-section, all of the abdominal muscles are cut through, including the very important deep abdominal muscle called the transverse abdominus (TA).

When the TA is cut through, it can be vulnerable to a change in the mind-body relationship, thus activation and coordination for the abdominal support can be altered. This core support is needed for the lumbar and lumbosacral joints to function with ease.

Scar tissue mobility work and proper coordination training can help with total body integration, postural support, and core strength.

The respiratory diaphragm is another important muscle that contributes to core coordination. When there is scar tissue in the abdominal wall, the diaphragm can experience movement restrictions as well. Restricted movement of the diaphragm has been linked to low back pain and SIJ pain, so addressing these deficits can be vital in comprehensive treatment plans.

Do you experience burning pain with sex after C section?

Another important aspect of our core system is the pelvic floor muscles. The TA and the pelvic floor work together for optimal core coordination and so when the TA is affected, we usually see the pelvic floor function non-optimally as well. This can explain why folks with c-section scars still demonstrate signs of pelvic floor dysfunction including urinary incontinence and pain with penetration.

After a trauma such as a cesarean delivery, the pelvic floor muscles may heal into a tension pattern. When muscles are often tense, they get tight and painful. Imagine if your fist was always clenched — it would probably hurt to open your hand fully after days, weeks, months, or years of tension.

During penetrative sex, the pelvic floor muscles are being asked to relax and stretch. Pain during sex after a C section is not uncommon.

There are also nerves that travel to the pelvis, and these nerves may heal with increased sensitivity after a cesarean delivery.

The commonly affected nerves are the iliohypogastric, the ilioinguinal, and the genitofemoral nerves.

The iliohypogastric nerve runs from the upper lumbar spine, to the top and front of the pelvic bones to the lower abdomen. In its course, it travels in front of the quadratus lumborum muscle and behind the kidneys. It moves through the abdominal fascia, piercing through the TA muscle to tell your brain about what you are sensing from the skin of your upper gluteal muscles and pubic area.

The ilioinguinal nerve has a very similar pathway compared to the iliohypogastric, but it informs your brain of skin sensation from the groin area.

The genitofemoral nerve runs through the psoas major muscle, traverse the abdominal muscle fascia, to give your brain skin sensation information about your mons pubis, groin, and inner thigh (and scrotum for cis-men).

If any of these nerves are vulnerable and sensitive after a C section delivery, pelvic physical therapy can help to:

• improve blood flow to the nerves

• reduce muscle tension along the nerve pathways

• improve nerve mobility with prescribed nerve gliding exercises

• offer individualized guidance about how to gently return to activities, like sex, that may have provoked symptoms in the past.

If you are experiencing any of the unfortunate symptoms described in this blog, you are not alone and there are pelvic PT treatments that help many people like you. It typically takes about 2-3 months of PT care to experience a significant change in symptoms and to return to a joyful and easeful relationship to your pelvis.

Bodyful Physical Therapy and Wellness is a pelvic floor physical therapy private practice in the Bay Area, CA created by Dr. Karah Charette and Dr. Maryssa Steffen who are both pelvic pain specialists. 

Reach out here to book a free discovery call and learn more about what it would be like to work with one of us.