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These exercises and techniques are to help you get comfortable and recover after your caesarean section.
If you are given this leaflet before your surgery, practice the exercises so that you are familiar with them.
Breathing Exercises, in sitting or lying
Bend your knees up a little if you are lying down. Take a deep breath in through your nose, hold for 2 seconds, then sigh out. Be aware of your lower ribs expanding as you breathe in. Repeat 3 – 4 times.
You may produce phlegm which needs clearing, particularly if you smoke. Support your stitches with your hands or a rolled up towel, take a deep breath, then ‘huff’ – a hard, forceful breath out.
Follow this with a cough. You will not harm your stitches by coughing, and discomfort is reduced if you support your stitches.
While you are not walking about it is important to maintain blood flow in your legs to prevent a clot forming. Bend your feet up and down from the ankle briskly 15 times. You can also circle
Circulation and breathing exercises should be done every hour.
Turning over and getting out of bed
Before moving, bend your knees up and draw in the lower part of your tummy a small amount to ‘brace’ it. Reach your arm over in the direction you want to go, at the same time roll your knees over.
To get out of bed, drop your legs over the side and push yourself up in to sitting.
Standing up – put your hands on the side of the bed, draw in your lower tummy muscles, lean forward and push yourself up into standing. Remember to ‘stand tall’ when you walk.
Going to the toilet
You will have a catheter at first to drain your bladder. Sometimes the normal bladder sensations take a little while to return to normal after it is removed. After the catheter is removed, don’t leave it longer than 3 hours before you try to pass urine – it is important that your bladder doesn’t overfill. Take your time, to make sure that your bladder is completely empty. Tell your midwife if you are unable to pass urine.
Pelvic Floor exercises
Even though you have not had a vaginal delivery, your pelvic floor muscles have been supporting the weight of your baby throughout your pregnancy, so you need to exercise them to help recover their strength. The pelvic floor is a group of muscles like a hammock at the base of the pelvis. It has three openings – the urethra (the bladder outlet), the vagina (birth canal) and the anus (back passage). It supports the pelvic organs and helps control the bladder and bowels.
When your catheter has been removed, you can start these exercises
Sit comfortably or lie on your side. Imagine that you are trying to stop yourself passing urine and ‘wind’, by ‘squeezing and lifting’ the openings of the bladder and bowels, then let go. Start gently at first. ‘Squeeze and lift’ and try to hold for a few seconds (breathe normally –don’t hold your breath!) This is a ‘slow hold’. Rest for a moment, and then repeat 4 times if you can.
Now try squeezing the pelvic floor muscles quickly 5 times, with a little rest between each squeeze. This exercise helps your muscles react quickly when you cough or sneeze.
How often do you need to exercise your pelvic floor muscles?
• Try 5 ‘slow hold’ squeezes, followed by 5 ‘quick’ squeezes at least 4 times a day
• As your muscles get stronger, try holding the ‘slow’ holds for longer
• The hardest part is remembering to do your pelvic floor exercises – a good time to do them is every time you feed your baby
• Do not stop and start your flow of urine – this can interfere with normal bladder function.
You can download the NHS approved Squeezy app to help remind you to do pelvic floor exercises.
An early tummy exercise – You can start this on the first day, if you feel ready.
Support the lower part of your tummy with your hands or a towel. Squeeze and lift the pelvic floor, at the same time draw in the lower part of your tummy a small amount. Hold for 3 seconds while you breathe out. Relax, then repeat 5 times. Gradually increase the time you hold the muscle in. Bracing these muscles as you change position, get up from the chair or bed, or pick up your baby will help to make these movements more comfortable.
How to progress your exercises
After a couple of days you can move on to the exercises in the leaflet ‘Getting back into shape after your delivery’. Take your exercises at a steady pace, and don’t try to progress too quickly, particularly with strong tummy exercises. Your scar will heal quickly, but it takes several weeks for the deep muscles and the scar on the uterus to become strong.
You will need to rest at home, but continue with your exercises twice a day, gradually increasing the repetitions as you get stronger. Once your pelvic floor muscles are back to full strength, you will need to do a set of ‘fast’ and ‘slow’ exercises every day to keep them strong.
Walking for a short distance each day will improve your fitness and strengthen your muscles. Start gently with a 5 minute walk at a steady pace, building up the distance and the pace at which you walk as you recover. Avoid lifting, where possible, until you are 6 weeks post-natal.
If you continue to have pain from caesarean section scar after 6 weeks ask your GP to refer you to our experienced Women’s Health Physiotherapy team at MKUH. If you experience any problems with bladder control you can self-refer directly on 01908 995432.