Pelvic Pain and Abdominal Surgery… What’s The Connection?

C-section, abdominal hysterectomy (removal of the uterus), appendectomy (removal of the appendix), exploratory laparoscopy, endometriosis removal via laparoscopy or open abdominal incisions, cholecystectomy (gallbladder removal), colon re-section, and the list goes on…. There are a lot of body parts within the abdomen and anytime a surgeon needs to access one or more of those structures to perform an operation there is scar tissue that will form.

So, what is the connection between abdominal surgery and pelvic pain? As the layers of abdominal tissue heal back together some scar tissue will form. Clearly, we need scar tissue to heal the open wound back together. However, if that scar tissue starts to adhere layers of abdominal muscles together that previously were moving and gliding freely on each other, that lack of mobility can create tension through the muscular and fascial system. Fascia is a web-like covering that is found throughout our whole body and it’s purpose is to allow groups of muscle fibers to stay together and glide across other structures without creating friction. When muscles have been disrupted by a surgery, the scar tissue that forms can often create tension and loss of mobility in the fascia within these muscles. After a surgery of the abdominal wall has been performed that tension can start to affect the lower back as well as the pelvic floor because of the shared fascial connections between the abdominal muscles and all of the core muscles. Commonly, after any abdominal surgery people may experience lower back or pelvic pain symptoms. It can even cause pelvic floor symptoms such as urinary leakage or pain during intercourse.

Furthermore, the abdominal wall has a lot of nerve connections to the pelvic floor that travel through the area. Scar tissue in the abdominal wall can cause pinching or compression of nerves that supply the pelvic floor. It is also possible that during the abdominal surgery the nerves were stretched while the layers of tissue were being retracted back for the surgeon to visualize the organs they were removing or operating on.

We have identified that there is a clear connection between the abdomen and the pelvic floor through fascia and nerves, so what can we do about it when things are not moving well? In pelvic floor physical therapy, we can work together to improve scar tissue mobility and reduce neural tension through hands on techniques and teaching self-mobilization for home.

If you’re noticing pelvic floor symptoms, pain of the pelvic floor, lower back pain, or abdominal pain after an abdominal surgery - reach out to Shift Physical Therapy. Whether your abdominal surgery was 2 weeks ago or 20 years ago, we can help!

Written by: Renee Hancock, Pelvic Floor Physical Therapist