Abdominal Binders Post Cesarean Section

Should you wear one?

Let’s approach this question with a physical therapist’s perspective on whether an abdominal binder is necessary after a cesarean section (c-section).

We will consider four main factors to evaluate if wearing an abdominal binder is advantageous, particularly in the first few days following surgery.

  1. Pain control
  2. Mobility status
  3. Muscle recovery
  4. Symptom distress

You may be wondering, what is an abdominal binder? Generally speaking, it is a wide compression belt that surrounds the abdomen and supports the surgical site. It is commonly thought to be used to aid in recovery after abdominal surgery. Both elastic and non-elastic binders are available. There are literally hundreds of different styles on the market, and quite frankly, it can be overwhelming when pursuing finding one on the internet. Before you spend time searching for the perfect binder though, let’s dive into the research. This will support my personal opinion from professional and individual experience on whether a binder postoperatively is necessary.

1.     Pain Control

Binder use has the potential to be a non-pharmacologic and cost-effective way to reduce postoperative pain. With the rise in narcotic use leading to dependence, in addition to the negative side effects they can cause, an abdominal binder could be highly valuable if it decreases the need for these known-to-be addicting drugs as one randomized control study demonstrated (Ghana, et al, (2), 2017).

One theory regarding how an abdominal binder functions to promote pain control is by providing compression. This circumferential compression is thought to reduce stress on the wound during transfers, such as getting into and out of bed and walking.

It’s like a gentle hug from a friend when you’re hurting that just feels good.

Another theory is that the binder provides sensory input when in contact with the skin. This input signals to override the neural pathways carrying pain signals to the brain.

Think of it as you feel the binder more than you feel the pain.

When reviewing seven different randomized controlled trials published over the last two years, the majority of studies demonstrate that an abdominal binder reduces pain at all or at least some of the evaluated time points (within three days of surgery) except for two of the studies (Chankhunaphas and Charoenkwan, 2019) (Gillier, et al. 2016).

Diving further into the research:

The following studies all support binder use for managing pain when assessed by the Visual Analog Scale (VAS), a standard tool used to allow patients to report their pain.

In 2017, 2018, and 2019, three different studies assessing 56 patients, 178 patients and 150 patients, respectively, found that pain was significantly lower at all three of the postoperative time capture points they assessed in the binder group (Ghana, et al, 2017) (Gustafson, et al, 2018) (Saeed, et al, 2019).

Another 2019 study evaluated pain in 89 patients following elective c-section at three time points (8th hour, 24th hour, and 48th hour postop). Pain was significantly reduced in the binder group, but only at the 24th hour time point (Karaca, et al, 2019).

But is there a risk of the binder increasing pain?

It’s important to point out though that there was very little report of binder use increasing pain with only two studies reviewed reporting one subject each who requested to remove the binder during the intervention period, but no adverse effects were observed. Even more valuable is what a 2017 study found regarding use of significantly fewer analgesic medications administered in the binder group when compared with the control group (Ghana, et al, (2) 2017).

In conclusion, it’s likely a case of personal preference, as most subjective matters are, and pain is highly subjective. Some people tend to shy away from tight-fitting clothing in general and therefore, would less likely to find a binder comfortable.

However, since no adverse effects have been documented, and it has the potential to decrease medication use, it seems like a feasible option to try as a non-pharmacologic and cost-effective pain management strategy following surgery.

An exception would be if a patient has risk factors for IAH (intraabdominal hypertension). In this case a binder should not be recommended (Zhang, et al, 2016). Even without this risk, caution must be taken to ensure the binder is not applied too snuggly. Pain when donning should be a clue, but if taking pain medications, it may be masked. One danger of applying compression too tightly is increasing intraabdominal pressure. This would be detrimental in facilitating pelvic floor recovery postpartum as described in “Managing Pressure to Prevent Prolapse”.

2.     Mobility Status

It’s a well-known fact that early mobility (such as walking) following any major surgery is advantageous in promoting recovery (2013 Enhanced Recovery After Surgery (ERAS) Guidelines). Benefits include decreased risk of deep vein thrombosis, hypostatic pneumonia, muscle atrophy and other complications caused by a lack of activity and helps with wound healing.

Early activity within one to three days after the operation is crucial in promoting recovery. However, many newly postpartum mothers fear movement.

It could be because of the anticipated pain or concern they may injure the surgical site or excessive fatigue. Simply walking the hospital hallways after an unscheduled c-section with little to no sleep the night prior due to being in labor may sound like a much more daunting task, such as climbing one of the 58 fourteener mountain peaks in Colorado. 

According to recent literature, there is good support to wearing an abdominal binder in the first three days following a c-section in favor of increasing mobility when using the six-minute walk (6MWT) test to evaluate mobility. The patient is asked to walk as far as he or she can in six minutes. Total distance is recorded at the conclusion of the test. The patient is encouraged to walk at a self-selected pace and is allowed to take rest breaks, but the timer does not stop when resting.

Diving further into the research:

A 2019 randomized control trial looked at mobility in 150 patients following elective and emergency c-sections. There was no statistically significant difference in the 6MWT distance before and on postop day one, but the difference was significant on postop day four and seven in favor of the binder group (Saeed, et al, 2019).

Another 2019 randomized control trial looked at mobility in 89 patients following elective c-section. The binder group walked further than the control group at all three time points (8th hour, 24th hour, and 48th hour) with the first time of mobilization (8th hour post-op) being statistically significant (Karaca, et al, 2019).

In a most recent study though from 2019, a randomized control trial with 90 patients in each group, no significant difference between groups for mobility was determined (Chankhunaphas, and Charoenkwan, 2020).

As a side note, elastic binders increased mobility on average earlier than non-elastic binders (Zhang, et al, 2016).

3. Muscle Recovery

Unfortunately, the research is lacking for studies specific on evaluating abdominal activation in these very early stages following a c-section. However, by applying basic principles of neuromuscular reeducation and anecdotal experience both as a physical therapist and a mother who has delivered children via c-section, here are a few considerations.

A binder could be used to promote proprioceptive feedback.

Proprioceptive feedback is extra information provided to the brain to help your body move better mechanically. It may be used as a good reminder to activate your core, specifically the deep abdominal and pelvic floor muscles, during activity. The earlier your body learns to use its muscles again, the better. The old adage, ‘if you don’t use it, you lose it’ holds especially true here. Because during the course of pregnancy, your abdominal and pelvic floor muscles are under increased stress. Your pelvic floor is asked to support a significant increase in weight (and sometimes it can’t handle it, leading to incontinence and pelvic pain). Your abs get stretched to their max to allow for growing baby and essentially even “split” to some degree (diastasis recti abdominis). It is extremely important to note though that using a binder for proprioceptive feedback is not as effective if used as passive intervention. Therefore, you must be mindful to take an active role in activating your abdominals utilizing the three E’s approach from “A Better Way to Breathe and the Right Way to Kegel”. This video  reviews how to properly exhale, engage, and exert in order to reap the benefit of proprioceptive feedback. Effort must be made to activate the core in your day-to-day routine.

A binder could be used to temporary facilitate muscle recovery, but not foster dependence.

Using it during the first few days following surgery and gradually weaning off it is recommended. Consider wearing it longer, though, to provide additional support as you heal if you are a momma caring for older siblings at home who require extra attention also.

4.     Symptom Distress

Symptom Distress was commonly measured with the Symptom Distress Scale (SDS) in the literature reviewed. Symptom distress is defined as the degree of discomfort from the specific symptom being experienced as reported by the patient.

Two out of the three studies determined that wearing an abdominal binder decreased the distress caused by symptoms postpartum.

Diving further into the research:

In two studies, a 2019 randomized control trial of 89 patients following elective c-section, and a 2017 randomized control trial looked of 178 patients, the binder group reported lower (better) scores at all three assessment time points (Karaca, et al, 2019) (Ghana, et al, 2017). Specifically regarding coughing and breathing, less distress was reported in the binder group in a 2019 study that looked at pain management following a c-section (Tussey, 2019).

Contrarily though, a 2016 randomized control study with 87 patients in binder group and 68 control group found no difference at post op day one or two. However, there was no adverse effect associated with binder use either (Gillier, et al. 2016).

Hopefully after reviewing these four research-studied factors list below, you can better determine if an abdominal binder post c-section will benefit you personally.  

  1. Pain control
  2. Mobility status
  3. Muscle recovery
  4. Symptom distress

Before purchasing a binder ahead of time… 

Be sure to check with your doctor. The hospital you deliver at may provide one to you post-operatively. Alternatively, you could consider purchasing other “support” garments like compression shorts/leggings or bloomers instead. Although they may not be able to provide the same level of compression, these could be worn for a longer length of time. They tend to be less noticeable when wearing due to being less bulky. This could make the monetary investment more justifiable. Also, consider what your insurance may cover as some insurance companies may reimburse your purchase.

If looking for specific brands or recommendations, refer to the list below. I have no affiliation to these products or their stores.

BaoBei Postpartum: https://www.baobeimaternity.com/collections/postpartum-nursing

Belly Bandit: https://bellybandit.com/collections/postpartum

Blanqi: https://www.blanqi.com/collections/postpartum

Belly Bandit: https://bellybandit.com/collections/postpartum

DonJoy: https://www.donjoyperformance.com/donjoy-advantage-abdominal-support , https://www.djoglobal.com/products/procare/abdominal-binder

Post-op Panty: https://www.postoppanty.com/c-section-recovery-and-incision-panty 

ReCORE Products Maternity and Post-Natal FITsplint: https://www.recorefitness.com/products

References:

 

Chankhunaphas, Wisit and Charoenkwan, Kittipat. (2019). Effect of Elastic Abdominal Binder on Pain and Functional Recovery After Caesarean Delivery: A Randomised Controlled Trial. Retrieved from: https://doi.org/10.1080/01443615.2019.1631768.   

Ghana, Samieh, et al. (1) (2017). Randomized Controlled Trial of Abdominal Binders for Postoperative Pain, Distress, and Blood Loss After Cesarean Delivery. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/28241386/.

 

Ghana, Samieh, et al. (2) (2017). The Effects of Abdominal Binder on Wound Healing and Consumed Pain Medications After Cesarean Section: A Randomized Control Trial. Retrieved from: https://www.semanticscholar.org/paper/The-Effects-of-Abdominal-Binder-on-Wound-Healing-A-Ghana-Hakimi/5604c776d1531b808bb115e80efb0b5763b11126#paper-header.

 

Gillier, Christin M., et al. (2016). A Randomized Controlled Trial of Abdominal Binders for the Management of Postoperative Pain and Distress after Cesarean Delivery. Retrieved from: https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1016/j.ijgo.2015.08.026.

 

Gustafson, Jamie L, et al. (2018). Elastic Abdominal Binders Reduce Cesarean Pain Postoperatively: A Randomized Controlled Pilot Trial. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5962320/.

 

Karaca, Ibrahim, et al. (2019). Influence of Abdominal Binder Usage after Cesarean Delivery on Postoperative Mobilization, Pain and Distress: A Randomized Controlled Trial. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6812913/.

 

Saeed, Summaya, et al. (2019). Use of Abdominal Binders after a Major Abdominal Surgery: A Randomized Controlled Trial. Retrieved from: ncbi.nlm.nih.gov/pmc/articles/PMC6827701/.  

 

Zhang, Hua-YU, et al. (2016). The effect of different types of abdominal binders on intra-abdominal pressure. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724682/.

 

1 thought on “Abdominal Binders Post Cesarean Section”

  1. Finding relief and aiding in recovery without use of pain medications is so, so important. I love this suggestion and hope mamas out there will talk with their doctors about this option for recovery.

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