Painful Scar Tissue after C-section: physical therapy and the healing process

C-Section Scars

Thirty percent of all childbirths are performed via cesarean section. A cesarean delivery requires multiple layers of tissue to be cut through and stitched back together. The outside layer is the skin, then fat, then fascia, then the peritoneum, more fascia holding your organs in place, and then finally your uterus. After these layers are stitched back together, many women have excess scar tissue causing pelvic pain or abdominal pain. It is similar to tucking in the front of your shirt tightly, then reaching up to reach the top shelf and pulling your shirt out, or in this case, tugging at the cesarean scar.

What is the natural healing process?

Our body is organized so that all of our layers (of skin, fascia, fat, etc.) should slide and move across one another. When our bodies begin to heal after a cesarean delivery, it does its best to glue together whatever tissue it can. The human body is very efficient in that way, however, it does not differentiate between what should be adhered together and what should not. This can cause excess scar tissue allowing the layers to become “sticky” and not slide across one another with grace. Scar tissue differs from regular tissue, in that it is less pliable and elastic.

Cesarean scar tissue can not only cause abdominal pain and pelvic pain, but it can also cause a change in posture. This is due to pulling, causing the abdominal muscles to weaken and result in less support for the back. Adjacent tissues and muscles to the cesarean scar can also be affected, not allowing them to contract, relax, and coordinate properly. This can result in issues with bowel and bladder functioning, such as incontinence, constipation, and chronic pain.

PT for C-Section Scars

The good news is, that cesarean scars can be addressed with physical therapy. Pelvic floor physical therapists are trained in scar mobilization to help align the tissue fibers so the scar can move better and muscles can function. If a scar is moved and pulled in all directions, the body will lay down the fibers of the excess scar tissue with more organization. The cesarean scar can then blend in better and behave like normal tissue. This may involve your PT massaging and manipulating your cesarean scar both internally and externally, as well as the area around it. Gentle strengthening exercises may also be part of the treatment, as muscles may be inhibited by the scars.

Just as important as it is to address the scar tissue, it is important to allow the body to heal in the first 6-8 weeks following delivery. The body needs time for the healing process to allow the incision to close and remodel.

Some helpful things to do during this healing process:

Think POSITIVE Thoughts

Yes, I know, it sounds silly. Our brain does not differentiate between what is real and what is not. Whatever you think the brain believes it to be true, and starts releasing hormones that go with that thought. So you can use your thoughts to help you in the post-partum healing process. With every thought, your brain sends ‘messengers’ around the body’s organs, telling them what hormones to release in response to that thought/feeling. Many women before you and many women after you will heal wonderfully from a cesarean delivery, and so will you. Think positive!

Diaphragm Breathing

Our diaphragm acts as a sump pump for our system. This improves blood flow throughout the abdomen which in turn helps send healing cells to the area. See this recent post for why our diaphragm is so important https://www.foundationalconcepts.com/the-pelvic-chronicles-blog/amazing-diaphragm/

A healthy diet and fluid intake

Ingesting foods that are good for our body allows it to regenerate and speed up the healing process.  Looking at consuming a diet of whole foods and no processed foods is best. It is recommended we drink ½ of our body weight (lbs.) in ounces of water daily (and even more if breastfeeding). Keeping our system well-hydrated and nourished will help with the healing process.

Monitor for infection

Every cesarean scar carries the risk of infection. Inspect your scar daily for a minute or two to look for signs of redness, swelling, hot skin around the scar, fever, or pus. A small amount of fluid from the incision is normal, however pus is not. Inspecting your cesarean scar will ensure you recognize any signs of infection early and it will also allow you to be in tune with your body!

Moisturize

As a cesarean scar heals it can cause symptoms of itchiness- this is a sign of healing. Avoid any lotions the first few days until the incision is well closed. After closure, applying some coconut oil or vitamin E oil can help with sensations of itchiness. This also promotes a smooth healing process.

It Doesn’t Matter How Much Time Has Passed

Whether you are hours or years after a cesarean section, there IS something that can be done. The human body is amazing in that it can forever be changed, rehabilitated, and remodeled. An appointment with Pelvic Floor physical therapy is a good place to begin your recovery journey from your cesarean delivery. At Foundational Concepts, we recommend seeing every mom 6 weeks postpartum.  However, if you are experiencing pain prior to this point, it is never too early. We offer a free 15-minute phone consult to answer any questions you may have and ensure you are in the right place to heal.