The Scar Is Healed! Not So Fast, Mama.
Navigating C-Section Scar Care
Birth is this amazing, complex journey that may have souvenirs than you unknowingly opted-in for after nine months. C-section scars are evidence of your babes entry into this world.
Scars can impact one’s social, emotional and physical wellbeing. They are reminders that something happened in our lives – good, bad, major or minor. Scars talk, sometimes with clear communication of their needs but often as a distant echo. For mothers with C-sections, they know that beyond the work they need to do for their new baby, a longer recovery lies ahead of them due to the incision and stitches. However, little information is given to these moms regarding the scarring from C-sections and the potential long term side effects. In fact, the scar tissue from C-sections and other abdominal surgeries can spread approximately two years post surgery, with the ability to bind tissues and organs together, creating dysfunction and discomfort.
Mamas generally do not get a user’s guide sent home with them about their postpartum body, let alone the incision they now have.
The prevalence of C-sections in the U.S is now 32% (source: CDC), and most mothers are taught little about how to care for their body after delivery, much less their incision site. OB-GYNs often clear moms to return to activity after 6-8 weeks, and we assume all is well if the incision is closed and well healed — not necessarily! Majority of women have chronic scar pain related to their cesarean surgery, resulting in difficulty and pain with daily activities including childcare. It’s major surgery, so why don’t we get rehab resources?
What Happens During a C-Section and After?
The baby is born and moms are generally reassured that their tummies will be perfectly flat and heal nicely once repaired (gravity is much more kind to your abdominal contents when you’re flat on your back.) You will have a cute “bikini line” scar and it will be like you were never pregnant, right?
Boom, you’re good to go! Just don’t lift anything for 6-8 weeks and you’re all set — which isn’t so easy if you have another kid who hangs on you like a zoo animal.
Let’s break down the procedure a little so you can understand the layers of repair.
First, an incision is made in your skin. The rectus sheath (this is the fascia that blends all your abs together at the center of your belly) is pulled apart, then incisions are made in the peritoneum (the lining of your abdominal cavity) and the uterus. The baby and placenta are delivered and then the uterus, rectus sheath and skin are sutured back together again. This video is a great, simple resource.
Why Should I Care About My Scar?
In general, scars are your body’s way of forming a bandage, and you want a scar to do two things: heal well and most importantly, be mobile. Women don’t typically associate a scar with mobility.
Normal tissue in our bodies is aligned in a nice uniform direction. However, when scar tissue forms, it is kind of like when your toddler plays with their crayons and tosses them all over the floor.
Here’s another simple analogy: pretend that you have several layers of waxed paper and someone put a curling iron down through it. All the layers sort of blend and melt together. The tissues from your skin down to your uterus, although may seem sealed closed, do not lay in the same fashion as before, just like this.
The scar tissue is laid down in haphazard directions, just like the wax or crayons.
Whenever an incision has been made, a scar may form as part of the healing process. According to the American Academy of Dermatology, during the healing process, a temporary scab forms to close the edges of the incision together, and then the body creates scar tissue from collagen (a tough fibrous protein), which takes the place of the scab.
It is important to note that scar tissue is not only what you can see on the surface, but it can extend into deeper layers below the skin.
Scar tissue is composed of the same protein as the tissue it replaces, however, the fiber direction and pattern of the collagen is different! This is the kicker. The collagen fibers in normal tissue go in all different varying directions, while the collagen fibers in scar tissue are formed in a linear single direction.
Scar tissue is fibrous tissue that replaces normal tissue after an injury. It’s made of the same stuff as the tissue it replaces—collagen. However, the quality of the collagen is inferior to the tissue it replaces. The tissue is usually not as elastic as the original tissue. It’s important to bear in mind that the scar that you can see is actually only the tip of the iceberg as most scars extend deeper into the body than the bit of scar that is outwardly visible.
Why would this direction of collagen fibers matter?
This scar tissue can cause adhesions to the abdominals, pelvic floor and surrounding muscles. This can cause many more problems, beyond cosmetic. When the scar tissue impacts the muscles around it, it can cause issues with the deeper core muscles firing correctly, and can cause issues with incontinence. It also leads to back pain and pain with sexual intercourse. This irregular pattern of collagen fibers that the scar is comprised of can create a wide variety of problems for new mothers including (but not limited to):
Low back pain from compromised/weakened abdominal muscles. The key here is to work your core musculature through core training with us prior to labor and delivery, as this can not be an issue.
Myofascial trigger points in abdominal muscles that can refer pain to the urethra and clitoris.
Pain/sensitivity at and around the scar.
Issues with lower digestion such as irritable bowel syndrome or constipation. This occurs because of the tightening created by the scar tissue pulls within the abdominal cavity and thus affects the organs.
Reduced mobility and elasticity; making bending forward and lifting uncomfortable.
Superficial nerve irritation surrounding the area of the scar.
Urinary urgency and frequency.
Feeling like that area is being pulled/tugged on, when standing up straight and reaching overhead, which can affect your posture.
A common complaint after a C-section is the sensitivity of the scar itself. For instance, it may hurt to lean over to pick up baby or may cause pain with lifting or other positional changes. Standing up straight may be painful as well as reaching over the head.
The scar may cause a slight postural change, a sort of “pulling forward” that along with a decrease in the support of the back from the abdominal muscles could result in back pain. Guess what helps with this? Diaphragmatic breathing, again.
So often I find that moms think that once they have a C-section scar, it is what it is and there is not much they can do about it.
The good news is this, collagen is the building block for tissues and scar. This collagen is influenced by tension and can be re-organized to be more aligned and mobile. because it reorganizes in this fashion, doesn’t mean you are stuck with it, forever.
Scars are beautiful, they are a mark of your journey with your child but they need to TLC too, don’t forget to pay attention to them!