By Shannon Pacella
If you’re reading this, you probably know what a Cesarean birth (C-section) is,* but what you may not know is what to do once you have had one. Most women post C-section are not given much information regarding their healing incision, except to “keep it clean in order to prevent infection.”
*A Cesarean birth (C-section) is the delivery of a baby through an incision in the mother’s abdomen and uterus. The incision can be transverse/horizontal near the pubic hairline, or it may be vertical at midline.1
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, as seen in the picture above.
Scar tissue is composed of the same protein as the tissue it replaces, however, the fiber direction and pattern of the collagen is different. The collagen fibers in normal tissue go in all different varying directions (as seen below in box A), while the collagen fibers in scar tissue are formed in a linear single direction (as seen below in box B).
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):
- Pain/sensitivity at and around the scar.
- Reduced mobility and elasticity; making bending forward and lifting uncomfortable.
- Feeling like that area is being pulled/tugged on, when standing up straight and reaching overhead, which can affect posture.
- Low back pain from compromised/weakened abdominal muscles.
- Myofascial trigger points in abdominal muscles that can refer pain to the urethra and clitoris.
- Superficial nerve irritation surrounding the area of the scar.
- Urinary urgency and frequency.
Now that you know what potential impairments may occur, we can discuss how to properly care for and treat this area, in order to reduce and even prevent these symptoms from happening. And the answer is…MASSAGE! Scar massage (also known as scar tissue mobilization) is different than the typical massage you may be familiar with, but it has many beneficial effects. A literature review of ten journal articles that looked at the role of massage in scar management concluded that 90% of the surgical scars treated with massage had improvement based on the Patient and Observer Scar Assessment Scale.2
You’re most likely wondering how massage can help with all the aforementioned impairments. Scar massage is all about reorganizing the collagen fibers in a similar pattern as the normal tissue, so the scar moves and stretches more like the skin surrounding it. The massage will also reduce adhesions in underlying connective tissues and myofascial layers. Adhesions are parts of the scar tissue that have attached onto other structures closeby, which if left untreated, can lead to reduced blood flow, nerve irritation, and pain.
This is where pelvic floor physical therapists can help! A pelvic floor PT will be able to assess your C-section scar and start treating the area with scar massage. This entails the physical therapist using their hands to manipulate/mobilize the scar and surrounding tissues in all different directions using skin rolling techniques, and pressing and rubbing motions.
This may be a bit uncomfortable and sensitive at first, so it is important to communicate how you are feeling with your physical therapist. It may be more comfortable to apply a warm compress to the area prior to the massage. If appropriate, the physical therapist can teach you how to perform the scar massage on your own as part of your home treatment plan.
Feeling nervous or uneasy about touching your C-section scar? You may find it helpful to start out with brushing/rubbing various items over the scar to get yourself more comfortable and connected to it, without directly touching the scar. This can also get the scar use to different textures and sensations. Some items to try may include: a damp face cloth, makeup brush, cotton ball, and q-tip.
Before starting C-section scar massage, wait until your ob/gyn confirms that your incision has closed, typically at the six-week post delivery follow-up. It is best to start the scar massage soon after the incision has closed, as the tissue will respond more quickly and reduce the amount of adhesions from occurring. Even if you have had a C-section scar for a long time, it can still be beneficial to perform the scar massage since your body is constantly remodeling and forming new tissue.
To find out more about how a pelvic floor physical therapist can help postpartum, check out these resources:
- Cesarean birth (C-section) frequently asked questions: labor, delivery, and postpartum care. The American College of Obstetricians and Gynecologists, 2015.
- Shin, TM and Bordeaux, JS. The role of massage in scar management: a literature review. Dermatol Surg, 2012. 38: 414–423.