C-section recovery is so much more than the scar. Not only is there the physical healing process but also an emotional healing journey to consider, especially if you’ve ended up with an emergency c-section.
Did you know that a c-section is major abdominal surgery. How many women or men do you know would get straight back into things after undergoing major abdominal surgery? Not many I would believe. Recovering from a c-section can be confusing and challenging all at the same time with little direction from your surgeon.
Since there is soooo much info I would like to share with you, I’ll be covering the content over 3 blog posts.
Blog 1- important considerations for scar healing
Blog 2- what’s the pelvic floor got to do with it and bladder changes
Blog 3- guidelines to return to exercise
WHAT IS A C-SECTION?
Aka Caesarean section is a procedure involving an incision to the lower abdominal region under general aesthetic or a spinal block to birth your baby. An incision is made through 5 layers including:
- Fatty tissue
- Rectus or abdominal sheath and
- 2 layers of peritoneum
The bladder is moved aside to access the uterus, where the final incision is made. Baby is born, placenta follows, uterus is stitched up, bladder is put back in place and the remaining layers are sutured up again to varying degrees. There is a reason your incision is sore and you feel like the wind has been taken out of your sails.
HOW LONG WILL IT TAKE FOR MY SCAR TO HEAL?
You will often hear of the magical 6 week mark when it comes to postnatal healing whether you’ve birthed vaginally or via c-section. The truth of the matter is, is that physiological tissue healing takes an average of 6 weeks. So whilst your scar from the outside may look healed, the process of healing is still well and truely underway deep down away from sight (think of an iceberg here) and may continue for up to a year.
Whilst no muscle tissue has been cut through, fascial connections (sheaths) are disrupted meaning that muscles no longer have the same strength they once had. Research tells us that abdominal muscles have only regained ~ 50% of the original tensile strength by 6 weeks. And by 6-7 months, only 73-93% of original tensile strength is regained (Ceydeli et al 2005). This has important implications for the types of exercises you should do and when.
WHEN CAN I START TO MASSAGE MY SCAR?
C-section scar massage is gaining momentum as a must do thing post baby. When considering when to start, it is very important to get the green light from your Obstetrician/Gynaecologist or Women’s Health Physiotherapist. Typically you should wait until scar is dry, not scabby, not bleeding or oozing. This usually happens around the 4-6 week mark. However, there are individual variations.
Your doctor may have given you a silicon based cream- use it to massage your scar ( I can teach you how to do that) . Sometimes doctors also give you a sheet of silicon, place it over the scar to help with healing.
Please speak to your doctor if you notice your scar is angry:
- Discharge (fluid)
- Foul smelling
MY C-SECTION SCAR IS STILL PAINFUL, WHAT CAN I DO?
I hear this alot…”my scar is so sensitive, even underwear against the skin bothers me”.
Pain can continue for up to 6 weeks for some ladies whilst for others may persist for much longer. The surgeons hand, sleep, genetics, nutrition, hydration, your birth story and other factors will impact your healing and how sensitive your tissues are.
If you’ve seen your health professional and have been told you have a healthy scar but still struggle with sensitivity, you are not alone. Sometimes scars can be tricky and hold memories especially if you have experienced a traumatic birth. Like I said there is physical and emotional healing that needs to take place. Something you can do at home is to take a clean blusher brush and stroke around the sensitive area gently. Nerve’s roughly regenerate at 1mm per month. Talk to your Women’s Health Physio on further strategies to help desensitise your scar.
It is also important to keep your scar and surrounding tissue hydrated to optimise skin quality and minimise sensitivity- use creams such as the silicon cream given to you, Vitamin A or D or Bio-oil.
WHAT IS A KELOID SCAR?
A keloid scar occurs when scar tissue extends beyond the original boundaries of the wound. Usually a sign of over production of collagen in the healing process. This results in lumps of scar tissue forming around the incision and may restrict mobility. Scar massage probably won’t do much for you here and it is best to discuss this with your doctor to obtain a referral to a dermatologist to consider your options. Some options include corticosteroid injections, laser therapy and cryotherapy with varying outcomes.
I’VE GOT THIS SHELF OF SKIN/ OVERHANG- WHAT CAN I DO ABOUT THAT?
There are a number of reasons that this may occur and it may be a combination of:
- excess skin
- excess fat
- diastasis recti
- scar tissue or
- loss of muscle tone
Whilst our bodies are amazing at healing, sometimes that may not be enough…Understanding your goals and contributing factors will help to inform your recovery approach. Options can include targeted exercises, dietary advice, laser, or surgical intervention.
SHOULD I WEAR AN ABDOMINAL BINDER?
Though they are not the most comfortable of contraptions, often you will be discharged with an abdominal binder. In the early days and weeks, this is very useful to aid in supporting the healing wound, help with pain management and to be able to get on with your day to day activities.
Compression garments are a good alternative to wearing the binder. At the clinic I sell Tubi-grip (a boob tube but for your to torso). Or you may want to consider the purchase of the SRC recovery shorts or pants. I can fit you at the clinic for the right size, also give you to opportunity to feel the product before you commit and provide you a discount code too! Other great products are the Solidea range.
If you have questions about Jamu Jamu Binding or want to learn more about abdominal binding in the postnatal period read my other blog click here.
WHAT MIGHT MY RETURN TO EXERCISE JOURNEY LOOK LIKE?
I like to educate my mummies on the stages of healing to contextualise where their efforts should lie and when.
Weeks 1-3 are all about wound support
return to exercise postnatal-embrace physiotherapy
a. Get on top of pain and inflammation.
b. Support your wound-with a small rolled up towel placed over the wound when opening bowels, cough/sneezing or moving in/out bed.
Weeks 3-6 wound mobilisation
a. Scar can get sticky much like your spine might feel.
b. Start as early as comfortable and under the advice of your Physiotherapist or Doctor.
Weeks > 6 core connection
a. Muscle inhibition occurs due to swelling and the incision. Nerves supplying the muscles take time to fire-up optimally again, so we need to make it a conscious effort not a max effort.
b. Blow before you go and do ‘the knack’- When picking up the baby, capsule, stroller, breath out and pre-contract the pelvic floor with movement as this allows for the pre-activation of the deep core system.
Week > 12 return to exercise
a. Under the guidance of your Women’s Health Physiotherapist or qualified pre/post-natal trainer.
HOW HEAVY SHOULD CARRY?
Use your baby’s weight as a guide. If you have other kids, ask them to climb up to reduce the load on your scar and pelvic floor (and back for that matter).
WHEN SHOULD I SEE A PHYSIO?
Mummies, this blog post is intended as general advice. You only get one chance to do it right, know better, do better 🙂
If you feel like you could benefit from specialised guidance and treatment for your c-section recovery or return to exercise, reach out by calling/whatsapp or email .
Ceydeli A, Rucinski J, Wise L. Finding the best abdominal closure: an evidence-based review of the literature. Curr Surg. 2005;62(2):220-225.
Shin, TM and Bordeaux, JS. The role of massage in scar management: a literature review. Dermatol Surg, 2012. 38: 414–423.