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Recovering from your C-section- Scar healing

Congratulations!

If you’re planning to give birth by c-section, or you simply want to be prepared for all eventualities, read on. Here Embrace Physiotherapy share all your c-section recovery essentials.

Firstly, know your c-section recovery time is about so much more than the c-section scar. Not only is there the physical process – you’ll gradually see your c-section scar healing – but there is an emotional healing journey to consider too. This is especially true if you’ve had an emergency c-section.

Did you know that a c-section is major abdominal surgery?

Very few people would get straight back into daily life after undergoing such a serious operation, and despite the need to care for a tiny baby afterwards, your c-section is no different. Recovering from a c-section can be confusing and challenging all at the same time. And often, you’ll have little direction from your surgeon. But, worry not. We’re here to ease the process and help you, and your c-section scar heal as well as possible.

Since there is so much information, we would like to share with you, we’ll be covering the content over three blog posts.

What is a c-section?

A c-section, aka Caesarean section, is a procedure involving an incision to the lower abdominal region under general anaesthetic or spinal block to birth your baby. The c-section incision is made through seven layers of your abdomen including:

The c-section incision goes through several layers of abdomen, represented here by a kiwi fruit. The C-section scar will take time to heal as each layer knits back together.

  • Skin
  • Fatty tissue
  • Rectus or abdominal sheath
  • Two layers of peritoneum
  • Uterus
  • Amniotic sac

The bladder is moved aside to access the uterus, where the final incision is made. The 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. When you know all this, it’s not surprising your c-section incision is sore and you feel like the wind has been taken out of your sails.

How long will it take for my c-section scar to heal?

You will often hear of the magical six-week mark when it comes to postnatal healing. Whether you’ve birthed vaginally or via c-section, the physiological tissue healing takes around six weeks. However, whilst your scar from the outside may look better, the process of healing is still well and truly underway deep down. Your c-section scar is just the tip of the iceberg and internal healing may continue for up to a year.

Healing takes time as there are four stages through which your body needs to progress:

  1. The haemostasis phase, where platelets stick together to stop the bleeding and allow clotting. This happens immediately during your surgery.
  2. Next, the inflammation stage, which assists with bleeding control and prevents infection. There is a migration of inflammatory markers which results in the area looking puffy and swollen, red, hot, and uncomfortable.
  3. The proliferation phase follows, which occurs on days two to five post-surgery as your body lays down collagen layers in a disorganised fashion to help the wound contract. At this time, a new network of blood vessels must be constructed so that the tissue can receive sufficient supply of oxygen and nutrients to stay healthy.
  4. Finally, your wound enters the remodelling phase. During days five to fifteen, the collagen fibres reorganise and align to ensure optimal tensile strength and flexibility.

Whilst no muscle tissue has been cut through, fascial connections (sheaths) are disrupted meaning that muscles no longer have the same strength or ability to transfer load they once had. Research tells us that abdominal muscles have only regained ~ 50% of the original tensile strength by six weeks. And by six to seven 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 C-SECTION SCAR MASSAGE?

C-section scar massage is gaining momentum as a must-do healing therapy post birth. However, it is very important to get the green light from your Obstetrician/Gynaecologist or women’s health physiotherapist before starting. Typically, you should wait until the scar is dry, not scabby, and not bleeding or oozing. This usually happens around the four-to-six-week mark post birth. However, this varies from person to person so use your body as your guide.

Your doctor may have given you a silicon-based cream, which you can use to massage your scar. We can teach you to do that here at Embrace Physiotherapy, so get in touch for advice if you need it. Sometimes, doctors also give you a sheet of silicon which you can place over the scar to help with healing.

Please speak to your doctor if you notice any of the following with your scar:

A red, painful c-section scar is cause for concern. Contact your doctor for if your scar shows any worrying signs of infection.
● Red
● Hot
● Bruised
● Bleeding
● Discharge (fluid)
● Swelling
● Fever
● Foul smelling

My c-section scar is still painful, what can I do?

We hear this a lot…”my scar is so sensitive, even underwear against the skin bothers me”.
C-section scar pain can continue for up to six weeks, whilst for some it may persist for much longer. The surgeon’s hand, sleep, genetics, nutrition, hydration, your birth story, and other factors will impact your healing and the sensitivity of your tissues.

Other things you can do to support C-section scar healing is to ensure you don’t smoke. If you suffer from diabetes, ensure this is well-managed. You can also limit your alcohol intake and optimise your nutrition. 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. There are memories held in your scar, especially if you experienced a traumatic birth and you need to heal both physically and emotionally from the trauma.

Most c-section scar pain resolves by three months postpartum, however a small percentage (6%) of women will still struggle with this at 12 months and 2% will complain of severe persistent pain at this time (Jin et al 2016 and Nikolajsen et al 2004). To improve your pain, something you can do at home is to take a clean blusher brush and gently stroke around the sensitive area. Your nerves will regenerate at roughly 1mm per month. If you need more help, your Women’s Health Physiotherapy will be able to advise you 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 rose-hip.

What is a keloid scar?

A keloid scar occurs when scar tissue extends beyond the original boundaries of the wound. Usually, it is a sign of overproduction of collagen in the healing process. This results in lumps of scar tissue forming around the incision and may restrict mobility.

Women with darker pigmented skin are far more likely to develop a keloid scar. This is followed by people of Hispanic and Asian backgrounds. Keloids are more common in persons younger than 30 years, and in patients with elevated hormone levels e.g. those experiencing puberty or pregnancy (Juckett et al 2009, and Brissett et al 2001).
Unfortunately, c-section scar massage probably won’t do much for you here, so it is best to discuss this with your doctor to obtain a referral to a dermatologist. Some options to improve the appearance of a c-section keloid scar include corticosteroid injections, laser therapy, and cryotherapy with varying outcomes.

I’ve got this shelf of skin/pooch- what can I do about that?

There are several 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 it is not quite enough. Understanding your goals and the factors contributing to your overhang will help to inform the approach to rectify it. Options to reduce an overhang can include targeted exercises, dietary advice, laser, or surgical intervention.

Should I wear an abdominal binder after c-section?

SRC recovery range to help you recover after your c-sectionThough they are not the most comfortable of contraptions, often you will be discharged with an abdominal binder after c-section surgery. In the early days and weeks, this is very useful to support the healing wound, help with pain management, and allows you to get on with your day-to-day activities (Tussey et al 2019). Compression garments are a good alternative to wearing the abdominal binder. At the clinic we sell Tubi-grip (a boob tube for your torso), or you may want to consider the purchase of the SRC recovery shorts or pants. We can fit you at the clinic for the right size and give you the opportunity to feel the product before you commit.

If you have questions about Jamu Jamu Binding or want to learn more about abdominal binding in the postnatal period read our other blog click here.

How much can I carry after a c-section?

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 women’s health physiotherapist?

Read this blog!

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, we are here to help. Please call us or WhatsApp 9780 7274, or get in touch with us at help@embracephysio.sg to make an appointment.

References:

Betarbet U, Blalock TW. Keloids: A Review of Etiology, Prevention, and Treatment. J Clin Aesthet Dermatol. 2020;13(2):33-43

Brissett AE, Sherris DA. Scar contractures, hypertrophic scars, and keloids. Facial Plast Surg. 2001;17(4):263–272.

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.

Jin J, Peng L, Chen Q, Zhang D, Ren L, Qin P, Min S. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol. 2016 Oct 18;16(1):99.

Juckett G, Hartman-Adams H. Management of Keloids and Hypertrophic Scars Am Fam Physician. 2009 Aug 1;80(3):253-260.

Nikolajsen L, Sørensen HC, Jensen TS, Kehlet H. Chronic pain following Caesarean section. Acta Anaesthesiol Scand. 2004 Jan;48(1):111-6.

Shin, TM and Bordeaux, JS. The role of massage in scar management: a literature review. Dermatol Surg, 2012. 38: 414–423.

Tussey C, Kelly LA, Oja KJ, Bay RC, Makarova N. Reducing Discomfort After Cesarean Birth Using Abdominal Binders. MCN Am J Matern Child Nurs. 2019 Nov/Dec;44(6):310-316. doi: 10.1097/NMC.0000000000000571. PMID: 31490194.

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I had a fantastic experience visiting Preet’s clinic 6 weeks after I delivered my baby. The physio Alex was detailed, caring and thorough in her assessment of my pelvic floor, back and abdominal muscles. The clinic is a beautiful, calming place and perfect for new mums to get taken care of. Thank you and I would definitely recommend visiting Embrace not just for post-partum issues, but any issues to do with your physical well being particularly for women’s health. Keep up the good work Preet, Alex and the Embrace team!!

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