Cesarean-section Scar Management
Dr. Hannah Lattanzio, PT, DPT, CMTPT/DN
Introduction
Okay so you’ve just had a c-section – now what?
We’ve all heard of a c-section (ceasarean section) delivery before but there is still a lot of mystery around what really happens and how to care for your body afterward, so let's clear a few things up.
First, it is common knowledge that your baby is delivered through an incision in your abdomen (usually horizontal and low near your bikini line, but can sometimes be vertical along midline). But no – despite what you may have heard, the abdominal muscles are not cut but are actually gently moved out of the way (phew!).
Most of us know to keep the incision clean, but when it comes to fully recovering – like healing your core, moving your body and just feeling like yourself again – things can get a little confusing. Don’t worry, we’ve got you.
Pelvic floor PT isn’t just for moms who give birth vaginally, we as pelvic floor physical therapists are here to help no matter how you delivered your little one.
C-section Scar Tissue Management
To help you understand why scar management is important, let's first dive into what scar tissue is exactly.
As with any scar, what the scar looks like at the surface does not always reflect what lies below as scar tissue can be quite extensive throughout deeper layers of tissue. Scars are made out of the same materials and proteins as the skin they are replacing, however what makes scar tissue different is their fiber direction. Healthy tissue consists of collagen fibers that are crossed in various directions while scar tissue is laid in a linear fashion.
The presence of scar tissue anywhere in the body can create a wide range of symptoms. If you experience any of the below symptoms following your c-section delivery you may benefit from pelvic floor physical therapy.
Symptoms include:
Pain and increased sensitivity of or around the scar
Reduced mobility or stretch of the scar, meaning the scar does not move or pull as easily as other parts of your body
Feeling a “pulling” sensation around the scar and you can only find relief when altering your posture or trunk in some way
Pelvic floor symptoms such as increased urinary frequency and/or urinary urgency
These symptoms can result in long term effects such as altered posture and body mechanics, low back pain, muscle dysfunction, etc.
If any of these sound like you, we recommend seeing a pelvic floor physical therapist for scar tissue mobilization.
How Pelvic Floor PT Can Help
You may be asking, what is scar tissue mobilization and why would I need to see a pelvic floor physical therapist for it?
We will go over some introductory techniques below so you may begin your mobilization at home if you wish. However seeing a physical therapist will help you progress your scar work under the guidance of an expert.
Scar tissue mobilization can help reorganize the tissue to resemble healthy collagen (criss-crossed remember?) which can reduce pain and sensitivity while improving mobility and adhesions. Adhesions are bits of scar tissue that attach to nearby structures (think uterus, abdominals, etc.) and can lead to further increases in pain and impaired elasticity.
Back to PT – physical therapists as a profession are uniquely positioned to assist with scar tissue rehabilitation. Physical therapists are trained to help patients post-operatively for any surgery (think from ACL to open heart) and scar tissue management is always included in the treatment plan.
Your pelvic floor physical therapist can help initiate this process by working on your scar themselves and if appropriate can teach you how to do it yourself at home. You or your therapist may use techniques such as rubbing, gentle pulling, or skin rolling. It is important to make sure the wound is healed and healthy before beginning mobilization (around 2-4 weeks postpartum) with no scabs or open areas. If you are uncomfortable touching your own scar, you can glide various items across the scar, starting with something gentle like a cotton ball, and moving up to soft blankets and washcloths with more texture, this will help with desensitization.
Once that feels comfortable, you can gently rub your pointer and index fingers in small overlapping circles near the scar and then on the scar itself. Don’t be afraid to use cream or lotion if that feels good for you, or you can do it in the shower! Whatever floats your boat.
If you have any questions or are ready to try more intense techniques such as fascial dry needling or skin rolling, don’t hesitate to reach out to a pelvic floor therapist near you or book a discovery call with us for assistance! Your pelvic floor therapist will also be able to help you re-learn how to connect with your core muscles and strengthen them safely.
While it is best to start scar mobilization as early as possible, it is never too late to begin! Many mothers of older children still find benefit from mobilization many years later.
