Scars can impact one’s social, emotional and physical well -being. They are storytellers that remind us that something happened in our lives – good, bad, major or minor. Scars do chatter, sometimes with clear communication but often as a distant echo. For mothers with C-sections (cesarean 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. But 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. But there are self-care strategies that moms can work with to prevent these issues from escalating!
The majority of C-section recipients receive a low transverse incision above the bikini line, where the muscle density of the uterus is the thinnest. Many layers are cut through including the skin, fatty layer, and fascia (connective tissue) followed by the separation of the rectus abdominus muscles before reaching the peritoneum. This semi-permeable membrane covers all of our abdominal organs and is also cut through to access the uterus. This process will automatically set off an inflammatory response throughout the body to prevent further damage to the affected area. Fortunately, the body is resilient and acts quickly to regenerate new collagen fibers, a major component of our connective tissue, in and around the C-section incision site for repair. While these new fibers are regenerating, the uneven distribution of the collagen cells is often chaotic and jumbled in its final arrangement. If left untreated, a thicker, more dense and fibrous tissue can form known as scar tissue.
Bands of scar tissue, known as adhesions, can then form within the abdominal cavity and pelvis connecting surfaces that normally slide over one another, leaving them literally stuck together. This fibrous scar tissue lacks the same fluid, blood circulation and lymphatic flow. What follows is the inability of soft tissue and muscle fiber surfaces being able to slide and glide against one another efficiently. Without the slide and glide properties – range of motion becomes restricted. As with any restriction, the body will find a way to compensate by weakening, tightening or overworking other areas of the body. Very few mothers may consider their C-section scar a possible source of their discomfort or dysfunction in their bodies. And why should they? This is not the information that most new mothers either receive, focus on, or have the information to connect the dots – heck, they have a new baby who needs their full attention. When a scar heals after a C-section – it may look great aesthetically, but isn’t the true test of a healthy scar pliability of all layers beneath the surface?
According to Lynn Leech, a PT specializing in Women’s Health and Visceral Manipulation, low back, pelvic pain and frequency of urination top the list of some of the most commonly made complaints post C-section surgery – but, please note, many of these issues may not show up right away.
Lynn Leech explains, “The scar tissue adheres to all the tissues directly in front of the sacrum…There is fascia that runs from the pubic bone around the bladder, uterus and colon and attaches back to the sacrum. There is also an uterosacral ligament (a major ligament of the uterus) that can get tight from scar tissue that inhibits the sacrum from moving freely as it needs to when we bend, twist and walk. This restricted tissue mobility causes limited sacral mobility and is what leads to back pain.”
In addition, “if the scar tissue from a C-section incision in the lower abdomen is inhibiting the bladder from expanding fully…Once the bladder tries to expand it hits the scar tissue, it sends a signal up to the brain telling it you need to empty your bladder.” (Read more on scar massage here.) There you have it moms, the reason you may need to pee much more frequently than you did pre-pregnancy. Additionally, scar tissue after a C-section can also attach to the hip flexor/psoas muscles causing chronic tightness, back and hip pain.
Wow… deep breaths…and while these symptoms may not always be attributed to C-section scar complications, it is certainly worth investigating.
For self-care strategies in caring for your C-section scar see my next blog, 3 Tips for Healing Scar Tissue and Adhesions!