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!
Enjoyed this article? Read Abdominal Massage: What Do You Store In Your Core?
Learn more about retraining the abdominals with the Coregeous DVD.
A reminder that caring for our scars is a lifelong endeavor. Once we have a scar, we will shall care for it forever. Wishing there was more awareness shared about this with women who have c sections and patients in general who have surgeries of any invasive sort (are they not all?).
Thanks for sharing such a great content, keep up it.
So interesting! I will continue my readings with tips for healing scar and connective tissue!
Such and interesting topic. I’m glad you posted here.
Thanks for the informative post Amy. I still feel numbness after a c-section 16 years ago. I never realized the deep affects of the scarring.
One of the very reasons I chose to train with YTU is because I felt immediate relief from my section scar through rolling the first time in my 200YT.
Its incredible the connections you can create and eleviate from future problems. My section scar has sensation back after a few minutes of connection. Imagine if we connect to ourselves j
I had an emergency c-section 14 years ago. I have felt numb, weak and inflammed in the area of the scar and procedure since. I felt like this was a major procedure yet I was never provided with any follow up therapy or advice on healing. I love that I can use YTU to gently start healing and to bring back awareness of the area to my body. There is a lot of healing to be done and I love that I have found a tool that will finally help.
Excellent explanation of the c-section process, healing and possible secondary effects. In Canada we offer very little rehabilitation information to mothers. Your blog helps fill the void. We also need to take about recovery from birth as a whole, caring for a new born, and vaginal births. I look forward to reading what else you write!
Awesome detail here. In my Level 1 training now and I was trying to understand why after a Cesarean Section it would be hard to create a “tubular core” once the rectus abdominis sewed itself back together. This explains how deep the scar tissue can really go brilliantly, and makes sense as to why certain exercises are counter indicated post pregnancy.
Thank you for this article. I am hoping to avoid a C-section with my current pregnancy but due to a large fibroid I may not be able to. I don’t relish the thought of a C-section and believe that a lot more awareness needs to be raised around how to recover function in the abdominals after such birth. The medical profession seems to shrug its shoulders and not care about our health nearly as much as our offspring’s. “A healthy baby is a priority, isn’t it?” I was told when I expressed some dismay at the prospect of CS. Well, yes, but you know, I teach yoga and Pilates for a living and I kinda need to be able to make things work in that area again, and pretty soon! It amazes me how quickly doctors and midwifes are willing to just sign off any trauma to our bodies as collateral “mummy damage”. I will be using all the balls I can on my scars, should I actually have the procedure!
This might be my favourite post so far. After reading about havoc scars can cause internally and having a c-section several months ago, I can’t wait to pull out my courageous ball and practice the techniques you have shared. Thank you.
Thanks for the information! I am only now learning about everything involved with my c-section scar. I only wish someone has told me sooner.
Have battled with pelvic pain since being pregnant. Had some scar tissue pain between week 18-22 on right side. Then had muscles let go from about 32 weeks and would fall over from about 36 weeks. Ended up with a second caesarean. I am now almost 2 years post caesarean and still battling with issues. Have very tight hip flexor and Psoas muscles and my pelvis keeps twisting even with regular chiro / Osteo appointments. I have had an internal ultrasound and ultrasound done and it did not show anything. How can I be tested to see if the scar tissue has attached to my Psoas / hip flexor?
I am so glad that I searched for posts about “scar tissue” and this one came up! I wish doctors/nurses would shed some light on this post C-sections and other surgeries. It will take some time to undo the layers of scar tissue that have built up over the years of not doing any abdominal massage. I’m nervous but optimistic to use the Coregeous ball on a daily basis to see if this will tap into physical (and emotional) changes for me.
Despite years of training, 23 years after my C-section, I am still unable to do an old-fashioned sit up. I yearn to know more about this topic!
Thank you Amy. Some excellent information to think about as I have had 2 c-sections and have wondered how it all connects. I’ll be revisiting your post and the sensations in my body!
Scars are often like icebergs…there’s much more to them beneath the surface! The body’s processes of healing an incision are so powerful and intricate but can yield adhesions that inhibit or impede function. The information in this article is also applicable to any surgery (just as Lee commented on), shedding light on the incredible interconnectedness of the body and the importance of a self-care regime in rehabilitation. Enter: The Coregeous Ball. This is definitely entering my toolkit both for my personal use and for my private practice for my perinatal specialty population!
Scar tissue is often out of sight. I love that the coregeous ball can be so effective at rolling out adhesions that could be impeding healthy movement patterns, especially in the abdomen. Beyond the healing of c-sections, can infer how useful it may be for endometrial adhesions and use in long term healing after any surgery (bowel, gall bladder, appendix, breast, shoulder, knee) etc.
Very interesting exploration . I, like many mothers, have assumed the blind spots in my abdomen were inevitable and a natural side effect of childbearing. This also speaks to my low back pain and even perhaps digestive issues. Thanks and will be reading more!
Very interesting. In my experience, many women detach themselves from their abdomen after childbirth, especially if the C-section was unplanned and unexpected. They are discouraged that they had the surgery, and tend to disassociate themselves from the event. It’s so important to practice self care, accept what happened and work with the tissue as early as possible. The Coregous balls are a perfect way to access those deep, scarred tissue layers.
It would have been so helpful to have had this mimics information about what happened when I had my c-sections. Of course there wasn’t time to worry about what happened afterward, I just had to work with recovery. And here I am 4 years later and I still have issues that I attribute to my c-sec: tightness in the hip flexor area, less communication with the low abdominal a on my left side, and breath pattern change that I am just starting to id. I can’t wait to work more with the coregous ball to help!
This is fascinating! I sent this to my two friends who are new mothers. I’m looking forward to taking a core immersion to learn more!
2 years?!? Wow! I wish I would have known this 4 years ago. I never would have thought my hip flexor issues could be coming from my c-section scar! Look out coregous ball, here I come.
Thank you. I’m on to the next blog to see what to do about it and thanks for the link regarding scar massage! My personal experience with it is that I had a c-section after attempting natural child birth. I was so glad to have had a really good surgeon when the necessity arose, and now have a greater respect for that profession. I recovered well and quickly and when I had been out of the hospital for less than a week and was home, my dog (100 lb Akita) decided he was petite and wanted a walk and reared up and put one paw on my lower abdomine and scraped downward across the healing scar on one side. Needless to say it was very painful and just about dropped me to my knees. The interesting part is that now there is absolutely no surface scar on the side he scraped. This was such a strong lesson for me and encouraged me to work at the deeper layers of the scar and also to encourage others to do this. I am glad to see this information here. Thank you
This is a great article explaining exactly what can happen after a C-section, and what might be the cause of the pain that can linger well after the baby is born. It is also a good reminder that even if a surgery is “routine,” that simply means it has been performed often with little threat of death or serious injury. It does not mean that it’s a “routine” or “simple” even in your body. Self care for scars is so important! Thank you!
Incredible article! In many countries around the world C-sections and worse, scheduled c-sections are the way to go. Women don’t realize they are having MAJOR abdominal surgery and worse yet, those that do, don’t know how it can affect them and their health for the rest of their life. Beyond that, who (but you) tells you what to do about it??? Thank you so much for this article, very interesting and very important. I hope you get the healing message out!
I’m guessing the Coregeous ball will be an essential part of the C-section scarring self-care…