“I had an emergency cesarean three weeks ago and the scar still hurts.”
“I had a cesarean 16 months ago and it hurts to be touched.”
“I had a c-section 3 years ago and it still hurts when I exercise.”
“I had a c-section 13 months ago and it is constantly itching.”
Each year 1.27 million mamas will have a c-section in the US and up to 228,000 mamas will develop chronic pain afterwards. I wish the stats were different, but I want you to know that you are not alone in worrying about c-section scar pain. When you have a c-section, your doctor cuts through sever layers to reach your sweet baby and bring them into this world. Your doctor had to cut through skin, fat, fascia and the rectus abdominis muscles, the peritoneum which helps support the organs as well as the uterus and amniotic sac. SEVEN LAYERS. That is no laughing matter, in fact it is major abdominal surgery. If you had an ACL surgery you would give yourself time to heal and recover and you would also expect therapy to strengthen the area as well. Fascia, which is the third layer, regains 51-59% of its strength at 42 days postpartum (~6 weeks) and 73-93% at 4.5 months postpartum. If you are newly postpartum (less than 6 weeks), please know it is not only OK but beneficial to slow down and allow your body the time and space to heal.
A few key things to remember are that if you are newly postpartum or the pain increases in severity, it is important to see your provider for further evaluation. If you are concerned that the scar you can visibly see looks gnarly, please remember that the outward appearance of your scar does not represent how the inner layers look, feel or move!
Steps to relieving cesarean scar pain:
Breathe
Whether you are newly postpartum or your youngest baby is in college, start your healing by working on the breath. This may sound easy, but holy moly can it be hard after having a baby. During pregnancy our bellies grow and our ability to breath in 360º becomes increasingly more difficult each month. After birth our bodies naturally hold onto this newfound breathing pattern, even if it isn’t ideal. Add the c-section scar into the mix and it is even harder to breathe optimally because it’s almost like there is a speed bump in the way when we inhale and it requires more work for the breath to gently descend into the pelvic floor. The key is to keep practicing and get some 1:1 work to ensure you are breathing in a way that makes the abs, back and pelvic floor all work together!Mobilize
A recent study showed that 4 sessions of manual therapy can decrease chronic pain associated with c-section scars. If you are at home, you can gently massage the scar yourself. In an ideal world we want to work on all layers of the scar, including the fascia which is the connective tissue between muscles and the skin. As the fascial layer and muscle layer are deep, it is helpful to see someone trained in scar tissue release and mobilization to ensure the entire body is moving properly.Align
It’s not uncommon to have the “mom stance” after having a baby. You know the one, where you jut out your left hip so you can support your baby hippo on your hip it rather than using your arms. Or the one where you lean so far back you pretend you are a crib to prevent the sleeping kiddo from waking up from their nap. Either way, moms often find themselves in awkward positions and it’s for that reason that it’s also important to look at alignment. There’s no need to be afraid of any position, but it is important to try and keep a neutral spine (diaphragm and pelvic floor aligned, hips centered, weight over the whole foot and not just the heel) to help keep the pressures of motherhood over the center.Nourish
Nourishing our body through food following a cesarean is similar to how we prepare for birth - nutrient dense foods, fiber, and making sure we are well hydrated. We want to make sure we are getting enough macronutrients such as carbs, proteins and fats as well as micronutrients. It’s also important to have regular bowel movements - that means so straining or pushing and going daily.
When it comes to healing, proteins are important because they are the building blocks of the entire body including repairing tissue! I love grass-fed meat, eggs, bone broth, beans and lentils, wild-caught fish as well as nuts and seeds as sources for postpartum protein.
When it comes to tissue repair, collagen and vitamin C are both important in helping the body optimally heal. For collagen you can consume hydrolyzed collagen or you can eat fibers high in threonine (most foods listed above plus carrots, bananas, dairy products and spirulina) as well as green leafy vegetables (spinach, kale, arugula), strawberries, citrus, pumpkin seeds and garlic. When it comes to vitamin C it isn’t just organist—try to eat kiwi, bell peppers, strawberries, broccoli, kale, pineapple, cauliflower, peas or even tomatoes to boost your Vitamin C levels without supplementing.
Fiber and water should go hand-in-hand to help with bowel movements and regular poops are a great way to decrease pressure on the scar! When it comes to fiber, getting it through foods is a great. A few high-fiber foods include berries, pears, avocados, figs, peas, Brussels sprouts, beans (black, lentil, kidney, chick, lima, split) and seeds (flax and chia). I don’t love over-the-counter fiber supplements because consuming fiber supplements and not enough water can basically make you have concrete poops…and nobody enjoys that.
If you want individualized help with nutrition postpartum, I love Mama & Sweet Pea Nutrition and Lactation. The owner, Meghan, is a a Registered Dietitian and Certified Lactation Counselor who understands the nutritional needs of pregnant and postpartum mamas.Strengthen
Remember that ACL? Yeah, I’ve never met a surgeon who doesn’t recommend therapy following major surgery…except when it comes to women’s health. Your provider literally cut through your muscle, so now that your scar is moving better thanks to eating well, regular bowel movements, and manual therapy, it is time to strengthen. A few of my favorite core strengthening exercises are deadbugs, birddogs, side planks and rolls as well as simply carrying objects! I also love mixing them up and adding more or less resistance based on your personal needs!
Cesarean scar pain can be worrisome, but it isn’t something you have to deal with for the rest of your life! If you are tired of your scar keeping you from exercising or playing with your kids or you are done worrying whether or not this pain will last forever, schedule a visit with Dr. Lauren today.
References:
Guttormson R, Tschirhart J, Boysen D, Martinson K., 2008
DOI: 10.1097/JWH.0000000000000103
The information by Dr. Lauren Keller of Elemental Chiropractic, Inc. is provided for general information only and should in no way be considered as a substitute for medical advice or information about any particular condition. While every effort has been made to ensure that the information is accurate, Dr. Lauren Keller nor Elemental Chiropractic, Inc. make no warranties or representations as to its accuracy and accept no responsibility and cannot guarantee the consequences if individuals choose to rely upon these contents as their sole source of information about a condition and its rehabilitation. If you have any specific questions about any medical matter or think you may be suffering from any medical conditions, you should consult your doctor or other professional healthcare provider. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.