C-section Scar Pain Recovery

“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:

1. 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!
   

2. 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.
   

3. 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.
   

4. 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.
   

5. 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:

1. Guttormson R, Tschirhart J, Boysen D, Martinson K., 2008

2. 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.

Breastfeeding and Pelvic Organ Prolapse

Is weaning the best option when a mama has incontinence or prolapse?

Birth, it is a magical time where we finally meet the newest love of our life. Unfortunately, the birthing process sometimes leads to less than magical side effects like incontinence (leaking of urine when we laugh, cough, sneeze, jump or lift or a strong urge to go all.the.time) and maybe even pelvic pain or pelvic organ prolapse. For many moms that are breastfeeding they are given two options: 1) deal with it until you decide to stop breastfeeding or 2) wean your child. Since I’m feeling feisty today I’m going to put it bluntly, both of those options are steamy pile of BS. And since I like to back up my feistiness with research, here’s why you deserve better:

Relaxin and estrogen are not the enemy

Doesn’t increased relaxin and decreased estrogen weaken the tissues of the pelvic floor? Well, kind of. Prolactin, can block the production of estrogen. And it’s true, a decrease in estrogen can weaken the pelvic floor musculature but this is most commonly seen with the hormonal shifts of menopause, not postpartum. Relaxin has also been shown to decrease by three days postpartum so it is unlikely that relaxin is causing the pain or discomfort.

Many mamas who supplement also experience similar issues so emphasizing the hormonal effects of breastfeeding at the expense of looking at the bigger picture can lead to insufficient care for new moms. For a long time breastfeeding and hormones have been blamed but there is new information coming out about the importance of nutrition, methylation (liver support), the gut microbiome and even sleep quality as it relates to pelvic pain. All of this to say, it isn’t just breastfeeding but everything going on around you that can affect what’s going on down there.

Prolapse, incontinence and pelvic girdle pain are all signs of mechanical dysfunction

Often times mama who have prolapse or incontience also have hip and/or low back pain, diastasis recti and even pelvic pain. These are all signs of a mechanical problem. Mechanical problems are often best treated, well, mechanically. This is where a professional trained in pelvic floor rehabilitation and functional movement excels. A proper evaluation of the pelvic floor looks at you, the mama, as whole. If you aren’t sure what to expect, here’s a great article on what to expect at Your First Visit to See a Pelvic PT. The evaluation often includes your history, a movement exam (including how you are breathing, your posture, etc), specific tests to look for both stability and mobility, myofascial palpation (do you have tenderness in the abdomen, pelvis, buttocks or even the thighs), and the pelvic floor exam once you feel comfortable. This whole-body approach will help your provider determine the mechanical cause(s) of prolapse, pain, discomfort or incontinence in order to treat the entire system.

Breastfeeding and Pelvic Girdle Pain - Are they related?

There was longitudinal study out of Norway that followed over 10,000 women that showed breastfeeding has a small beneficial effect on pelvic pain and should be encouraged rather than discouraged.

The Catch: Lactational Atrophic Vaginitis

Atrophic vaginitis is dryness and inflammation of the vaginal tissues generally seen in post-menopausal women but can sometimes cause symptoms in lactating moms due to excessively low estrogen. Signs of lactational atrophic vaginitis include pain during sex, decreased sex drive, vaginal itching or dryness, frequent UTIs, irritation with clothes and an increased urge to urinate.

Although lactation atrophic vaginitis is caused by decreased estrogen, there are solutions that can help manage this discomfort! The management of atrophic vaginitis is different than the management of prolapse, pelvic pain or incontinence as it may include hormone replacement in the form of topical estrogen (see OB/midwife for appropriate recommendations), botanical therapies and self-help measures. Botanical therapies may include moderate amounts of phytoestrogens like soy, oats, sesame seeds, barley, apples, carrots, lentils and pomegranates. Self-help measures include using water-based lubricants to help moisturize the tissue or Vitamin E oil or hyaluronic acid suppositories.

There are many factors that influence postpartum recovery. It is important to figure out what influences you individually. For some moms, they need more emotional support or self care time, others benefit from attention to nutrition, improved sleep (yes, difficulty sleeping is closely related to pelvic pain) some are in pain from physical complications related to their birth and labor experience. If any provider undermines your confidence in feeding your child by stating breastfeeding is the only cause of your pain or discomfort, you are allowed to fire them. Each mama is different and it is important to enlist the appropriate support team to look at the whole picture. Along with you, that team may include a chiropractor or physical therapist trained in pelvic floor rehab, your OB or midwife, nutritionist or a functional medicine doctor. It’s important for the team to work together WITH YOU to determine the root cause of your incontinence, prolapse and/or pelvic pain.

I know you would probably love to be in control of your pelvic health and have a plan so I’m excited to offer a complimentary 15 Minute Healthy Mama Strategy Session or you can schedule an appointment today. I look forward to hearing from you and if you have questions, don’t be afraid to reach out and ask!

References:

1. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13118?fbclid=IwAR0g9BcZRjxZjUA-rpXpWykvR_gWeDzF7-nNd78k7OA9_e4gp6ZF5UJNCa4

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307380/

3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(86)92068-4/fulltext

4. https://www.ncbi.nlm.nih.gov/pubmed/12867914

*Disclaimer:

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.