Cesarean Section Scar Mobilization – A Closer Look

By
By Lakeview Physio
Leah Milne
,
MScPT, Pelvic Health Physiotherapist, Integrated Dry Needling, Pilates
on
Pelvic Health
December 19, 2019

Studies show that the rate of cesarean sections in Canada continues to rise. This also means that as Pelvic health Physiotherapists we are also seeing an increasing number of patients that have had a cesarean section. Whether planned, or not, a cesarean comes with certain risks, and one of these is pain or dysfunction related to scar tissue.

Studies show that the rate of cesarean sections in Canada continues to rise. (1) This also means that as Pelvic health Physiotherapists we are also seeing an increasing number of patients that have had a cesarean section. Whether planned, or not, a cesarean comes with certain risks, and one of these is pain or dysfunction related to scar tissue.

To understand why scar tissue might cause problems lets review what happens in a Cesarean birth.

  • In a planned cesarean (an emergency cesarean might require a different technique) (2) an incision will be made in the skin of the lower abdominal wall about 3 centimeters above the pubic bone.
  • The next layers to be cut are the subcutaneous fat and then fascia (which can also be called the rectus sheath).
  • Next the surgeon has to get through the muscles, which are in- fact not cut, but pulled apart from the mid-line at the rectus abdominus (the six-pack muscles).
  • After the surgeon is through the abdominals they come to the parietal peritoneum. This is a thin piece of tissue that covers the abdominal organs.
  • Once through the peritoneum a cut is made into the uterus and then the baby is born! (2)

This process actually happens quite quickly; and usually in a matter of minutes the parents are meeting their new baby. It is after this that the more difficult work begins. The surgeon will then start to suture layer by layer, starting with the uterus, and finishing with the skin. (2)

Post surgery the healing process begins. Scar tissue begins to form to bring each layer back together. Scar tissue is actually made of the same protein as regular tissue, however instead of being oriented in the same direction of the tissue it is replacing, it can orient itself in many different directions. Think the scar tissue formation like the game of pick up sticks, different fibers going in many different directions. Whereas, the fibers in the tissue it is replacing are all be oriented in the same direction. For some Mom’s, the scar tissue formation may not really affect them that much. For example, they may notice some decreased sensation around their cesarean scar and some light pulling while it is healing. However, for others the scar tissue can have more lasting and negative impacts such as:

  • Reduced skin mobility
  • Nerve irritation in the scar tissue or skin surrounding the scar.
  • Pain or increased sensitivity in the skin around the scar.
  • A feeling of tugging or pulling around the scar. This could then also impact posture and alignment and lead to other muscular pain.
  • Increased tension in the muscles (and fascia) around the scar.
  • Increased urinary frequency or urgency

As a Pelvic Health Physiotherapist, there are lots of things that we can do to help a person who may be struggling with some of the above listed complications from their Cesarean scar. We usually would not start treatment on the scar until the patient is about 6 weeks post- partum, and the scar looks like it is well healed, and there are no signs of infection. If the scar does not look like it is healing properly, there is still significant redness in the scar or around it or the scar is unusually tender we would have the person check back with their doctor.

If the person’s pain or dysfunction is coming from scar tissue formation, scar tissue mobilization can be a great way to improve function and decrease pain. The massage/ mobilization technique encourages realignment and lengthening of the scar tissue fibers so that they are not obstructive of the normal tissue.  Click here for a quick go-to guide on C-section scar massage.  Thus, each layer of skin moves independently on another. This allows the scar tissue in each layer to be oriented in a more favorable fashion so that there is more skin movement and less restriction. As a physiotherapist we might also utilize other modalities such as needling, cupping and other soft tissue mobilization techniques to address the scar tissue restriction.

Another important part of the scar tissue massage is desensitization of the nerve fibers around the scar. Often times after a surgery, injury or trauma, nerves in the surrounding area become more sensitive than the nerves in the un-injured tissue. Our sensory nerves function in our body like pain “alarms” letting us know when something is dangerous and could cause us harm. Often times, after an injury has occurred our nerves can become a little too sensitive. I like to think of this like your fire alarm going off when you have burnt toast. Yes, there is a little bit of smoke, but there is no real danger from burnt toast. Thus, we need to “recalibrate” our pain alarms. Scar massage can be a great way to do this. As long as the tissue is well healed and there is no infection, pressure to the scar should be fine, and really must be tolerated if you want to wear jeans, or lean against your countertop at some time in the near future. So starting with some gentle massage is a great way to recalibrate your nervous system. This might initially set off some of your body’s “pain alarms, “ however, with practice, they will calm down as your body re- calibrates and understands that the pressure is not doing any harm. Another great way to do this is to rub different textured surfaces over the scar, think hair brush, soft cloth, or scrub brush. Allowing the nerves to feel that different surfaces or feelings are in fact not causing any harm can be very helpful!

References:

  1. Denver. R. (2018, April 19). C-section rates continue to increase as birth rates decline. Retrieved from: https://www.cihi.ca/en/c-section-rates-continue-to-increase-while-birth-rates-decline?
  2. Murphy, M., Mcdonagh Hull, P. (2012). Choosing Cesarean: A Natural Birth Plan.

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