Scar After a C-Section

Any scar, even an old one, can be the source of various issues. Scar care doesn’t only involve daily care for a few weeks after surgery. According to dermatologists, a scar takes 12-24 months to heal. From experience, we know that in rehabilitation, it’s necessary to care for the scar over the long term—initially every day, and later several times a week. Scar care is important because it can help prevent a number of further complications.

Scar as a Common Source of Restriction

You can think of a scar as an area that is constantly at work. It passes through all layers of skin, subcutaneous tissue, fat, and muscle. These structures heal individually with scars that are interconnected. Normally, the layers are mobile and glide smoothly over one another. Each scar, as it heals physiologically, tends to contract and increase in strength. During the healing process, an immobile piece of tissue forms in each layer, hindering the smooth transfer of forces. If a scar adheres to deeper structures, adhesions form. These structures stop moving, and the stiffened area (adhesion) creates a restriction that often spreads throughout the body. If you feel increased tightness in the scar, it needs to be gently released by shifting it, and an experienced physiotherapist can best advise you on this.

It’s essential to constantly restore mobility around the scar. A C-section scar can worsen the function of gynecological organs and contribute to painful menstruation or functional sterility. It can even limit bowel function and cause constipation. Problems can also be more distant, such as back or sacral pain, or even headaches.

The Risk of an Active Scar After a C-Section

Scar healing occurs in several phases, and each phase takes time, which is why another pregnancy after a C-section is recommended after 12-24 months. By then, the scar on the uterus will be fully healed. If the tensile forces around the scar outweigh the tensile strength of the scar itself, for example, due to incorrect overuse of the still-healing rectus abdominis muscle and abdominal fascia, tiny tears can occur inside the wound, leading to the risk of an active scar. An active scar typically appears raised and reddish in color. Lifting heavy objects, holding the body in a backward position, or standing for long periods (such as during cooking or ironing) can also exert excess strain on an unhealed scar. It’s also not advisable to put long-term volumetric pressure on the lower abdomen, such as from a full bladder or a distended colon.

How to Recognize a Problematic Scar:

• It’s painful
• It’s less resistant to mechanical stimuli, meaning it sometimes pulls
• It’s a more pronounced color than the surrounding skin—most commonly red or pink
• It’s indented or raised
• It occasionally itches
• You don’t like touching it
• It’s not freely mobile, and movement in certain areas is restricted

Oproti tomu normálně zhojená jizva

• Is soft and smooth
• Is pale and blends in with the surrounding skin
• Doesn’t itch
• Doesn’t protrude above skin level
• You may hardly notice you have it

What Can a Scar Cause:

• Breathing changes
• Headaches
• Neck pain
• Back pain
• Leg pain
• Hypertonus of the rectus abdominis muscle, leading to diastasis
• Constipation
• Adhesions (which can complicate future abdominal surgeries)
• Painful menstruation
• Pain during intercourse
• Intermenstrual bleeding or spotting
• Functional sterility
• Chronic pelvic pain
• Stress incontinence
• Pelvic organ prolapse

It’s Never Too Late to Start Caring for Your Scar

At Fyzio Svět, scar care is given significant attention as part of physiotherapy. For us, it’s a kind of groundwork before other physiotherapy techniques (mobilization, manipulation, release techniques, exercises, etc.) are applied. It’s never too late to start caring for your scar, even if it’s years old. However, the older the scar, the deeper we need to go in the care process. Our goal is to separate the individual layers and restore their mutual mobility and flexibility.

Listening and Helping Gently

For some mothers who had a traumatic birth by C-section, the scar represents an unpleasant area that they don’t like to touch. We must first gently teach the woman how to touch the scar. This helps them more easily cope with the complications that the birth may have brought. For example, an emergency C-section due to a non-progressing labor when the mother had hoped for a natural birth. The C-section scar represents the place where their child came into the world, so it deserves respect and acceptance. Take care of your scar with love and joy, and learn to appreciate it.

Often, the stiffness of the scar goes hand in hand with tension in the abdomen around the organs. If this tension persists, the breathing pattern changes as well. The diaphragm, the main breathing muscle, doesn’t want to work in this increased tension and favors upper chest breathing. This further overloads the muscles of the head and neck. Another function of the diaphragm is to stabilize the entire torso and prevent chronic spine-related problems. In the long run, therefore, it’s more beneficial for the entire torso to breathe using the diaphragm.

Your Most Common Questions

Are the rectus abdominis muscles cut during a C-section?

No. During a C-section, the rectus abdominis muscles are separated at the linea alba to avoid unnecessary trauma and potential sources of future problems. However, all the flat abdominal muscles are attached to this area, so it’s important to allow it to heal properly and prevent the development of diastasis.

Why do I feel a pulling pain in my lower left abdomen after a C-section?

Every pain needs to be carefully examined to find the cause. There are many possible causes. Most often, it’s due to the fact that doctors, to prevent the development of postoperative hernias, anchor the strong stitches of the fascia to the left side, which can cause pain in the lower left abdomen. Targeted physiotherapy can help.

Can I give birth naturally after a previous C-section?

Yes, a natural birth is possible, but under certain conditions. The decision is always up to the obstetrician. However, it’s best to plan the next pregnancy at least 12 months after the C-section, when the scar is fully healed. The width of the uterine scar, determined by ultrasound, should be at least 2mm. It’s also crucial that the scar doesn’t cause pain. The estimated weight of the baby and the reason for the previous C-section are also key factors. If you want another natural birth, it’s a good idea to visit a physiotherapist in advance, who can advise you on proper scar care to promote flexible healing of all structures.

Isn’t there a risk of pelvic floor injury and resulting incontinence or sexual dysfunction with natural childbirth?

According to scientific studies, the most significant risk factor for pelvic floor dysfunction is pregnancy itself, which places a great strain on these structures. Therefore, even mothers who have had a C-section are at the same risk of developing incontinence and sexual dysfunction. Proper muscle function here is also influenced by the scar. Therefore, timely and targeted rehabilitation of the pelvic floor muscles before pregnancy is essential.

Why does a scar cause problems so often?

There are many reasons why a scar can cause problems, and many of them are beyond the control of healthcare professionals. The quality of your body’s healing response is crucial, as it determines how the scar heals. The scar should not be mechanically stressed during the first few weeks after surgery through inappropriate work positions or excessive muscle tension, for example, during exercise or coughing. The final appearance of the scar may also be influenced by whether you were under stress in the first weeks after surgery. Other important factors include whether your body is generally prone to adhesions and whether any inflammatory complications occurred during the healing process.

If you have concerns about your scar, we recommend visiting a physiotherapist specializing in the abdominal and gynecological area. They often work with scars and have valuable experience. They can best assess whether your scar is problematic and teach you how to release it. It’s never too late to start caring for your scar.