Today roughly one-third of women are giving birth by c-section. Unfortunately most of these women don’t realize that once their incision has healed completely, problems can still occur as a result of the scar tissue. No instructions are being given to women for how to heal and care for their c-section scars after they go home.
My friend Colette has had two cesareans. Her post-operative instructions while in hospital involved a list of activities to avoid like household chores and driving.
“Scar tissue was never mentioned by any of the doctors over the course of either of my two pregnancies or after my surgeries. I feel like some time should have been spent explaining the risks of post-surgery, not just the risks of surgery itself,” she says.
Colette has been dealing with a myriad of issues related to her c-section scar tissue. Cesarean scars can cause pain well after they’ve healed. This can happen at the incision site, but in other areas as well. It’s important to remember that the scar you see on a woman’s lower abdomen is just one spot that scar tissue has formed. There are also internal scars that, over time, can spread throughout the body. This scar tissue can cause lingering pain and dysfunction well after delivery.
What is Scar Tissue?
To understand why scar tissue needs more attention, you need to understand what it does and how it forms. When tissue in our bodies is damaged, scar tissue forms as part of the natural healing process. After a c-section, scar tissue forms along the abdomen and uterus. It’s made from collagen, like our original tissue, but it has an inferior structure and is less flexible. Our normal skin has basket weave-like fibers whereas scar tissue lays down in a cross hatched formation usually opposing or countering the normal alignment. It’s actually stronger, but less functional.
How Can Cesarean Scar Tissue Cause Pain?
Cesarean scars can be painful. Some women feel pain or tightness in their scars when they are lifting, leaning, reaching or even standing up straight. If a woman cannot stand up straight without feeling pain or a “pulling” sensation, it may cause her to limit movement, change her posture, and eventually lead to pain in her body (for example, lower back pain).
The scar can also cause muscle, connective tissue, and nerve damage in adjacent areas to the scarring. Over time this can lead to pelvic pain, bowel problems (such as constipation and IBS) and painful sex.
Marjorie Brook is a Licensed Massage Therapist and owner of Brook Seminars – Scar Tissue Release Therapy, where she treats and teaches other health care professionals about scar tissue release therapy. “C-section scars are typically located in an area where they can entrap nerves,” she says. “This can cause pain to the urethra and clitoris, and also create an urgency or frequency to urinate. “
“The incision is also right over the area where the round ligament crosses the pelvic brim. This ligament attaches from the sides of the uterus to the labia and can be caught up in scar tissue. If this happens, a woman can experience labial pain, especially with transitional movements like going from a seated position to a standing position.”
“It’s important to remember that the pain and dysfunction caused by a scar is not always going to be in the area where the scar is located. If not treated scar tissue from a c- section can spread in multiple directions, attaching to the pubic symphosis, the hip flexors, straight through to the vertebra and muscles of the back restricting movement and causing pain. It can also travel up towards the diaphragm and inhibit breathing.”
Cesarean scars can also contribute to other problems, such as low back pain, sciatica, incontinence, and pelvic organ prolapse.
How Can You Heal and Treat a C-Section Scar?
As most people know, the best thing for a new Mom is rest and recovery. Doing too much, too soon, after a cesarean is a health risk that far too many women take. Of course it’s important that you keep your incision clean, avoid lifting anything heavy, and eat well to support healing but there’s still more that should be done.
Marjorie recommends that women have lymphatic and myofascial massage 60-48 hours prior to surgery and as soon as possible post-surgery, even in the hospital bed. Lymphatic massage (also called manual lymphatic drainage) is a light massage that encourages drainage and helps the collagen to lay down in line with the incision.
At three months post-cesarean women can begin scar tissue release therapy, which Marjorie calls “The STRAIT Method.” It involves massaging the scar tissue so it becomes softer and more pliable like the surrounding skin and internal tissues. Marjorie describes this as using a “three dimensional focus, slowly and gently seperating the adhered tissues in all directions.” While some find scar tissue release therapy painful, others only feel mild discomfort or no pain at all. Some of Marjorie’s clients have described the pain as a burning sensation. Others have described it as an emotional release that had them reliving their surgeries.
Once the tissues are released the work isn’t over. Marjorie continues her treatment with “integrated therapeutic stretching and other rehabilative modalities to reset the body back to how it was designed to move. “
What About Other Scars?
Every scar, no matter how old, could benefit from scar tissue release therapy from injuries to burns to surgical scars. Surface and internal scarring from surgeries (such as hysterectomy, tummy tuck, breast augmentation, etc.) could be contributing to many of the issues described above. Sometimes scarring is just a piece of the puzzle of your pain and/or incontinence so seeing a pelvic floor physiotherapist in addition to your scar tissue release therapy is recommended.
How Does Scar Tissue Release Therapy Affect the Appearance of a Scar?
In Marjorie’s experience, scar tissue release therapy greatly reduces the appearance of cesarean scars. “It softens tissues and increases circulation, which all lead to a lightening in color of the cesarean scar.” She also added that the “pooch” caused my cesareans are often fluids that have been trapped by the dam of scar tissue, so therapy could help release those fluids as well.
Who Can Work on Cesarean Scars?
Scar tissue release therapy is done by licensed massage therapists, physical therapists, and some acupuncturists may be trained to do it as well.
Find out More:
Marjorie Brooks, LMT & International Educator (Long Island, NY)
Marjorie founded Brook Seminars after working for a decade as a nationally recognized massage therapist. She instructs continuing education courses on her Scar Tissue Release and Integrated Therapies (STRAIT) Method™ all over the world, and has articles published in magazines such as Massage Today, American Fitness, and Massage World.
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