One uncomfortable and sometimes surprising side effect of having a cesarean section (c-section) is that c-section scars may continue to hurt months or even years after the scar has healed. While c-section scar pain is expected in the 6-8 weeks after the date of the c-section, it can be puzzling when it continues to hurt months or years later. Chronic c-section scar pain, defined as pain continuing beyond 3 months postpartum, occurs in up to 25% of people who have a cesarean birth. Fortunately, once we identify the cause of the continued c-section scar pain, we can identify appropriate treatment to help bring your pain and sensitivity down.
In this guide, we’ll go through types of c-section scars, common symptoms associated with a c-section scar, different treatment options, and things you can do to reduce pain at your c-section scar.
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What is a C-Section Scar
During a c-section surgery, an incision (typically horizontal but sometimes vertically) is made in the low abdomen. When horizontal, the incision is made around the bikini line. A c-section requires the surgeon to cut through each layer of the abdominal wall and uterus to reach the baby. Once the baby is born and the placenta is removed from the uterus, sutures are made to close the incision.
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While the incision creates a surface level scar that we can see on the skin, it’s important to note that the scar tissue extends through all layers of the skin, fascia, and muscle tissue. In fact, while we can see the sutures or glue on the skin, deeper tissue layers are sutured as well. If you’ve ever felt around your scar and noticed a bump under the skin, you may be feeling an internal suture. So when we talk about a c-section scar, we’re not only referring to the surface level scar but also the deeper layers.
Because postpartum people are less mobile in the first four to six weeks following a c-section and often protective of the tissue surrounding the scar, additional tightness and restrictions in the body can contribute to further abdominal and scar restrictions.
Types of Scar Tissue Seen in C-Sections
Scar tissue is a type of tissue that forms after surgery or injury — in this case, a c-section. But not all scars form the same way. Some types of scars may be more likely to occur as a result of infection or increased tissue trauma, while others may be prone to certain types of scarring as a result of their genetics. Some common types of scar tissue that can form at a c-section include the following:
Hypertrophic scars
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Hypertrophic scars are red and raised, however, they don’t extend outside the borders of the area of the original incision. Hypertrophic scarring occurs as a response to wound healing, creating a raised and red scar. Oftentimes the appearance improves within 6 months to a few years. Genetics may play a role in the formation of this type of scarring.
Keloid scars
Keloid scars are more noticeable because they are similarly red (in some cases purple, white, or lighter skin tone than the surrounding area) and raised. However, these scars extend beyond the boundary of the original incision. While we’re not sure exactly what causes keloid scars, there does seem to be a genetic link.
Adhesions in scars
While not a specific type of scar, adhesions can contribute to a specific type of scar appearance that some find concerning. As mentioned above, your c-section scar has multiple layers below the skin. When adhesions or scar restrictions form in any of these layers, this can contribute to the appearance of an indented scar. This can also create the appearance of a c-section scar shelf. Adhesions are a normal occurrence in a healing body but certain treatments that we’ll discuss below can help to reduce the appearance associated with them.
Understanding the types of scars that might occur from a c-section is helpful for determining how to treat the scar pain, as each type or scar may may benefit from different treatments.
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