Care for Your C-Section...what your doctor may not have told you

“Take it easy”, they say. “Don’t lift anything heavier than the baby”, we’re warned. What is not advised is how to care for your scar after your 6 week check up.

Post surgery Expectations:

Post surgery, you will have to keep the area around your stitches dry. It will be hard to move as you are weaning off the medication your doctor gave you. But what you feel for weeks on is pain moving around and numbness is the lower abdominal area. Even if you do feel pain, you should try to walk around a few minutes a day if possible to get the blood circulating.

C-section will cause surgical adhesions. These are bands of scar tissue that form inside your abdomen or pelvis after surgery. As your body heals from surgery, this scar tissue connects organs together, causing them to stick to one another. These adhesions will cause some pain, numbness, and discomfort. It is a natural response due to the trauma your body has undergone. All of your abdominal organs are wrapped in a clear membrane, called the peritoneum. During cesarean section, the peritoneum is cut in order to expose the uterus. As a result, the peritoneum becomes inflamed. After surgery, this inflammation triggers the formation of scar tissue. Typically, this scar tissue disappears after a little while from fibrinolysis. (def: Body’s process of keeping blood clots from forming) However, cesarean section surgery sometimes decreases the blood flow to the peritoneum, preventing the fibrinolysis process from taking place. As a result, the scar tissue forms into adhesions.

There are two options to get rid of the adhesions, one is surgery, the other much less invasive is c-section massage. Until you get clearance from your doctor at the 6-week check-up you should not massage it as you could open up the stitches.

Once you get the ok and the scar is healing nicely, you should massage gently above and below the scar. As the scar becomes less sensitive, you can massage the scar, typically, at the 3-4 month mark.

Importance of C-Section Massage:

Scar tissue does not form neatly, instead it lays haphazardly in whichever direction it pleases. It can attach to tissues, muscles, and fascia, binding together things that should not be connected.

Other problems that may occur is low back and pelvic pain. The scar tissue adheres to all the tissues directly in front of the sacrum. The sacrum is the triangular bone located at the base of your spine that joins to the hip-bone on each side and forms part of the pelvis. The sacrum needs to be able to bend forward and backwards with all of our movements.

There is fascia that runs from the pubic bone around the bladder, uterus and colon and attaches back to the sacrum. There is also an uterosacral ligament, (another major ligament of the uterus), that can get tight from scar tissue that inhibits the sacrum from moving as freely as it needs to when we bend, twist and walk. This restricted tissue mobility causes limited sacral mobility and is what leads to low back pain.

Scar adhesions can also cause frequency in peeing, which most women didn’t think would happen with a C-section. This symptons may not show up for 10-15 years until after surgery. This need to pee more often happens because the scar tissue from your surgical incision in the lower abdomen is inhibiting the bladder from expanding fully. Once the bladder tries to expand and it hits the scar tissue and sends a signal up to the brain telling it you need to empty your bladder. The more scar tissue you have, the less the bladder can expand, and the more you will have to pee!

Scar Process:

When you massage your scar you help the scar tissues learn where to lie down and relieve it from growing in unwanted places like on the fascia and surrounding organs. Massage can facilitate increased blood flow, which is beneficial for healing the area. Massage aids in smoothing out thick scars and can help stop the scar from growing larger during the initial phase of healing.

A scar heals in two phases. The first phase, immature, the scar has just initially formed and healed together. During this phase the scar can be itchy, painful or sensitive as the nerve endings within the tissue heal. While the scar will look red initially, it eventually will fade to normal flesh color with maturation. You can get the most results with exercise, massage and heat application.

The second phase is a mature scar. It can form for up to two years. When scar tissue is no longer being produced then the scar is considered mature. At this point, massaging is still beneficial but requires a more disciplined and vigorous approach. Remember, it is never too late to gain some benefit from massaging your surgical scar!

Massage Technique

1. Purchase some Vitamin E oil pills. Pierce one for each use as that will be just the right amount of oil needed. Take a needle to puncture the oil.
2. Lay down, breath normally, and try not to tense your abdominal muscles.
3. Putting the fleshy part of your fingertips on the skin, gently move 2-3 fingers left to right, and then up and down, and circular, moving it gently against the resistance. There will be some areas that feel tighter than others, move slowly against the resistance, and hold it there until you feel a release under your fingers. You may feel a slight discomfort, and even some pain the next day but that is normal.
4. Once you have been able to do this successfully, you should move deeper into the massage with a firmer pressure to get at the below deeper muscular layers.
5. If you have time, work through your entire lower abdomen area, as adhesions can form near your hipbones.
6. Lastly, once your scar feels less numb, lay down with legs bent this time, gently put your fingers on top of the scar, go left to right, up and down, and if possible circular. Massaging this will help prevent back pain and frequency of urination.
7. It is recommended this massage be done up to year 2 of your surgery. But if you are just seeing this article and you had the surgery 2 or more years ago, you can still do the massage and reap in its benefits.

Click on link for instructional video: C-Section Massage Instructional Video

References:

http://thebalanceguru.wordpress.com/2012/02/25/did-you-massage-your-c-section-scar/

http://www.nappylippy.com/massage-your-c-section-scar/

http://www.pregnancy.org/article/massage-your-c-section-scar

http://www.pelvicphysiotherapy.com