Cesarean Scar Massage
Dr. Amanda Welter — February 16th, 2024
Your cesarean scar may be the culprit behind those nagging postpartum aches and pains. It may also be contributing to your bladder, bowel or digestive problems. Beyond the sensitivity or pain that can develop along your scar, there are several more unsuspecting symptoms that can be caused by your cesarean scar which include: pain with sex (typically pain with deeper penetration), lower back or pelvic pain, urinary urgency or increased frequency of urination and impaired digestion or constipation.
PSA: even though you had a c-section, your pelvic floor is not spared. Your scar can wreak havoc on your pelvic floor, bladder and bowel function because the tissues along your abdominal wall work very closely with your pelvis and pelvic organs. If the abdominal tissue is disrupted upstream, it will definitely have an effect downstream. The abdominal wall is connected with your pelvic floor through tissue called fascia, muscles, blood vessels and nerves. When you disrupt this intricate network, your body will form scar tissue as a way to heal, yet this scar tissue is not laid down neatly like “healthy” tissue. The body detects danger and lays down tissue urgently, looking more like a bowl of spaghetti than a block of uncooked ramen. The disorganization of the tissue is what leads to unfavorable compensations.
Healthy tissue without adhesions or scarring is like two layers of saran wrap on top of eachother with oil in the middle, able to easily glide on top of one another. But when scar tissue or adhesions form, it’s like two layers of saran wrap with honey in the middle. It creates more stickiness and restriction within the tissue so the layers can’t glide on top of eachother as easily. So the real problem with your cesarean scar are the adhesions that develop in the healing process, creating restriction in your tissues.
Your scar is also the culprit behind the “cesarean shelf”. Many confuse this shelf or overhanging tissue around your lower abdomen for stubborn belly fat, but really it’s a result of these adhesions. While many women are displeased with the aesthetics of the shelf, it can also be associated with pain. You’re more likely to develop the shelf if your incision was tied up too tight, you have more abdominal fat or you have loose, excess skin.
Fortunately, there are several things you can do to help with these adhesions including cesarean scar massage. While the jury is still out on whether or not we can truly “break up” scar tissue, we do know that we can use specific massage techniques to show the body how to heal and realign, improving symptoms associated with adhesions. It’s hypothesized that these manual techniques like cesarean scar massage work by tapping into the healing controls in our nervous system; ultimately, promoting an easier glide between the tissue layers and a better functioning system. So essentially, the body carries out the healing process on its own, it just needs a little nudge in the right direction.
You want to ensure your incision is fully closed and there are no signs of infection before starting cesarean scar massage. Note:“closed” is not the same as “healed”. True healing takes months, but you can start gentle massage before the scar is fully healed. You have about 25% tensile strength built back up along your incision at 2-3 weeks postpartum. You have about 50% tensile strength at 6 weeks and about 75% tensile strength at 12 weeks. 75% is the most strength you will get back after a surgery like a c-section.
Based on these healing principles, if your incision is fully closed, you can start gentle, indirect mobilizations at 2-3 weeks postpartum because adhesions generally start forming at 3 weeks and it’s best to get ahead of this. Gentle indirect mobilizations will look like light pressure in opposite directions (up and down, side to side, circles) above or below the scar - not directly on the scar. You can gradually work to direct pressure on the scar as tolerable. Around 6 weeks you can apply more force with your mobilizations by using techniques like pinching or the “lift and roll”. And at 12 weeks you can apply even more pressure, using techniques like cupping.
Desensitization is another technique that can be helpful. This technique helps the nerves around your scar “recalibrate” and learn how to find the appropriate sensitivity levels again. You can start this as soon as your incision is closed, around 3 weeks postpartum. It’s very common to develop numbness or hypersensitivity around your scar which can build over time if left untreated. I’ve worked with too many women that have developed a severe aversion to their scar over the years, not able to tolerate waistbands rubbing against the scar or even light touch around the scar.
To do this, you will just need to gather different household objects with varying textures. You’ll want to start with softer materials like cotton balls, q-tips or silk and progress to rougher materials like a towel, velcro or sandpaper. Start by rubbing a softer object along your scar for 3-5 minutes, then progress to rougher objects as the material no longer irritates you. If done early on, you should find improvements in your sensitivity in just a few weeks. If doing years after your cesarean, the progress will likely take longer.
Cesarean scar massage and desensitization are helpful for ANYONE who has had a c-section, even if you don’t have the symptoms mentioned above. It’s ideal to start these techniques within the first 6 weeks postpartum, but it’s never too late to benefit from them.
It is most effective to work with a physical therapist when doing your cesarean scar massage. They can show you what techniques will work best for you and when to implement them. They will provide individualized strategy recommendations to help with adhesion management such as supplements, stretches, and techniques like cupping or myofascial decompression. Not to mention, they will build you a customized exercise routine to help rebuild your core strength without causing pain or worsening conditions like diastasis recti or prolapse. You can refer to our blog, “The Most Common Misconceptions around Diastasis Recti” (coming soon) to learn more about how to grade your core strengthening routine appropriately.
