If you’ve had a Cesarean birth please read on….

There is one thing you must do after having a c-section to save yourself many painful problems down the road.  The thing is, most doctors won’t tell you to do this. It’s really simple but some women have an aversion to doing it.  What is it? It’s c-section scar massage. 

Once you get the ok from your doctor that your scar is well healed, usually at your 6-week check-up, you will want to begin massaging your c-section scar. 

Why do you need to do this? 

When scar tissue forms it lays its fibers down very haphazardly in all different directions.  It also may adhere to tissues you don’t want it to, mainly the surrounding organs. In the abdomen, it can cause adhesions.  Adhesions are bands of scar tissue that bind one organ to another. Any tissue it comes into contact with will adhere to it.  With C-sections, it’s very common to have an adhesion on your colon, ovary, or between your bladder and uterus. Scar tissue needs to be shown how to lie down properly.  A way to do this is by massaging your c-section scar.  

What happens if I don’t massage my c-section scar?

Many women were never told to massage their surgical incision and years down the road they start developing different issues.

Low Back Pain

The most common issue is low back pain.  The scar tissue adheres to all the tissues directly in front of the sacrum.  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 a uterosacral ligament 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 can lead to low back pain. 

Frequent Urination

Another issue that c-section scarring can cause is frequency of urination.  This can happen 10 to 15 years after your surgery. You may find yourself feeling like you have to pee every 15-20 minutes, even though you just urinated.  The scar tissue from your surgical scar in the lower abdomen is inhibiting the bladder from expanding fully. Once the bladder tries to expand and it hits the scar tissue it 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 are going to have frequency. Fortunately, with good scar tissue release work you can be back to urinating normally, which is every 2-3 hours. 

Pelvic Pain and Pain With Intercourse

Two of the most painful issues scar tissue creates is pelvic pain and pain with intercourse.  Adhesion on the organs in the pelvis creates tremendous pain. Our organs are very sensitive structures.  When their mobility is limited, pain is inevitable. With intercourse, the uterus and all the vaginal tissues need to move superiorly.  When scar tissue inhibits this motion, deep thrusting during intercourse is very painful.

How does c-section scar massage help?

When you massage your c-section scar, you help the scar tissue learn where to lie down and you keep it from growing in unwanted places like on the surrounding organs.  Massage can help increase blood flow, which is beneficial for healing the area. Massage can help smooth out thick scars and can help stop the scar from growing larger during the early phases of healing as described below.  

There are four phases of a scar’s healing progression.   The first step is the body’s attempt to stop the bleeding.  The second phase is the scabbing over. The third phase is a rebuilding phase when the scar is immature and 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 effect with exercise, massage, and heat application during this phase.  The fourth phase is a maturation process where the scar strengthens. With C- sections, scar tissue can form for up to 1 to 2 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. 

What is the best way to massage your c-section scar?

As soon as the scar is no longer open and considered well healed, you can begin gentle massaging.  While the scar is in its immature phase, you will want to take a gentle approach when massaging the scar.  Initially, the scar may be really tender, red, and painful. In this stage, it may be best to work around the scar, working the tissues above and below.  As the scar gets less tender, you can follow this procedure with your fingers on top of the scar.

Place your fingertips so the pads of your fingers lay just above your scar line.  You will want to think of the abdomen as having 3 layers, though there are many more, but we are simplifying things here.

Layer 1: Superficial Skin

The first layer is the superficial skin.  You lightly put your fingers on the skin and see how mobile the skin is in moving up and down and side to side.  You may feel it moves down more than it does up so you will want to work more in the upward direction to regain movement in that direction.  Does it move easier to one side than the other? If so, work more in the direction of resistance taking the skin until you feel a gentle stretching in the tissue. Hold it there until you feel a release or the tissues melting. So the movements you want to do are up, down, side to side, and also little circles.  Start by working the tissues around the scar, and later include on top of the scar as your pain and tenderness allows. Eventually, you will want to be able to roll the scar between your fingertips. 

Layer 2: Muscles

The second layer just below the skin is the muscular layer.  Allow your fingers to melt deeper into your abdomen where you feel the abdominal muscles.  Check to see how this layer of the tissues move. Does one side move less than the other side?  I usually find one end of the scar is more restricted than the other side. My theory is the more restricted side is the side the surgeon stood on during the operation.  Does that hold true for you? Do the same movements as with the skin: up, down, side to side, and circles. You want to do it all around the scar and even on top of the scar as pain/tenderness allows.  Doing the whole lower abdomen is not a bad idea. Adhesions can form way over on the colon which lies near your hip bones so feel free to work the entire lower abdomen. Again, if you feel an area or direction that doesn’t move very well, encourage that direction, gently take the tissues to where they don’t want to go and gently hold them there.  You may feel a slight burning sensation, which is normal for stretching tissues. Hold the tissue at their end range of motion until you feel a softening or melting of the tissues. That is scar tissue releasing. It feels like butter melting under your fingertips. If you work respectfully with your tissues, and don’t force them but encourage the tissue to go the directions it doesn’t like to go, you can get the release or melting feeling.  With forcing, the tissue may fight back and not release. 

Layer 3: Organs

The third layer is the deepest layer, working down at the organ level.  Right below your c-section scar line (with a horizontal incision) lies the small intestines where it rests on top of the uterus and bladder.  The bladder sits right behind the pubic bone, the uterus behind and a little up from there. To reach this level, you need to be laying down with your knees bent up to allow the lower abdominal tissues to slacken.  This lets your fingers sink deeper into the tissues and abdominal cavity. Not only do you want to do this massaging at your scar level but also lower near the pubic bone. You want to sink below the muscles and see if you can move these deeper tissues side to side and up and down.  This deeper level is what needs to be released to ensure you don’t develop low back pain or frequency of urination in years to come. Make sure one side feels as mobile as the other side. If it doesn’t, then take the tissues in the direction it doesn’t want to move until you can’t move it any further and gently hold it there until you feel the tissues melting and releasing under your fingers.  Then recheck the tissue’s mobility and see if it matches from side to side. 

How long do I need to massage my c-section scar?

Initially, you will want to do the massaging regularly until your tissues are freely moving in all directions with all 3 layers.  Once you’ve achieved that, then you will want to check in with the area every so often, whether it’s every other week to once a month for the first year or two after your surgery.  If you find the tissues getting tight again, continue with more regular massaging.  

Whether your c-section scar is new, several months, or years old, doing this massaging can help you now and to avoid problems down the road.  This may sound like a lot of work, but spending just 5 minutes a day can do great things in releasing scar tissue and increasing mobility in your lower abdomen.  

If you have difficulties doing this or notice your tissues don’t seem to be responding to your efforts, then you should seek out a Birth Healing Specialist or a Women’s/Pelvic Health physical therapist for treatment. 

Check out my video below or on YouTube describing exactly how to massage your c-section scar.