The “C-section shelf,” is described as the pouch or “pooch” of fleshy, sometimes fatty tissue that hangs over the incision. It can be a concern both aesthetically and functionally.
Many report feeling self-conscious of the abdomen blousing out over the low-lying bikini line incision. The 5-7 inch low transverse incision was a major aesthetic victory over the archaic 8-10 inch vertical incisions of decades past.
The current gold standard low transverse incision is described as “below the bikini line.”
While this incision is less invasive, the marketing suggests that cesarean birth evidence is best kept hidden. Such messaging can contribute to already existing feelings of shame and disappointment surrounding cesarean birth.
What causes a "c-section shelf"??
During incisional healing, collagen is deposited in the gap to help build tissue strength in the scar. Unfortunately, scar tissue collagen is often laid down in a haphazard, chaotic pattern that creates a dense ridge with worm-like appearance. That scar can inadvertently form adhesions between layers of abdominal tissue pinning tissues down.
If there is excess skin/fat from pregnancy or postpartum, it may end up hanging over the adhesion creating a shelf-like appearance.
Why do adhesions cause issues both functionally and aesthetically?
Scar adhesions often include several layers of skin, fat, muscle, and fascia which is the web-like connective tissue that spans throughout the body. Adhesions in the c-section scar can create abnormal tension in other parts of the body such as the low back, hips, and pelvic floor. Adhesions can also bind our pelvic organs such as bladder, uterus and rectum creating a host of pelvic symptoms to include painful sex and urinary urgency.
Scar mobilization is a safe therapeutic exercise that can be performed with a PT or at home that can reduce the impact of adhesions in the body.
Do you need crunches to "fix" your c-section shelf?? NOPE!
It’s easy to be targeted by fitness influencers and quick fix solutions to “fix” the “c-section shelf”. You may be bombarded with programs filled with ab exercises and crunches, or a cream or belly wrap you can wear. You may even get told to take supplements or drink celery juice because the shelf is due to excessive fat from pregnancy.
BUT, all of these are marketing gimmicks to prey on our vulnerability in this transformative time in our lives.
YOU DO NOT NEED TO LOSE WEIGHT OR DO 1000 CRUNCHES A DAY TO HAVE A FUNCTIONAL CORE.
What actually helps with the "c-section shelf" appearance??
Manual scar tissue mobilization and cupping can help to minimize the shelf-like appearance.
Both techniques essentially lift and move tissues that are stuck which can reduce the indentation and thus minimize “shelf.”
1) Scar Tissue Mobilization
Scar tissue mobilization uses movement to release and breakdown adhesions at scar site. Remember, that adhesions can be several layers deep, not just at the superficial layer.
Scar mobilization can use a variety of techniques that vary in difficulty, such as circles at varying depths and the pinch and lift technique.
Casey Backus, physical therapist and 2x c-section mom, shares her personal and professional experience with scar mobilization to support optimal healing and function of your c-section scar and core postpartum.
2) Cupping Techniques
Cupping techniques use external suction to lift the layers apart from one another. This creation of space between layers can also break up adhesions and allow the various layers to glide more smoothly.
Both techniques can be utilized in physical therapy and can be done at home!
What about surgery?? You will still need mobilization to support!
Other remedies for the shelf-like appearance include abdominoplasty which is the surgical removal of excess skin and belly fat. It is sometimes paired with breast surgery and marketed as a “mommy makeover.”
While this procedure can improve the appearance of the shelf, abdominoplasty is another major surgery with a very large hip to hip incision and an expected 6-12 month recovery.
It is important to note that abdominoplasty outcomes are best when paired with scar mobilization and physical therapy to restore core and pelvic floor strength and coordination.
Curious about how to implement scar mobilization for yourself or your clients?
Join us live in our 90-minute C-section scar mobilization webinar or catch the recording/self-paced version on our website.
Ditch the crunches! Focus on mobilizing your scar for optimal function!
Doing endless core workouts and crunches, or using other gimmicky products targeting postpartum women to take up less space, will not help with the c-section shelf.
Ultimately, a c-section shelf is a sign of adhesions at the scar site, and beyond aesthetics, could be affecting your function!
You may find that you experience low back pain, bladder issues, or even pain with intercourse if you have adhesions at your scar!
Focusing on scar mobilization and cupping techniques to release adhesions will not only support your overall function but can also improve the aesthetic appearance of the c-section scar. And the best news? You don’t need to do any crunches.