My scar is “healed” so everything is fine, right?
The infamous 6-8 week “all clear” appointment is in the books so what now? If you were given clearance, your incision was likely labeled as well-healed. This feels like an indicator that we no longer need to treat the incision but unfortunately, that isn’t optimal. C-sections account for ~32% of all births in the US and a bit less internationally. It is important that moms are aware of healing strategies after this major surgical procedure.
Skin Healing versus Tissue Healing
When the provider labels an incision as well-healed, they are primarily addressing skin healing. The skin is clean, dry, intact, without any open areas, pus, blood, or drainage. This is an indicator that the incision is fully closed and not at risk of infection. All of these things are critically important to your health but they do not indicate how well your tissues are functioning during exercise, functional movement, or in life in general.
Part of the body’s skin healing mechanism is the laying down of a protein (known as collagen) in the incision to improve tissue strength. This phase, known as the remodeling phase, occurs from about week 3 post-cesarean until about 2 years. Collagen depositing strengthens the tissue but can also be responsible for the formation of adhesions. An adhesion is a band of scar tissue that joins two internal body surfaces that are usually not connected. Organs or tissues within the body adhere (stick) to other internal surfaces such as skin to fascia, muscle to skin, or uterus to the bladder. Adhesions develop as the body attempts to repair itself and cesarean birth requires the incision of 7 layers of tissue.
Could I have adhesions and not know it?
The answer is yes. Adhesions can impact function in a number of ways including affecting posture, core muscle activation, bladder urgency or incontinence, low back pain, pain with penetrative sex, the aesthetic appearance of a shelf or “pooch.” Recognizing and addressing adhesions with scar mobilization techniques can be paramount in return to the symptom-free living.
Adhesions can occur between the skin and fascia/fat, between the fascia and abdominal muscles, between the 4 layers of abdominal muscles, abdominal muscles and deep abdominal fascia, abdominal wall and the uterus, and between the uterus and bladder. It is not surprising that many people complain post-cesarean that their stomach just feels “weird.” If the tissues are stuck together, they are not able to move freely and function independently of one another.
For example, when the 4 layers of abdominal muscles are adhered together by scar tissue, they cannot contract or tighten in an optimal way. Lack of core activation can contribute to less than optional diaphragm function for breathing, low back pain, and pelvic floor dysfunction. Scar tissue mobilization can be an effective tool for addressing adhesions. It can be initiated as early as 3 weeks on the skin around the scar and patients can benefit from it even decades after cesarean birth. It’s never too late to mobilize these tissues.
I’d love to connect with you in our upcoming C-section Scar Mobilization webinar and discuss the specific techniques/parameters for mobilization as well as the signs that a scar may have adhesions. It is never too late to mobilize scar tissue and any amount of mobilization can create improvement. As a C-section mama x 2 and physical therapist, I am passionate about sharing these resources with any moms in need!