Can C-section scars contribute to abdominal and pelvic pain?
Absolutely—the scar itself can become a source of pain. A 2016 meta-analysis by Weibel et al showed a 15% rate of c-section scar-related pain at 3 months after birth, and a 11% rate of pain at 1 year or more.
What other problems can they cause?
It is well-known that with repeat C-sections, the rate of intra-abdominal adhesions rises significantly. After one C-section the rate has been reported at 7%, but after multiple C-sections the rate of adhesions can reach 68% (Elprine et al 2021). This same study also showed that women have severe abdominal stretch marks, and who have C-section scars that are very dark, highly vascularized, less-pliable, and elevated above the skin level are more-likely to have thick adhesions. Plus, these adhesions can also contribute to urinary urgency and frequency (Silva and Suarez 2016).
Why should I massage my C-section scar?
There have been many small studies that have shown positive effects from C-section or general abdominal scar massage; namely increased scar mobility (Kelly et al 2019), as well as decreased scar-related pain (Gilbert et al 2022, Wasserman et al 2019). Animal studies have shown that massage can decrease the frequency and size of cohesive adhesions specifically, without evidence for other types of adhesions (Bove et al 2017). A systematic review by Wasserman et al in 2019 even shows preliminary evidence for the benefit of scar massage on symptoms related to adhesions that can cause infertility and small bowel obstruction.
I wish I would have known all of this sooner! Is it too late for me to start massaging my scar?
Basically it’s never too late! The most benefits from scar massage are shown within the first 2 years after surgery, but even the scar itself has fully healed, the tissue around it can still get bound down from the scar. So working on the scar can still help improve the mobility of surrounding tissue and fascia, and relieve pain or other symptoms that the scar is causing. However, if you have just had surgery recently, you need to make sure the scar is FULLY closed before starting any type of massage. That means no open areas or drainage, stitches, scabs, or signs of infection like excessive redness or swelling. For most people, this is around 6 weeks after surgery.
Ok so how do I start? Is there something in MommaStrong that can help me?
Yes! We have several videos in Core Camp that instruct you on how to do various types of scar massage, plus abdominal visceral massage. These are found in Bite 13, but can also be watched independently of completing the whole Core Camp Incubator.
Bove, G. M., Chapelle, S. L., Hanlon, K. E., Diamond, M. P., & Mokler, D. J. (2017). Attenuation of postoperative adhesions using a modeled manual therapy. PloS one, 12(6), e0178407. https://doi.org/10.1371/journal.pone.0178407
Elprince, M., Taha, O. T., Ibrahim, Z. M., Khamees, R. E., Greash, M. A., Atwa, K. A., Gadallah, A. M., Al-Okda, N., Abdel Aal, R. M., Ibrahim, M. F., Aboelroose, A. A., Ashour, O. E., Elgedawy, A. M., Elbahie, A. M., Ghoneim, H. M., & Ahmed, A. A. (2021). Prediction of intraperitoneal adhesions using striae gravidarum and scar characteristics in women undergoing repeated cesarean sections. BMC pregnancy and childbirth, 21(1), 286. https://doi.org/10.1186/s12884-021-03763-z
Gilbert, I., Gaudreault, N., & Gaboury, I. (2022). Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar. Journal of integrative and complementary medicine, 28(4), 355–362. https://doi.org/10.1089/jicm.2021.0178
Kelly, R. C., Armstrong, M., Bensky, A., Foti, A., & Wasserman, J. B. (2019). Soft tissue mobilization techniques in treating chronic abdominal scar tissue: A quasi-experimental single subject design. Journal of bodywork and movement therapies, 23(4), 805–814. https://doi.org/10.1016/j.jbmt.2019.04.010
Silva, P. D., & Suarez, S. A. (2016). A Case of Disabling Urinary Frequency and Pelvic Pain Due to Postoperative Uterine Adhesions. WMJ : official publication of the State Medical Society of Wisconsin, 115(1), 43–45.