Why Does My C-Section Scar Hurt and What Can I Do About It?
One uncomfortable and sometimes surprising side effect of having a cesarean section (c-section) is that c-section scars may continue to hurt months or even years after the scar has healed. While c-section scar pain is expected in the 6-8 weeks after the date of the c-section, it can be puzzling when it continues to hurt months or years later. Chronic c-section scar pain, defined as pain continuing beyond 3 months postpartum, occurs in up to 25% of people who have a cesarean birth. Fortunately, once we identify the cause of the continued c-section scar pain, we can identify appropriate treatment to help bring your pain and sensitivity down.
In this guide, we’ll go through types of c-section scars, common symptoms associated with a c-section scar, different treatment options, and things you can do to reduce pain at your c-section scar.
What is a C-Section Scar
During a c-section surgery, an incision (typically horizontal but sometimes vertically) is made in the low abdomen. When horizontal, the incision is made around the bikini line. A c-section requires the surgeon to cut through each layer of the abdominal wall and uterus to reach the baby. Once the baby is born and the placenta is removed from the uterus, sutures are made to close the incision.
While the incision creates a surface level scar that we can see on the skin, it’s important to note that the scar tissue extends through all layers of the skin, fascia, and muscle tissue. In fact, while we can see the sutures or glue on the skin, deeper tissue layers are sutured as well. If you’ve ever felt around your scar and noticed a bump under the skin, you may be feeling an internal suture. So when we talk about a c-section scar, we’re not only referring to the surface level scar but also the deeper layers.
Because postpartum people are less mobile in the first four to six weeks following a c-section and often protective of the tissue surrounding the scar, additional tightness and restrictions in the body can contribute to further abdominal and scar restrictions.
Types of Scar Tissue Seen in C-Sections
Scar tissue is a type of tissue that forms after surgery or injury — in this case, a c-section. But not all scars form the same way. Some types of scars may be more likely to occur as a result of infection or increased tissue trauma, while others may be prone to certain types of scarring as a result of their genetics. Some common types of scar tissue that can form at a c-section include the following:
Hypertrophic scars
Hypertrophic scars are red and raised, however, they don’t extend outside the borders of the area of the original incision. Hypertrophic scarring occurs as a response to wound healing, creating a raised and red scar. Oftentimes the appearance improves within 6 months to a few years. Genetics may play a role in the formation of this type of scarring.
Keloid scars
Keloid scars are more noticeable because they are similarly red (in some cases purple, white, or lighter skin tone than the surrounding area) and raised. However, these scars extend beyond the boundary of the original incision. While we’re not sure exactly what causes keloid scars, there does seem to be a genetic link.
Adhesions in scars
While not a specific type of scar, adhesions can contribute to a specific type of scar appearance that some find concerning. As mentioned above, your c-section scar has multiple layers below the skin. When adhesions or scar restrictions form in any of these layers, this can contribute to the appearance of an indented scar. This can also create the appearance of a c-section scar shelf. Adhesions are a normal occurrence in a healing body but certain treatments that we’ll discuss below can help to reduce the appearance associated with them.
Understanding the types of scars that might occur from a c-section is helpful for determining how to treat the scar pain, as each type or scar may may benefit from different treatments.
What Other Symptoms Accompany C-Section Scar Pain?
Tissue healing occurs throughout the entire first year following a c-section. C-sections need a significant amount of recovery time because incisions are made through all layers of the abdomen, including the skin, abdominal musculature, fascia, adipose tissue, peritoneum and uterus, to deliver the baby.
Pain and other symptoms in the c-section scar typically improves over the first 6 weeks postpartum, but that’s not always the case. Up to 1 in 4 people continue to have c-section scar pain at 3 months postpartum, and if left untreated some can experience pain for years. Some of the most common symptoms associated with c-section scar pain include:
Tenderness and discomfort at the scar, or above or below the scar
Burning sensation surrounding the scar and low abdomen
Redness or discoloration at the scar and area surrounding it
Swelling at the scar or in the area
Pain when pressure is applied to the scar or surrounding area
Aching pain that is worse when in certain positions or when doing exercises that target the abdominal area
Difficulty moving the affected area due to tightness
Decreased sensation at the scar or surrounding tissue
While these symptoms are common, they are treatable. If you’re experiencing continued pain with your c-section scar beyond 6 weeks postpartum, it’s important to consult your medical provider to ensure your tissue is healing appropriately and there’s no sign of infection. But if your pain continues beyond the time the wound heals, consider working with a pelvic floor physical therapist who can help identify the cause of your pain and create a personalized treatment plan.
C-Section Scar Pain Treatment
There are a number of treatments and techniques that can reduce pain and discomfort stemming from a c-section scar. Our pelvic floor PTs offer all of these options and more in our clinic at Lady Bird PT.
C-section scar pain can come from aggravated muscle, fascia or irritated and sensitized nerves. There are a number of options for c-section scar pain treatment. Some of the most common your pelvic floor physical therapist may employ include:
The use of compression underwear, masks or silicone-gel plates
Scar massage performed at home or by a trained physical therapist
Dry needling
Cupping to the scar and surrounding tissue
Stretching and strengthening the muscles surrounding the scar
Myofascial release
Nervous system down training
Hip and lumbar spine mobilization
Pelvic Floor Physical Therapy for C-Section Scars
Physical therapy for c-section scars is a common and effect treatment option to address long-term pain. Manual scar mobilization is one of the most common techniques and involves hands-on c-section scar and surrounding tissue release. This release may also involve additional modalities like cupping, Graston or dry needling.
A pelvic floor physical therapist can also help address any related diastasis recti or abdominal muscle weakness that may be contributing to your abdominal discomfort. Regaining abdominal strength can be intimidating after a c-section, and pelvic floor PT can help you determine the right approach for your body.
FAQs
Why does my c-section scar hurt years later?
C-section scars can be painful months or years after the surgery, but this pain is treatable. Chronic c-section scar pain occurs for a variety of reasons, including scar and surrounding muscular restrictions, sensitized nerves and altered movement patterns resulting from the continued pain. Chronic pain is not necessarily a sign that anything is wrong with your scar or the tissue itself, but that doesn’t mean the pain isn’t real. Chronic scar pain can often be treated with a combination of manual therapy and exercise to help improve scar mobility, reduce down adhesions and nervous system sensitivity, and modify any altered movement patterns to get you feeling your best..
How long will a c-section scar hurt after surgery?
C-section scar pain typically lasts for 4-6 weeks, consistently improving week over week. With that said, some people experience pain and sensitivity in their scar for much longer. A variety of factors plays into how long a c-section scar will hurt including genetics, nutrition, hydration, sleep, your individual birth experience, and much more. If you’re continuing to experience pain beyond 6 weeks postpartum, contact us for an appointment here.
How long does a c-section scar take to heal internally?
It takes roughly 4 to 6 weeks for a C-section scar to heal on the skin level. This gives enough time for the uterus and abdominal wall to recover, as well. Scar maturation will continue to take place for up to 2 years after the surgery.
Why does my c-section scar hurt on one side?
In some cases, the scar pain may occur from tension or pressure in the abdomen area due to the formation of the c-section scar tissue. In other cases, the C-section scar may be painful due to a buildup of scar tissue. Having unilateral, or one sided, pain is not abnormal and is not a sign of a greater concern unless accompanied with redness, heat, swelling or discharge from the scar. If this pain is new, we always recommend discussing with your medical team.
How many people experience c-section scar pain?
Many suffer from discomfort in their c-section scars. While this is most common from the 3 to 12-month period following childbirth, it’s common for C-section scars to continue to hurt much longer. Up to 25% of people may experience chronic c-section scar pain.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.