Cesarean birth, which is often referred to as a c-section, is a surgical procedure performed by a doctor to deliver a newborn through an incision that is made in the abdomen and uterus. The doctor makes a deep cut through the bottom of the fascia of the abdomen. They retract that layer of fascia up in order to pull the baby out of the uterus. After the baby is out, they bring the fascia back down and suture it together.
Once the skin has been cut or damaged, our skin cells start growing new tissue to fall in the gap. As the incision heals scar tissue is formed on the surface of the skin and underneath the skin. It can take up to 6-8 weeks for it to heel.
Anatomy of C-section:
However, a C-section is a major surgery and just because everything is back in place and the incision has healed, it does not necessarily come back to its normal form and scar complications can persist.
C-section scars can be the culprit behind a wide range of issues, including:
- Hypersensitivity around the abdomen
- Pain with intercourse, even if you did not have a vaginal delivery
- Gastrointestinal issues such as constipation or slow transit
- Overactive bladder or frequent urination
- Cesarean section scars can lead to pain and tightness which can impact your abdominal strength, blood flow to the area, posture, hips and back. Sometimes these problems can start immediately after surgery but sometimes onset can be more insidious and can start weeks, months or even years post-surgery.
Many of the complications caused by c-section scars can be treated by releasing the tissue surrounding the scar. Massage can help to increase scar tissue mobility and elasticity, reduce muscle restriction, reduce numbness and improve sensation around the scar, improve healing process and its apperance, reduce pain, itching and sensitivity around the scar area, prevent the size of the scar from increasing.
When to start massaging C-section scar?
It is advised to wait at least 6 weeks before attempting to massage the scar tissue. In some cases you may need to wait 8 weeks, depending on how long it takes for your incision to heal.
Do not massage your scar direct until 6-8 weeks post partum although you can do indirect work before then.
Avoid scar massages if open areas or scabs are still present, and if showing signs of infection (such as pus, spreading redness, increased pain or swelling) or if you have any other complications.
Is it ever too late to massage a C-section scar?
Massage is particularly effective in the first 6 months postpartum, however you can still benefit from the scar massage, even if it has been months or years since you had a C-section. Aside from that, it can take up to 2 years for the scar to fully heal and reach the maturation process.
What should you expect during and after a C-section massage.
In the beginning, you may experience slight tenderness, however, the pain should never be excruciating. You may also feel some pulling or slight burning sensations in some areas, spending a little more time stretching in these areas should help. As you continue with your daily self-massages, the amount of pain or tenderness should decrease over time.
How long and regularly to massage a scar?
Begin with 5 minutes of massage daily until your tissues are freely moving in all directions. Then reduce to a weekly massage, if you notice any stiff or tight areas, then work with them. Scar massage can be done lying down on a bed with your knees bent, or completed in the shower or bath if that is more convenient.
How to use oils on a scar?
Start from massaging your scar without an oil because it will allow you more easily to mobilise your skin and scar. Your fingers will slip and slide with oil, and will not allow to stretch and mobilise your scar. Massage your scar without an oil for about 5 minutes and then you can finish off your scar massage by using your scar oil to help with scar hydration.
How to massage C-section scar?
Massage can be performed either directly on the scar itself or the areas surrounding the scar.
Initially, the scar may be quite tender, red, and painful, and it may be best to work around the actual scar itself, working the tissues above and below it. Use your fingers to move your skin up and down, side to side, and in little circles. Massage completely around the scar, repeating each movement 5-10 times. Use enough pressure that the scar can move but not so much that the massage is painful.
Place your fingertips lightly on the skin above the scar and see how mobile the skin is by moving it up and down. Does it move more quickly on one side than the other? Are you sore on one side? If you find a stiff or tight zone, maintain your hold there and breathe – you may feel a release or the tissues relaxing.
As the scar becomes less tender, you can follow this procedure with your fingers directly on top of the scar itself. The fingers should be slightly arched. Place pads of fingers on the edge of the scar. Focus on any area of tightness to encourage movement in that direction by moving the tissues to where they do not want to go and then gently holding them there for 5-10 seconds. Move along the scar every ½ inch-1 inch and repeat over the entire length of the scar, stretching in all directions (up/down, side to side, and diagonal).
You may feel a pulling or slight burning sensation, which is normal for stretching in the tissues. Hold until you feel a softening or melting of the tissues or the feeling that the scar tissue is releasing a little under your fingers.
Final Few Tips
For some women, touching the c-section scar can trigger a traumatic experience preventing them from being able to massage the scar. If you are one of these women, you are not alone, and it is understandable. You can start from touching a scar on top of your clothes to help you build up to direct touch. Also start massaging above your scar (upper abdominal area) and then gradually progress towards your scar but it can take a few weeks. You can also use a soft, clean make-up brush (or a soft baby toothbrush/ hairbrush, a small ball, cotton wool or a cotton bud) to help desensitise the area first.
Do not rush into anything you do not feel comfortable with. Give yourself time to get comfortable with the way it looks and feels.
If these tips do not work then a trained professional can help you with this.
At Woodside Clinic, we aim to provide you with the knowledge to make the best health choices for you. If you have any concerns about your health, we’re here to discuss options and, where necessary, we can refer you to your GP.
- Wasserman JB, Steele-Thornborrow JLS, Yuen JS, Halkiotis M, Riggins EM. Chronic caesarian section scar pain treated with fascial scar release techniques: A case series. J Bodyw Mov Ther. 2016 Oct;20(4):906-913
- Trewartha J and Sharon Wheeler S.Scars, Adhesions and the Biotensegral Body. 2020
- Smith NK abd Ryan C. Traumatic Scar Tissue Management: Principles and Practice for Manual Therapy. 2016