Much of the recovery process after a c-section birth feels out of your control. Really, other than “taking it easy,” patients are given little information on how they can help avoid painful issues down the road. However, despite getting very little press from physicians or other resources, there is one simple activity that can aid in both your recovery and long term prognosis — massaging your surgical scar.
When Should You Begin Massaging Your C-Section Scar?
Once you get the okay from your doctor that your scar is well healed, usually at your six-week check up, you will want to begin massaging your surgical scar. If you are having pain before then, you can do gentle massaging around the scar area while it is healing, but not on top of the scar tissue. Loosening up the surrounding tissues can help ease your pain. After you have clearance, however, don’t delay working directly on the scar to garner maximum benefits! Also note, whether it has been months or even years since your c-section, it isn’t too late to achieve improvements. Trust me, this is worth your time to learn more.
Why Should You Massage Your Surgical Scar?
When scar tissue forms it lays its fibers down very haphazardly in all different directions. It also may adhere to tissues you don’t want it to, mainly the fascia and organs. The fascia is a band of connective tissues covering or binding together parts of the body, such as muscles or organs.
In the abdomen it can cause adhesions. Adhesions are bands of scar tissue that bind together body parts that are normally unconnected. Any tissue it comes into contact with may stick to it. With c-sections it’s very common to have an adhesion on your colon, ovary or between your bladder and uterus. Think of these fibers as a tangled mess of yarn that has bounced around your room, wrapped around everything but where it should be! Scar tissue needs to be shown how to lie down properly.
The “training method?” Massage your surgical scar!
What Happens If I Don’t Massage My Scar?
Many women were never told to massage their surgical incision. “Healing” instructions are often limited to the outer appearance — to avoid redness, watch for signs of infection, etc. Years down the road these same women may endure numerous medical concerns. Without having a more in-depth physical exam, they may not even associate it with their previous c-section.
The most common issue is lower back and pelvic pain. The scar tissue adheres to all the tissues directly in front of the sacrum. The sacrum is the triangular bone located at the base of your spine that joins to a hip bone on each side and forms part of the pelvis. The sacrum needs to be able to bend forward and backwards with all of our movements.
There is fascia that runs from the pubic bone around the bladder, uterus and colon and attaches back to the sacrum. There is also an uterosacral ligament, (another major ligament of the uterus), that can get tight from scar tissue that inhibits the sacrum from moving as freely as it needs to when we bend, twist and walk. This restricted tissue mobility causes limited sacral mobility and is what leads to low back pain. In layman’s terms: Ouch!
C-section scarring can cause frequency of urination. Unbelievably, this symptom can delay until 10 to 15 years after your surgery! You will find yourself feeling like you have to pee every 15-20 minutes, even though you just urinated. Relatively young women may be horrified at this loss of bladder control and stressed by their need to either stay within a fast dash to the toilet or wear Depends™.
So what’s happening? The scar tissue from your surgical incision in the lower abdomen is inhibiting the bladder from expanding fully. Once the bladder tries to expand and it hits the scar tissue it sends a signal up to the brain telling it you need to empty your bladder. The more scar tissue you have, the less the bladder can expand, and the more you will have to go, go, go!
Don’t give up hope! This isn’t like that extensive exercise routine that you can’t seem to become motivated to do. A few minutes of effort on your part of good scar tissue release work will have you back to urinating normally, which is every two to three hours.
Two of the most painful difficulties scar tissue creates are pelvic pain and pain with intercourse. Adhesion on the organs in the pelvis generates tremendous pain. Our organs are very sensitive structures. When their mobility is limited, pain is inevitable. With intercourse the uterus needs to move superiorly out of the way. If scar tissue inhibits this motion, deep thrusting during intercourse can be downright agonizing. This often leads to almost complete avoidance which is likely to cause a strain on the best of relationships for both parties involved.
While massaging your c-section scar may not prevent all instances of these issues, it is shown to lessen the risks and/or impact of these matters for your future health in both long and short term! In other words, what are you waiting for?
What if I don’t like touching my scar?
For many women, especially if your surgery wasn’t planned, there most likely is trauma associated with your c-section experience. When anything occurs to us that is outside of our control and/or too overwhelming to deal with, there is a tendency for us to disconnect from ourselves. This disconnect is a natural part of a trauma response. Being unable to touch or even look at your scar are indicators that you are dealing with trauma in your body. I highly recommend seeking professional help, someone trained in trauma release work, to assist you in letting go of your trauma so you can reconnect to and take care of yourself.
How does massaging Your Scar Tissue Work?
When you massage your scar you help the scar tissues learn where to lie down and relieve it from growing in unwanted places like on the fascia and surrounding organs. Massage can facilitate increased blood flow, which is beneficial for healing the area. Massage aids in smoothing out thick scars and can help stop the scar from growing larger during the initial phase of healing.
A scar heals in two phases. The first phase, immature, the scar has just initially formed and healed together. During this phase the scar can be itchy, painful or sensitive as the nerve endings within the tissue heal. While the scar will look red initially, it eventually will fade to normal flesh color with maturation. You can get the most effect with exercise, massage and heat application during this phase.
The second phase is a mature scar. With c-sections, scar tissue can form for up to two years. When scar tissue is no longer being produced then the scar is considered mature. At this point, massaging is still beneficial but requires a more disciplined and vigorous approach. Remember, it is never too late to gain some benefit from massaging your surgical scar!
What is the Best Way to Massage Your Surgical Scar?
As soon as the scar is no longer open and considered well healed you can begin gentle massaging. While the scar is in its immature phase you will want to take a mild approach when massaging. Initially the scar may be really tender, red and painful. In this stage it may be best to work around the scar, focusing on the tissues immediately above and below it. As the scar becomes less sensitive you can follow this procedure with your fingers on top of the scar.
Place your fingertips so the pads of your fingers lay just above your scar line. You will want to think of the abdomen as having three layers, though there are many more but we are simplifying things here.
The first layer is the superficial skin. You lightly put your fingers on the skin and see how mobile the skin is in moving up and down and side to side. Think about placing your fingers on a keyboard and you’re checking to see if all the keys move equally in all directions.
Work in the direction of resistance. You may feel it moves down more than it does up so you will want to work more in the upward direction to regain movement in that area. Does it move easier to one side than the other? If so, work more in the direction of resistance, taking the skin till you feel a gentle stretching in the tissue. Hold it there until you feel a release or the tissues melting.
To recap, the movements you want to do are up, down, side to side and also little circles. Start by working the tissues around the scar and, in time, progress to doing it on top of the scar as your pain and tenderness allows. Eventually you will want to be able to roll the scar between your fingertips.
The second layer just below the skin is the muscular layer. Allow your fingers to melt deeper into your abdomen where you feel the abdominal muscles. Check to see how this layer of the tissues moves. Does one side move less than the other side?
I usually find one end of the scar is more restricted than the other side. My theory, which I haven’t proven yet, is the more restricted side is the side the surgeon stood on during the operation. Does that hold true for you?
Repeat the same movements as with the skin — up, down, side to side, and circles. Once again, you want to do it all around the scar and even on top of the scar as pain/tenderness allows.
Feel free to work the entire lower abdomen. Adhesions can form way over on the colon located near your hipbones.
Once more, if you feel an area or direction that doesn’t move very well, encourage in that direction. Gently take the tissues to where they don’t want to go and carefully hold them there. You may feel a slight burning sensation, which is normal for stretching tissues. Hold the tissue at their end range of motion until you feel a softening or melting of the tissues. That is scar tissue releasing. It feels like butter melting under your fingertips.
If you work respectfully with your tissues, not forcing but encouraging the tissue to have more freedom of movement, you can attain that release or melting feeling. Avoid forcing, as the tissue may fight back and never release.
The third layer is the deepest layer working down at the organ level. Right below your scar line lies the small intestines where it rests on top of the uterus and bladder. The bladder sits right behind the pubic bone; the uterus behind and a little up from there.
To reach this level you need to be lying down with your knees bent up to allow the lower abdominal tissues to slacken. This lets your fingers dive deeper into the tissues and abdominal cavity. Not only do you want to do this massaging at your scar level but also lower near the pubic bone, you want to sink below the muscles and see if you can move these deeper tissues side to side and up.
This deeper level needs to be released to ensure you don’t develop low back pain or frequency of urination in years to come. Make sure one side feels as mobile as the other side. If it does not, focus your attention to increase mobility in the area of most resistance until you can’t move it any further. Gently hold this position until you feel the tissues melting and releasing under your fingers. Continue to recheck the tissues mobility and see if it matches from side to side.
I have not heard of anyone causing problems or damage by massaging their own scar tissue, as pain usually stops you from doing too much. It’s very hard to inflict pain on yourself, unless you are sadistic! If you are doing any “damage,” pain will be created. Pain is a signal to stop! When you work respectfully with the tissues they respond by relaxing and releasing. A pulling or burning sensation may be experienced and that is ok, try to hold that feeling til it lessens or gives way. If you are too aggressive, pain will prevent you from getting those desired results.
How Long Do I Need to Continue Scar Massaging?
Initially, massage regularly until your tissues are freely moving in all directions within all three layers. Once you’ve achieved that mobility you will want to check in with the area every so often, whether it’s every other week to once a month for the first year or two after your surgery. If you find the tissues getting tight again return to a more regular massaging routine.
Whether your c-section scar is new, several months, or years old, performing this massage can help you avoid problems down the road. It’s never too late! It may sound like a lot of work but spending just five minutes a day can do great things in releasing scar tissue and increasing mobility in your lower abdomen. If you have difficulties doing this or notice your tissues don’t seem to be responding to your efforts, then you should seek out a Women’s Health physical therapist for treatment.
Lynn Schulte-Leech is a physical therapist with over 20 years of experience. She specializes in Women’s Health and Visceral Manipulation.