I have a surgeon friend who always says to patients:
“WHEN YOU CUT YOU CRY”
Not the most comforting words, but there is some truth in his statement. There is always pain with surgery. But what happens when the pain remains longer than anticipated?
WHY IS IT SORE?
The ceasarian scar looks healed. You had your six week check up with your obstetrician, and everything is “fine” and “healed”.
But why does it still hurt when you have sex? Why does it still hurt when you have a full bladder? Why does your scar feel sensitive? Why does your belly bloat? Why do you struggle with constipation?
Your scar could be contributing to this discomfort! Swelling or bruising in the area can be painful. The lack of movement in the area can also cause tightness and discomfort. Superficial nerves can become irritated by the trauma of the surgery or even due to scar tissue irritating it. Sometimes healing is slowed due to health conditions.
What are the four stages of healing?
Stage 1: Stopping the bleeding
Immediately after the C-Section your own platelets form a plug in the “hole” and your body narrows the blood vessels so that bleeding can stop. Now is a good time to keep the wound closed and protected.
Stage 2: Forming a scab
Clotting happens with the help of the protein called fibrin, that glues the platelets in place. Now your blood vessels open a little again, so that the area receives better blood flow to bring oxygen, nutrients, white blood cells (infection figthers) and macrophages (wound cleaners) to the area. Sometimes the wound might drain a little clear fluid until the scab has formed. The stitches keep the edges of the wound together so the scab can cover it.
Stage 3: Rebuilding
Once the wound is cleaned and a “cover” for the “hole” is in place, the building materials arrive to close up the deeper area of the wound. and stable, your body can begin rebuilding the site. Oxygen-rich red blood cells come to the site to help your body create new tissue. It’s like a construction site, except your body makes its own building materials. Your body builds a framework of collagen over the whole area.
Stage 4: Maturing
Your wound can continue feeling tight and itching for many weeks after it appears healed. Your body is still working on the area, remodellling the area – laying down material, taking a look, removing some tissue, re-adding, until the scar is more or less resembling the tissue surrounding it.
How long does it take for a wound to heal?
Most wounds continue healing for up to 12 weeks after the surgery. Your body is constantly working on the area long after the skin has closed up.
Scar tissue can be tight and restrict movement. Scar tissue can also be sensitive. Pain causes you to move in different ways than normal.
How can your physiotherapist help?
- After the removal of the stitches your physio can start with laser therapy to decrease pain.
- Deep ossilation therapy also improves circulation and reduces pain.
- Your will be shown massage techniques to decrease pain and improve the movement of the scar. Wasserman et al, 2016 reported in a case series that ceasarian scar pain was relieved using massage techniques. These results were also confirmed by Kelly et al, 2019. Both studies reported that an improvement was found after only FOUR sessions!
- Your physiotherapist will teach you specific breathing techniques to reduce belly discomfort.
Six weeks after birth your physio can do a check of your belly muscles and start rehabilitation of the “gap between the tummy muscles due to pregnancy”. Your pelvic physio is also trained to evaluate the pelvic floor muscles and determine what type of rehabilitation exercises YOUR pelvis needs.
Don’t cry about a cut. Let your physiotherapist help you recover from wound related pain and immobility.