Has any healthcare professional or even any friend or family member ever asked you this question? The answer can sometimes be more complicated than we think ever years after having a c-section. From physical symptoms such as pain, tightness and redness to emotional symptoms such as finding the scar difficult to touch or even look at, and finding that it triggers certain feelings from your birth good or bad. Have you ever considered that you might be able to make changes to your scar on the inside and outside, even years down the line?
This weekend I spent the day with pelvic health physio and (let’s be honest) c-section EXTRAORDINAIRE, Hannah Poulton. Hannah is the UK’s leading c-section and scar therapy expert and I was so excited to learn everything she had to teach me.
Let’s start with some facts about c-sections in the UK:
1 in 4 babies will be born via c-section but with the rates of inductions rising each year, this is expected to reach more like 1 in 3 in the near future, and this is already the case in some hospitals.
That equates to 14,472 c-sections a month in the UK
It is the most common surgery in the world
So, with it being such a common surgery that so many women are experiencing every day, as a nation we surely must have a really standardised approach to how to do them, the care women receive immediately afterwards and then during the months of recovery afterwards right? WRONG. As is a common theme within women’s health, this is an area that is seriously lacking structure, access to support and education, and with many people with abdominal scarring experiencing chronic pain and 50% of scars healing to become raised and dark, women are often left wondering what to expect from their scar recovery. Enter Hannah. Hannah is on a mission to change that, travelling around the UK bringing gold-standard teaching to physiotherapists and other healthcare professionals about how to manage these troublesome scars with the best scar massage techniques, products, techy devices and advice.
Ever wondered why your right hip hurts since your c-section? Or maybe why you can’t comfortably reach your arms above your head anymore? Or perhaps why you can’t seem to take a deep breath properly? Newsflash, it may well be because of your c-section scar.
During a c-section, the surgeon has to make their way through no less than 7 layers of tissue including, skin, fat, fascia, between the muscle, through the peritoneum (the covering around your abdominal organs), your uterus and finally the amniotic sac. Now, these layers of tissue aren’t contained in neat little compartments separate to each other, they are all held together by various types of soft tissue, and crucially all contained within the body’s network of fascia.
Fascia is a huge of web of connective tissue, which under a microscope, looks a bit like garden netting- a stretchy web that runs from head to toe and from front to back. On her course, Hannah uses a really simple demonstration to replicate the effect of a c-section incision on the body’s fascial system. Obviously this makes more sense in person but bear with me… Everybody stands in the circle holding a single large piece of green garden netting between them with it stretched out in the middle of the circle (think of those parachute games you used to play at girl guides). When she simulates the effect of c-section incision by tearing a hole in the middle of it and then pulling it back together again as the stitches would, you can see how this change in the original tension of the netting has a ripple effect on the whole of the net. Suddenly the holes are different sizes close to the incision and even the people holding the piece of net far away from the tear can feel the pulling from the “repair”. This is obviously a simplified version of what happens within your body, but the idea is that you can appreciate the huge effect that the cutting of the fascia at the incision has on the rest of the body. When scar tissue forms it is less stretchy and supple than healthy tissue so suddenly there is tension around the site of the scar as well as in places further away from the scar. This might be felt as tightness, soreness, stiffness in movement in the torso or hips, pain radiating down towards the pelvic floor or even tightness in the pelvic floor among other things.
Your scar itself may be troublesome on it’s own – it may appear red or raised, it may be wider than the original scar, it might look asymmetrical or cause the much talked about “overhang” which can affect mums regardless of how much fatty tissue is underneath it. It can be so frustrating for women who feel they are putting the work in with diet and exercise but just aren’t achieving their goals in terms of flattening their tummy again. This can also be due to a combination of tummy muscle separation, nutrition and scar care.
The good news is that by treating these area of tightness around the scar as well as the scar tissue over the scar itself, we can often make some really positive changes in how the scar feels but also on how it looks. Of course this doesn’t just apply to c-section scars – all scars can be treated with the same techniques if they are bothering you.
So, is it ever too late to treat a scar? No! Scar tissue takes two years to reach maturity so you can often make the biggest difference in this time period, however even years after this there is still hope. It takes a lot of determination and consistency, but if you’re willing to put the work in, in most cases changes can be made.
The best time to treat scars is when they are newly forming – starting your own scar tissue massage at home from 6 to 8 weeks is when you will have the most influence. Remember, your wound needs to be clean, dry, closed with no scabs before you can start massage, to avoid any infections. Your scar journey doesn’t just need to start with massage though – even just getting comfortable with looking and touching it can be a challenge for some women. Using the right products is also vital, from oils, scar creams and silicone strips, there is such a range of products on the market but ideally you need to make sure you are using the right product for your own personal recovery.
At Wilsmore Physiotherapy we offer a “c-section assessment” service. This is your chance to come and chat to us about your birth, any concerns you have postnatally (not limited to just the scar), allow us to assess your scar in standing, how it may be affecting posture and movement, how well your pelvic floor is working, how well your tummy muscles are working, whether you have any ongoing separation and feel your scar and tummy in lying. Treatment includes scar massage techniques in clinic and teaching you how to do them at home, recommending the right products for your scar and a digital postnatal rehab plan.
With the right advice and treatment, many women can feel a difference in their scar after just one session but more substantial changes can understandably take longer. Initial assessments start at £70 for a one hour assessment and treatment session, with follow up treatments priced at £40 for 30 minutes and £70 for an hour.