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Why Does My C-Section Scar Hurt Years Later?

Author| Dr. Maureen O’Keefe, DPT pelvic health, pregnancy and postpartum specialist

Why does my c-section scar hurt years later?

Here at Purple Mountain PT in Grand Rapids, MI, we routinely help people who have c-section scars that hurt. Our clinical specialization in pregnancy, postpartum recovery and pelvic floor physical therapy gives us unique insights into those pesky c-sections scars that hurt. We work with individuals in person in our clinic and online via telehealth. Our patients comes to us throughout the lifespan and some of our patients, whose kids are no longer babies, still have C-section scars that hurt. After your healing is complete following your cesarean delivery, your scar should not hurt you, but the truth is that anywhere between 7-18% of women develop chronic scar pain from their c-section. The good news is that you are not stuck with this painful scar tissue. We are licensed physical therapists who specialize in postpartum recovery, scar tissue mobilization and developing treatment plans that optimize your healing process, calm down your pain and enhance your scar mobility. Our specialty in pelvic health, pregnancy and postpartum care, c-section recovery, visceral mobilization, bladder, bowel and pelvic organ prolapse gives us unique insights into c-section scars that hurt. If you would like to learn more about our treatment methods to alleviate scar pain, contact us here.

What can you do for a cesarean scar that hurts years later?

Cesarean scars that hurt for years can still benefit from physical therapy that provides specialized scar tissue treatments and abdominal wall and pelvic floor recovery care. We commonly work with women who have developed scar adhesions and can recollect pain in their scar for years. Our clinical experience, patient feedback, and published research have all found that using advanced fascial and visceral release techniques to old, painful cesarean scars (and any other scar) can help resolve pain, improve function and optimize bladder, bowel and pelvic organ function. We provide physical therapy for women following cesarean and vaginal delivery to optimize postpartum recovery, even if you gave birth years ago. Our treatment plans include scar tissue and fascial recovery, to facilitate improved movement of your scar, viscera and muscles. While we all expect that a cesarean delivery is a painful medical procedure, none of us are expecting to have chronic c-section scar pain; if you fall into the 7-18% of women who do experience chronic c-section scar pain, please reach out to us. To inquire about cost and availability of our services, contact us here or call 616-516-4334 to learn more.

If you experience challenges with your c-section recovery, our licensed physical therapists are here for you! We provide you a treatment plan that includes pelvic floor PT and helps resolve your chronic scar tissue pain.

We have found that our patients tell us that the care they’ve received with us has improved their healing process, even when their cesarean delivery was decades ago. Improving the trigger points and fascial restrictions in and around the scar and also in areas far away from the scar can alleviate your pain and improve your function. Our licensed physical therapists have post-graduate training specific to chronic abdominal and pelvic pain, chronic c-section and other surgical scar treatment and pelvic floor dysfunction. We offer treatments, such as visceral mobilization, scar mobilization, trigger point release, pelvic floor dysfunction recovery, diastasis recti abdominis rehabilitation and more to help overcome the pain that a c-section scar can cause. To learn more about these treatments, contact us here or call 616-516-4334.

How many women experience C-section scar pain?

One paper examined the prevalence of c-section scar pain found the following:

18.3% of women at 3 months post-birth

11.3% at 6 months postpartum

6.8% at 12 months postpartum.

That’s a lot of people! Nearly 7 women out of 100 who have a cesarean delivery will have pain a year later! Flip these numbers and you’ll notice that nearly 82% of women have NO PAIN by 3 months after giving birth.

We recommend starting physical therapy before 3 months postpartum, especially if you are having pain. But, it is never too late to start! Some of our moms have adult children and are grateful to finally get the care they have needed for decades.

Our treatment plan for every patient, regardless of the age of their scars and adhesions, includes scar tissue work. We work with scars that are decades old and are able to meaningful improve these so there is less pain, adhesions and symptoms, like bladder urgency, related to scar issues. If you are reading this and wondering “should my c-section scar still hurt?”, chances are that, no, you should not be having ongoing pain and that physical therapy can help you. To learn more about cost and availability of our licensed physical therapists to help you during your old c-section scar that still hurts, contact us here or call 616-516-4334.

Our licensed physical therapists perform fascial release techniques that have been shown to help alleviate cesarean scar pain

One study provided fascial release techniques and scar tissue manual therapy to women who had chronic cesarean scar pain for 6-9 years following their cesarean delivery. In this study, the women reported high pain levels in the premenstrual period, with bowel movements and with any pressure on their scar. One woman also reported pain when she was trying to move around in her bed. Our physical therapists have advanced training in manual therapy methods, including fascial release techniques, to treat scars. The women in this study experienced resolution of their pain! This is huge. Their pain rating scale was 0 out of 10 after they completed treatment. Using these fascial release techniques, the scars were measured and their mobility and tolerance to pressure both improved. If you are interested in learning more about our treatment plan that comprehensively helps address old c-section scars that hurt, call our office at 616-516-4334 or contact us here.

In one study about c-section scar pain, women reported it hurt when:

*At Rest: Most women reported mild pain when at rest.

*They move: Moderate to severe pain with movement was present at 3 months and tended to decrease for some, but not all women, by 12 months.

*With Activities of Daily Living: Because your c-section scar hurts, this study found your activities of daily living were compromised.

Characteristics of chronic C-section scar pain

The women we work with who have chronic cesarean scar pain describe to us a lengthy list of what it feels like to have c-section scar pain. While this is by no means a complete list, any pain you experience in or around your cesarean scar is a valid experience. Some things our patients report vary and include:

  • My c-section scar feels tight
  • My c-section scar feels pinched
  • I don’t like to touch my abdominal muscles or cesarean scar
  • My c-section scar hurts, it can throb, when something comes in contact with it, like my pants
  • I can’t have a baby or child in my lap, because I may experience sharp pain in my lower abdomen and scar.
  • My cesarean incision always hurt, from day one! It was a really painful medical procedure, a major surgery! I feel like my healing process was not right from the very beginning.
  • Sometimes I have pain with bowel movements; it can feel sharp in my abdomen.
  • Sometimes when I reach behind me, twist or roll in bed I get a catching feeling, sharp pain or something that says “nope, you shouldn’t move that way.”
  • My cesarean scar looks asymmetric, puckers and pinches.
  • When I try to pull it up or to the side, it just won’t go. It feels very tight and can feel throbby.
  • My c-section scar burns or feels like there’s nerve pain.

Adhesions, tension and stiffness causes chronic c-section scar pain?

As your incision site heals, it goes through 3 stages of developing scar tissue.

  1. The first stage is the inflammatory stage, when beneficial inflammatory factors flood the tissue for the purpose of cleaning up the wound and beginning the process of scar tissue development.
  2. The second stage is the proliferative stage, when collagen and other cells begin to fill in the defect caused by the incision site.
  3. The final stage is remodeling and, in this stage, your new collagen scar tissue becomes more organized and structured, so it is stronger.

When someone experiences chronic pain from a cesarean section or any other surgery, often we find that their healing process may have led to scar tissue that is contracted and stuck to surrounding structures.

In many cases, the person sustained an infection in their postoperative days, but this is not always the case. If you are wondering why does my c-section scar hurt years later, come to an appointment with our licensed physical therapists and you will receive answers. We help you uncover what’s going on and also find a path forward to resolve your c-section scar pain. We find that chronic c-section scar pain has myofascial layers (abdominal muscles, connective tissue, nerves, blood vessels) that often have adhesions and are not able to slide and glide properly. The result is tension and stiffness in the scar tissue and nearby structures. If you have tension and stiffness in nerves and tissues that should be able to easily move when you are going about your daily activities, it is likely you will experience scar pain. In our postpartum recovery physical therapy, we provide skilled treatment to all types of scars, including adhesions, c-section scars, laparotomy scars, robotic scars, perineal tears, episiotomies, keloids and scars that had prior infections.

The physical therapy treatment plans that we provide for individuals who have any abdominal or pelvic pain, especially if it is pain that is related to a cesarean delivery scar, always includes a variety of manual therapy methods, such as visceral mobilization, trigger point release, fascial release to the scar, joint mobilization and massage. Our licensed physical therapists also incorporate exercise, postural correction, movement, stretching and core and gluteal strengthening into a recovery plan for anyone with chronic abdominal and pelvic pain. If you are interested in learning more about our treatment plans to help resolve abdominal, pelvic, back or hip pain, you can call our office at 616-516-4334 or contact us here. 

What are some of the predictors that your C-section scar is going to hurt?

If you have chronic c-section scar pain, please know that you have not done anything wrong. We don’t always know why one person’s c-section scar hurts years later whereas another person experiences no pain. Some of us simply lay down more scar tissue, develop adhesions and experience more nerve pain than others. Our licensed physical therapists are able to help you navigate the complexity of chronic abdominal and pelvic pain. If you are wondering “why is this happening to me?”, we do have some research that investigated risk factors for chronic c-section scar pain.

The risk factors for chronic c-section scar pain:

*How did it feel those first 24 hours? Higher pain intensity with movement within 24 hours of giving birth. This is an important indicator for women because this continued to be the associated with higher pain levels at your baby’s first birthday.

*Did you experience low mood before your C-section? Depression present before the operation was a risk factor for ongoing C-section scar pain.

*Did your operation take a long time? Longer duration of surgery was found to be a predictor of ongoing c-section scar pain.

Could my bladder, bowel or prolapse symptoms be related to my c-section scar tissue?

Because your cesarean scar and incision site penetrates all the layers of tissue in your entire abdominal wall, it can affect how your entire abdominal and pelvic region function. Scar tissue that is altering the ability of your abdominal muscles and pelvic floor to work optimally might contribute to back pain, hip pain, pelvic pain or abdominal pain. Scar tissue might cause non-optimal forces through the abdomen and pelvis, resulting in worsening of pelvic organ prolapse symptoms. Scar tissue might cause pinching or pulling when your bladder or bowel fill up. It is common that our patients have urinary urgency, frequency or incontinence. We also find our patients experience painful bowel movements and sometimes difficulty emptying their bowels. In our work as pelvic health specialists, this is why we examine and treat every scar, even if you don’t have any scar pain. Our experience with providing fascial release and visceral mobilization to all types of scars is because our licensed physical therapists have advanced training in these manual therapies and cesarean recovery. Because we specialize in pelvic pain, we have written a variety of articles, you may be interested to read this. To get your questions answered, you may contact us here or call our office at 616-516-4334.

About Purple Mountain PT’s Treatment for Chronic Pain in C-section Scars

Purple Mountain Physical Therapy is a specialty pelvic health clinic that serves women, men and children in Grand Rapids Michigan. We help kids and adults overcome pelvic conditions, including chronic abdominal and pelvic pain related to old c-section scars that still hurt. If you are looking for solutions for why does your c-section scar still hurt years later, we are here to help you. Our c-section recovery program helps women who are newly postpartum and women who have old c-section scars that still hurt. Our physical therapists focus exclusively on pelvic physical therapy and we’ve written before about chronic c-section scar pain. The treatment plans we provide for c-section scars and other scars that are adhered and cause pain, are comprehensive, effective and offer whole-body care. We have training and techniques specific to ongoing c-section scar pain, pelvic floor rehabilitation and abdominal wall recovery. If your c-section scar still hurts and you know that something doesn’t seem right, give us a call to get help. Our doctors of physical therapy are here to help you feel like yourself again. Give us a call at 616-516-4334 to learn more about cost and availability or contact us here. 

Peace,

Dr. Maureen O’Keefe, DPT specializing in pelvic floor physical therapy, pregnancy and postpartum recovery for 25 years.

Postpartum Pelvic Floor PT in Grand Rapids

Postpartum Pelvic Floor PT in Grand Rapids

What does Postpartum Pelvic Floor PT Treat?

If you are postpartum and wondering what postpartum pelvic floor PT in Grand Rapids would do for you, read on! We thought it might help you to hear of one woman’s recovery story with us. If, after reading this, you feel postpartum pelvic floor PT could help you, contact us!

Here’s a story of one woman we helped. Her problems: pelvic and perineal pain, pelvic floor dysfunction with bladder and bowel control problems, postpartum recovery following severe pelvic trauma with labor and delivery and pelvic reconstructive surgery.

Like all new moms, this woman was impressive! She worked full time, was in love with her baby, struggled with sleep deprivation and wanted to get back to being athletic. When we met, she was 6 months postpartum with problems of bladder/bowel control and pelvic instability, pelvic pain, pelvic floor weakness and diastasis recti abdominus (split abdominals). She experienced inner thigh and pubic pain with walking, exercising, moving in and out of positions when picking up her baby and when driving and moving her foot from gas to the brake. This pain was her dominant concern, but she also wasn’t happy to have embarrassing and unexpected loss of gas, problems with bladder control, a weak abdomen and a diastasis recti abdominus (split abdominals) as well as knee pains. Before I met her, when her baby was 4 months old, she had pelvic surgery to correct a serious injury from her labor and delivery. She had been referred to me by her urogynecologist surgeon, but had tried two other pelvic floor PTs prior to her surgery and before finding me. Neither of the prior pelvic health PTs could help her pain and she had been told that she needed to get in shape, but she found herself unable to exercise because of pain.

Her Goals:

  1. Get pregnant again and be healthier before the pregnancy, down the line.
  2. Get the adductor (inner thigh & pubic bone) pain to go away. “It prevents me from doing every other exercise.”
  3. Regain the strength of the pelvic floor and muscle control.

We got to work right away with a comprehensive postpartum pelvic floor physical therapy evaluation. This included a detailed assessment of her:

  • Load transfer ability: This was impaired, she could not shift weight from one leg to another and keep her pelvis and low back in stable.
  • Strength: Poor all around, she was deconditioned, had weakness in her glutes, pelvic floor and abdominals and low back.
  • Abdominal wall integrity: Disrupted by a diastasis recti abdominus that caused ineffective and abnormal load transfer through her legs, pelvis and core)
  • Pelvic floor integrity & coordination: Integrity of the multiple layers of the pelvic floor was intact, but coordination was impaired and deficient, poor timing and firing of the muscles noted).  This includes looking at pelvic floor strength and pelvic floor dysfunction.
  • Postoperative healing: She was doing well, but the vaginal tissues were fragile and needed to be treated delicately and carefully.

Her Plan of Care Included Hands-On Treatments and Graded, Specific and Careful Exercises to Promote Stability, Strength and Coordination

We worked together at each visit, with a very careful and coordinated plan to progressively help facilitate her recovery.  This person’s treatment included a combination of therapeutic corrective exercises and hands-on manual therapy to her abdomen, low back hips and thighs and internally to her pelvic floor. Together we worked to optimize her muscles and her fascia, to improve her pelvic stability, to advance her strength and conditioning and to restore her pelvic floor, breath and core muscle coordination, timing and strength. If you might benefit from postpartum pelvic floor PT in Grand Rapids, we can offer the same specialized and personalized care for you! Contact us here to ask us a question or call 616.516.4334 to speak with our knowledgeable and caring staff to get started!

At Her 5th postpartum pelvic floor physical therapy appointment, she was feeling better! Less pain! Less Worry! Hope and optimism were born!

She arrived with a smile and noticeably less stressed. She reported this was because she was feeling better and seeing that we were making progress. Her postpartum pelvic floor physical therapy program was different than the other two physical therapists had recommended and it was detailed, systematic and progressive. She was feeling improvements and this gave her confidence that she was getting the help she needed.

By this fifth appointment she reported improvement in her pain:

“every now and again I get twinges of pain in my inner thighs or my abs, but it goes away. It doesn’t happen often. My walking is pretty good. Standing on one leg still hurts a little; I have to sit down to put on shoes and pants. It is unstable and some pain in the proximal adductor.”

Difficulty with standing on one leg is something that women with pelvic instability can experience.

We perform a comprehensive evaluation to determine what are the driving factors with balance, pelvic stability, muscular control and motor coordination. Then, once we know what is causing this pain and problem, we devise a program to systematically address all of the contributions to it. In her case, we provided a postpartum pelvic physical therapy program customized to her post-operative precautions and designed to optimize both her post-operative and her postpartum healing. The results of pelvic floor physical therapy are born from the wisdom and experience of a good pelvic health physical therapist to design an effective and comprehensive treatment program. Contact us today to learn more.

Not all pelvic health physical therapy is the same!

For this woman we were challenged to develop a pelvic health recovery program that gave a “Goldilocks” effect. You remember the childhood 3 Little Pigs tale, with Goldilocks finding the “just right” bed and porridge? We needed to evaluate and treat her with the “just right” methods of physical therapy. Enough to stimulate pelvic recovery, coordination and strength while also reducing pain and instability. Too fast, too aggressive or the wrong exercises and treatments and she was at risk for a huge flare up and possibly adverse healing. Too little or the wrong exercises and treatments and she was at risk for physical therapy not helping her, having no response and thinking “this doesn’t work and I’m never going to get better.” If you might benefit from postpartum pelvic PT in Grand Rapids, we are here to help you. Contact us today to learn more about our model of care.

We’ve Seen This Before & We Can Help You!

Because the physical therapists at Purple Mountain PT specialize in pelvic health, pregnancy and postpartum recovery and pelvic floor dysfunction, we offer our patients an experienced eye assessing and treating your condition.  We had seen this condition many times over the years.

By working with so many other postpartum women and having advanced training in pregnancy and post-partum pelvic floor physical therapy, our PTs know how to help our patients, even when they have tried other therapies or have complex problems.

This patient benefitted from the specialization our PTs have undertaken.  All of our PTs have their doctor of physical therapy degree & also post-doctoral training specific to pregnancy and postpartum recovery, including in rehabilitation for complicated postpartum conditions, such as chronic pain and traumatic birth injuries.  The pregnancy and postpartum physical therapists at Purple Mountain PT are also avid readers of clinical research and participants in professional education and societies.

We provide our postpartum patients comprehensive and wholistic care, which is what will help them feel better.

By treating the entire person, including the midback, low back, hips, abdominal wall, pelvic floor, balance, posture, strength, flexibility and more, our patients are able to feel better.  In this woman’s case she had a diastasis recti abdominus, which is split abdominal muscles. In the last ten years there has been a lot of research, debate and clarifications on how to best treat this condition. Having kept up with all of this, our PTs are able to provide you current and effective methods to resolve diastasis recti abdominus.  We love to work with women throughout their pregnancy and postpartum journey and find this work to be joyful and rewarding, because we see you get back to being confident in your body!  If you are interested in learning more about our postpartum physical therapy here in Grand Rapids, Michigan or via telehealth for those who qualify, you can speak with one of our team members by reaching out here or calling 616-516-4334. 

At 6 Months After Starting Pelvic Floor Physical Therapy She Was Roller Blading!

To help someone recovering after pregnancy and surgery requires a systematic and progress approach, customized to the person’s needs.

At 6 months after starting physical therapy, this patient returned with happiness reporting

“I’m feeling ok! I feel fine doing my core exercises (this is an improvement!). I went roller blading and felt good. I feel some soreness in my inguinal region, not like it was before, it is mildly sore, same as my abs. My knees and back have felt better. I’m doing all of the exercises you gave me and some extra squats throughout the day and my knees are fine.”

You can see this is a huge advancement in her activity tolerance. Rollerblading? That was absolutely out of the question when I first saw her, she would have had pelvic pain, possibly knee and low back pain also, possibly loss of gas or urine.

And, here she was able to roller blade without anything more than some soreness that was normal post-workout soreness! Her success with roller blading was a huge win and a reflection that all of our pelvic floor physical therapy had correctly addressed her myriad problem. If you would love to get back to doing something you enjoy, contact us to speak with our knowledgeable staff, get your questions answered and make an appointment today!

If you are interested in finding out more about postpartum pelvic floor physical therapy call us at 616-516-4334 or contact us here and we will be in touch!

This story gives you a glimpse into one woman’s experience of postpartum pelvic floor physical therapy. This woman had an unfortunate and complicated case and was able to get back to an active life and achieve her goals. Many women we help are fortunate to have fewer problems. But, most postpartum women do experience some challenges to their recovery. Even when they are feeling fine they don’t know exactly which exercises they should be doing. Or, they may experience some urinary leakage from time to time and don’t know how to get that to go away. If you wonder if postpartum pelvic floor PT in Grand Rapids could help you and have some questions, we are happy to chat to see if our care is a good fit for you.  If you are interested to learn more about working with our pregnancy and postpartum specialist physical therapists, call 616-516-4334 to chat with one of our knowledgable team members who can answer your questions.

Blessings,

Dr. Maureen O’Keefe, DPT

Founder of Purple Mountain Physical Therapy

You may also be interested in these articles we’ve written related to pelvic health conditions

Exercise in Pregnancy: A Physical Therapists Perspective

What Can Pelvic Floor Physical Therapy Help With?

Why Does My C-Section Scar Hurt Years Later?