Caesarean scar recovery
What are the different types of caesarean incisions?
Caesarean section incisions vary in location and technique depending on the surgeon’s preference and the patient’s medical history. The most frequently used incision type is the low transverse incision, commonly referred to as the “bikini cut”. This incision is made horizontally across the lower abdomen, just above the pubic hairline, and is preferred for most C-sections due to its association with lower blood loss and fewer complications.
Vertical incisions may be used less frequently and involve making an incision down the middle of the abdomen. These may be necessary in cases where a transverse incision is deemed unsafe, such as with placenta previa or other complications.
Proper care of the incision site is crucial to ensure healing and minimise infection risk, regardless of the type of incision used. This includes maintaining cleanliness and dryness of the incision site, avoiding strenuous activity or heavy lifting, and adhering to prescribed medication instructions.
The skin’s amazing ability to heal
Healing of your caesarean scar is a complex process that involves several stages, including haemostasis, inflammation, proliferation, and remodelling/maturation.
Here’s a brief summary of each stage:
Haemostasis: The first stage of healing is haemostasis, which begins immediately after surgery. This simply means the formation of a blood clot to stop bleeding and prevent infection.
Inflammation: The second stage of healing is inflammation, which begins within a few hours of injury. During this stage, white blood cells move to the site of the injury to fight off infection and remove any debris or bacteria.
Proliferation: The third stage of healing is proliferation, which begins around 3-4 days after injury. During this stage, new blood vessels form and cells begin to divide and migrate to the caesarean site to help rebuild damaged tissue.
Remodelling/maturation: The final stage of wound healing is remodelling or maturation, which can take several months to complete. During this stage, the newly formed tissue undergoes changes in texture, colour and strength. The maturation stage typically begins around 3 weeks after the caesarean and generally takes several months, or years in some cases.
The remodelling stage
The duration of the remodelling stage of healing varies depending on several factors, including the size and depth of the wound, the overall health of the woman or birthing person, and the type of tissue involved. In general, remodelling can take several months to complete, with some scars continuing to improve and fade for up to two years or more.
During the remodelling phase, the body continues to build and remodel new collagen fibres, which replace the initial scar tissue that was formed during the proliferation stage. This remodelling process can help to improve the strength and flexibility of the scar tissue, leading to a smoother and less noticeable scar over time. Blood vessels within the scar tissue also become more organised, which helps to improve blood flow and overall healing.
It’s important to know that the final appearance of a scar can also be influenced by factors such as age, genetics, and the location of the wound.
Taking care of your body while it heals
Taking proper care of a caesarean scar is important for promoting healing and reducing the risk of complications.
Here are some tips for caring for a c-section scar:
Keep the incision site clean and dry: Follow your doctor’s instructions for cleaning the incision site. In general, you should avoid soaking the incision in water until it has fully healed. You may be instructed to clean the area with soap and water or to use a sterile saline solution.
Avoid activities that can put strain on the incision: It is important to avoid heavy lifting,strenuous exercise, and other activities that can put stress on the incision site until it has fully healed.
Eat a nutritious diet: A nutritious diet can help promote healing and reduce the risk of infection. A diet that includes plenty of fruits, vegetables, and lean proteins is ideal.
Stay hydrated: Drinking plenty of water can help promote healing and prevent dehydration.
Avoid tight clothing: Tight clothing can irritate the incision site and interfere with healing.
Wear loose-fitting clothing that is comfortable and does not put pressure on the incision.
If you have any concerns about your c-section scar, it’s always important to speak to your midwife, doctor or health visitor.
The role of massage in C-section scar recovery…
The limited research available on post-operative scar massage, and specifically C-section scar massage, suggests that it may improve some scar characteristics like those feelings of tightness or tugging. This is because massage can increase mobility and reduce stiffness. Scar massage can also help improve your perception of your scar and help you to come to terms with changes to your body. Remember, this scar is the mark of your body having done something amazing.
When and how massage should be implemented isn’t currently determined but you should wait until the scar is fully healed before starting. Early on in the healing process, movement of the scar should be limited in order to reduce the risk of hypertrophic scarring (which happens when excess collagen is produced at the site of a wound).
How to massage your C-section scar…
The healing time for a C-section scar can vary from person to person, but typically it takes about four to six weeks for the outer incision to heal and close completely. However, it can take longer for the deeper tissues to heal fully, sometimes up to several months.
Once you feel comfortable, use a water-based cream like E45 to reduce friction and keep the skin supple. Use your fingertips to massage the scar and the skin around it in all directions, applying pressure that feels comfortable without causing pain. However, if you experience any pain, itching, or burning along your scar, you should avoid massaging it and speak to your healthcare provider. Scar massage is also not suitable for keloid scars or if you are at high risk of developing either keloid or hypertrophic scars.
It is important to note that there is not enough research to confirm that massage can reduce the visibility of scars. Alternative treatments for this include silicone gel patches and corticosteroid products.
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References:
Scott HC, Stockdale C, Robinson A, Robinson LS, Brown T. Is massage an effective intervention in the management of post-operative scarring? A scoping review. J Hand Ther. 2022 Apr-Jun;35(2):186-199. doi: 10.1016/j.jht.2022.01.004. Epub 2022 Feb 25. PMID: 35227556.
Ogawa R. The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago. Plast Reconstr Surg. 2022 Jan 1;149(1):79e-94e. doi: 10.1097/PRS.0000000000008667. PMID: 34813576; PMCID: PMC8687618.
Abd-Elsayed A, Pope J, Mundey DA, Slavin KV, Falowski S, Chitneni A, Popielarski SR, John J, Grodofsky S, Vanetesse T, Fishman MA, Kim P. Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review. J Pain Res. 2022 Apr 5;15:925-937. doi: 10.2147/JPR.S355096. PMID: 35411187; PMCID: PMC8994628.
Hosseini M, Brown J, Khosrotehrani K, Bayat A, Shafiee A. Skin biomechanics: a potential therapeutic intervention target to reduce scarring. Burns Trauma. 2022 Aug 23;10:tkac036. doi: 10.1093/burnst/tkac036. PMID: 36017082; PMCID: PMC9398863.