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You've spent time planning for your labour or surgery, or perhaps it was an emergency procedure. Your focus has been on getting through the in-patient phase and getting home again. But what happens next? How should you care for your body following surgery to the adomen. I see patients with a variety of scars from cesarean section to laparoscopic abdominal surgery. Although each come with a different story, the management is equally important for them all.
What's going on under there?
It is important to bear in mind that the stages of healing (see image below) are happening through-out the layers of skin, underlying muscles and viscera. Even as the superficial layers appear to be healed, there may be remodelling still going on below the surface.
Scars are made up of collagen fibres that are laid down by the body in a haphazard manor to unite the edges of an incision. Initially these adhesions are very important to seal the wound, but once the base level of healing has occurred soft tissue massage to the area is hugely helpful in minimising later problems.
Possible negative impacts of scarring.
Pain, reduced or altered sensation of the surrounding area, pelvic organ and muscle dysfunction, urine incontinence, skin or muscles feeling restricted during movement, fear avoidance of touching scar region. I am a firm believer in Women self-massaging their wound site once basic healing has happened, this helps with achieving better sensation of the area and reducing pain perception.
What should I look out for?
Occasionally incisions heal poorly or become infected. It is important to look out for any discharge and weeping from the wound, redness that continues to intensify, the area feeling hot to touch, a bad odour or feeling generally unwell with a temperature. These are signs something isn't going to plan and you should see your doctor.
When can I start massage?
The scar needs to have healed before you can start any massage. That means no gaps, no visible stitches, no acute redness or weeping. Your doctor/midwife or physiotherapist will be able to tell you when the healing is far enough along to start
How to massage?
Using a body lotion or body oil that suits your skin type, you can start to massage the area surrounding the scar with moderate pressure. Use the pads of your finger tips.
Take your time and get used to touching the area, it may initially feel sensitive or psychologically unpleasant, this is common but will reduce with time.
Over the scar itself, it is effective to rub in a small circular action. If you are unsure, seeing a Pelvic Health Physiotherapist to teach you the best technique and guide you on pressure is helpful.
Massage can be done for a few of minutes per day until the area feels softer and more mobile. Then aim to check and massage the area once a week.
Other top tips
> Posture. Your scar will form in response to the load you put on it. If you are sitting hunched over repeatedly the area will heal tight and shortened. Aim to sit up and move normally to help the scar to heal at a good length.
> Get moving. Pain and tiredness, can, understandably, be big factors that stop us from getting up and moving about. But getting adequate blood flow and oxygenation to tissues is key during healing. Gentle walking for 15-30 minutes a day and moving around your home will be enough to get you started.
>Nutrition. I am not a trained nutritionist but it is well evidenced that eating well and eating enough food to minimise excessive inflammation, optimise energy levels and give your body the fuel to heal is very important.
>See a specialist. Pelvic Health Physiotherapists are trained to assess and treat women post-partum or post-laparoscopic surgery. They have a wealth of techniques up their sleeves to help manage not only your scar, but also the recovery of the whole body following surgery or labour.
FAQs
I don't like seeing or touching my scar.
Surgical scars are of course physical, but also have an emotional component. It is commonly the emotional disconnect that can be challenging to overcome. Speaking to a Pelvic Health Physiotherapist, specialist midwife or councillor can help.
I can feel stitches and bumps under the surface.
This is normal in the first 6 months, as the body takes time to heal the deeper layers of tissue and absorb the internal stitches. Keep the pressure moderate and check in with your doctor if something seems unusual.
Some parts of my skin are numb
When incising the skin, some of the small surface nerves are cut through. Nerves heal very slowly and it can take up to two years to regain normal sensation. In some cases the areas around the scar can remain numb long-term.
Is there anything I can do sooner, whilst the wound is healing?
With the support of a specialist Pelvic Health Physiotherapist swelling can be managed using K-taping techniques. Soft tissue release work carried out to surrounding muscles can help with pain and tightness. Pelvic pain can also be treated with acupuncture to the points on the hands. And guidance on returning to normal movement and exercise can start from the day of your surgery.
image credit: healthline online. https://www.healthline.com/health/pregnancy/c-section-scar