C-Section Scar Care | Massage
Working Out that Scar Tissue
Let’s talk about C-Sections and the scars that follow along.
When I discussed my Postpartum recovery in this post, I covered what actually happens when we get a C-section, to quote:
The surgeons cut through multiple layers to get to the uterus to pull your baby out.
And it’s not exactly a pull, they roughly yank and tug your uterus around, pull your baby out, and then jam everything back in and sew you up. That’s what my nurse explained to me.
What Exactly Happens During a C-Section:
→ A horizontal incision is made just above the pubic bone (in most C-sections, but cuts can also be vertical, just less common).
→ Then they begin cutting through the layers → First Layer: Skin, the Second Layer: Fat, Third Layer: Fascia, Fourth Layer: Muscles, Fifth Layer: Peritoneum, Sixth Layer: Uterus, Seventh Layer: Amniotic Sack
→ Baby is pulled out, and the umbilical cord is clamped and cut.
→ Placenta is removed.
→ They sew up your uterus and place it back in, then sew up the rest of your incision.
The healing process can be described in 3 stages: Inflammatory, Proliferated, and Maturation/Remodeling1. There are a few variations to this among platforms and sources, but this is a general summarization.
Inflammatory
This stage is the first few days after the incision has begun healing (will be swollen, red/pinkish), bleeding has officially stopped and white cells parade around fending against infection.
Proliferated
Over the next few weeks (2-4) the area will begin to strengthen and pull itself together (this is where collagen supplementation will come in handy), and new blood vessels will begin forming. The scar should be thickening.
Maturation (Remodeling)
This stage can last up to a year (sometimes 2), and scar tissue will start to dissipate and fade in color. About 6-8 weeks after your c-section, the incision should be completely healed, and you’ll be able to gradually return to business as usual.
In the beginning, you want to be gentle when massaging this area as it will be tender (I know that sounds like common sense, but it must be stated). You just went through a major change, give your body some rest. :)
Over time as the scar heals more and more, the massaging will become deeper.
This will be when the scar is no longer red or sore to the touch.
You will begin by massaging the outer layer of skin just before you reach the scar. You likely won’t massage the actual scar until your 6-week checkup (or until it is totally healed - no open skin/scabs).
You just mainly want to focus on the massage progression:
Skin → Muscle → Deep Muscle.
How to Massage the Area, in Short
After your scar is completely healed and isn’t sensitive to the touch follow these steps:
First, get into a comfortable position, preferably lying back at a slight incline—it’s easiest to access all angles of the scar tissue in this position.
Start around the area surrounding the scar with your index fingers and gently start massaging using small circular motions. You may want to use an oil or sensitive-skin-friendly lotion to move along the skin more easily.
Use a light and comfortable pressure so that the scar can move but it is not painful. (I can only describe this as it will feel like the tough fat part of a steak, not the gooey fat).
Next, work your way down to the actual scar area and start applying small amounts of pressure, then gradually add more pressure (this should not cause pain, only slight discomfort if any).
After massaging the scar itself, work your way back out and massage the area around the scar by gently pushing the skin while applying more pressure.
Your goal is to loosen the scar from the tissue.
You want to do this for about 10-15 minutes daily (sometimes twice a day if necessary and tolerated) until the tissues start to return to “close to” normal. Best done after warm showers or even a long Epsom salt bath.
Over time as the harder tissue starts to break up, these massages can be done less frequently (weekly, biweekly, monthly, etc.). Totally up to you, or you can always continue massaging indefinitely.
Let’s Talk About Technique:
I want to reiterate: be gentle, start and move slowly, and spend a good amount of time on this.
Massaging your scar tissue is highly beneficial. → It will reduce muscle restriction, improve sensations around the scar, increase scar tissue mobility & elasticity, and can improve the overall appearance and healing process of the scar. (Among other things).
Start by investigating and navigating the skin surrounding your scar: above, below, the sides, and then directly on the scar.
Is it sensitive to the touch? Maybe feels a bit numb at first? Try using cotton balls or a soft cloth to “wake up your nerves”.
Your body (in terms of scar tissue) needs to reestablish its sense of touch and perception of how certain things feel. (For example, we may still be sensitive to temperatures, avoid overly cold & hot temperatures until your sensations return).
Take note of how each motion feels and begin exploring the skin with your index & middle fingers in small circles in various directions → up & down, side to side, and circularly.
Move only the uppermost layer of skin first. Pay attention to how the skin moves around, and take note of if there is a point where the skin does not move as effortlessly.
Stop at those points and spend more time working that skin “apart”. Scar tissue does not exactly go away, but we are able to improve the mobility of it and remove adhesions2 between the tissue layers.
(This is what healed scar tissue looks like internally)3.
Move on to the upper layer of muscle with slightly deeper circles and motions. Again, searching for if there is any tension or rough points and spending more time there.
Explore all around the scar and also directly on the scar.
Finally, begin to move the deep muscles (underneath it all), with deeper circles and motions (again, this shouldn’t be painful, but maybe a little discomforting). There’s the possibility of more discomfort above or below your scar vs. directly on it (that’s normal).
Keep in mind that the incision is not always a straight cut—it may be more angled into the abdomen and the massaging should be directed in that manner. (This is also why lying on your back at an angle is beneficial, you can find all those rough points).
TLDR in 5 Steps
Desensitize → Gently touch the skin above and below the scar. Reintroduce the sense of touch/sensations with cotton balls, soft cloths, and gradually rougher (but still gentle) textures.
Massage → Get in a comfortable position, use your index and middle fingers, and move up & down, side to side, above and below the scar (not on the scar).
Look for and spend extra time on rough points → Place your fingers on the healed scar and investigate.
Apply more pressure → Move in circular motions and utilize the “lift and roll”/“pinch and lift” method to work out points of tension.
Go Deeper → Apply even more pressure and really press into the tissue to reach deeper muscle layers.
While we can’t completely get rid of scar tissue, we can continue to improve its mobility.
The more you work on the scar (touch & massage it), the softer and more flexible it will become.
#WAGMI
Your friend,
- BowTiedHeifer
Disclaimer
I am not a licensed personal trainer or pre/postnatal specialist—these are simply my personal experiences and things I have witnessed to work for many others. This is not legal, medical or financial advice. Please speak to a professional before starting any new programs, applying any new diet plans, or supplement protocols.
Adhesion - an abnormal union of membranous surfaces due to inflammation or injury.