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Cesarean Scar Pain: How Physical Therapy Can Help

Updated: Jan 8

There are 1.3 million cesarean sections performed annually or about 1 in 3 American births. Of those, 7-18% of women have cesarean scar pain after 1 year of their surgery. Chronic cesarean scar pain is more common that people realize. A study by Wasserman showed that soft tissue mobilization (similar to massage) helped chronic discomfort including premenstrual pain, pain upon pressure to the lower abdomen and pain during bowel movements. With 4 treatment sessions lasting 30-minutes over 2 weeks, they had improved pain and 0/10 premenstrual pain (Wasserman). Another study found similar results: 4 sessions lasting 30-minutes-- improved scar pain and abdominal pressure sensitivity (Ryan).

Moms who have had a cesarean scar should start mobilizing their scar once it has fully healed, usually around 6-weeks after surgery. We see only the "skin" layer, but there are 7 layers between the skin -- what we see (skin, fascia, muscle, organ) --and the uterus scar. We help not only the skin layer slide and glide, but also the organs (small intestine, bladder, uterus, colon) slide and glide.

Cesarean scars can cause the "layers" to be stuck resulting in:

1) Localized pain over the scar

2) Period pain and cramping: the uterus doubles in size with menstruation and when stuck by scar tissue, moms can experience increased cramping

3) Low back pain: the uterosacral ligaments attach to the sacrum and adhesions at the uterus restrict the normal mobility of the ligaments causing low back or sacral pain

4) Bladder urgency or frequency: the bladder needs to expand when it fills. Scar tissue can restrict the bladder's ability to expand

5) Painful sex (especially with deep thrusting)

6) Digestive issues (SIBO, constipation, diarrhea, gas & bloating)

7) Difficulty healing a diastasis: pulling on the fascia or muscle layers (causing a pulling apart)

8) Pain with bowel movements

9) Increased diastasis recti or abdominal separation

We assess and treat the cesarean scar through the abdominal wall. It is surprisingly gentle and effective and many moms are shocked that their "old" cesarean scar of 10+ years ago is causing them some of the issues they are having today such as back pain, painful sex, bladder issues or abdominal pain and bloating.

Some specialized treatments we offer are class IV laser and dry needling. Class IV laser is an FDA-approved treatment that helps to rebuild health tissue, decreases pain, increases blood flow and increases the body's natural healing abilities. It only takes 2-4 minutes!

For particularly chronic scars, we also utilize dry needling. It is very comfortable and case reports have suggested that scar needling generates a quick decrease in pain and improvement of mobility in scarred tissues. The patient photo below had a vertical abdominal scar on top of a cesarean scar and had wonderful results with dry needling her scar with improved sensation, less pain, reduced hypertrophy of the scar and more mobility.

If you are struggling with cesarean scar pain, reach out for an appointment locally in Richmond, Virginia or via telehealth in the state of Virginia-- specially trained pelvic health physical therapists are trained to help with cesarean scar pain, low back pain, pelvic health issues and adhesions. Call us at 804-372-0291

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