Caesarean scar pain
definition
Pain at the caesarean section scar is an unpleasant discomfort in the area of the scar tissue after a surgical birth.
Since the skin, abdominal layers and the uterus are surgically opened and sutured again during a caesarean section, the pain is to be regarded as normal up to a certain duration and intensity, as the tissues mentioned have to heal again.
The pain can be pulling, dull, pressing or, if the wound is still fresh and scarring is just beginning, shooting. These abnormal sensations can occur during exertion, but also sometimes at rest, and vary in their strength.
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Causes of caesarean scar pain
Numerous factors influence the pain perception of a caesarean section scar.
During the procedure, several layers of the body are penetrated that have to heal again at great expense and cause discomfort during this process. These include, above all, the uterus and the skin, but other tissues, such as the abdominal muscles or internal organs, can be irritated or injured and lead to pain.
These are transmitted via the smallest nerve fibers that are injured in the cuts. So-called nociceptors, receptors for pain perception, transmit the pain stimulus and reach the pain center in the brain via complex signal cascades.
During processing, the individual pain tolerance also plays a role, similar pain impulses lead to different pain reactions in every person. Therefore, the scar pain can be classified as severe by some and tolerable by others.
Another reason for a painful caesarean scar can be poorly or incorrectly healing tissue, a so-called hypertrophic scar can be the cause. This leads to an increase and thickening of the scar tissue, which can exert tension on the neighboring skin and restrict normal mobility. With a fresh scar, increased pain combined with local reddening can be an indication of an inflammatory process.
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Discomfort in the area of the caesarean section scar on renewed pregnancy
A new pregnancy after a caesarean section can cause discomfort in the area of the scar.
The increase in size of the abdomen as the pregnancy progresses leads to increased stretching of the skin and thus also of the scar, which can lead to discomfort. As with any scar, insufficiency can occur, which means that the scar can no longer perform its function of holding tissue together satisfactorily.
This can also manifest itself in increasing pain and sometimes also visible changes in the scar.
Pain can also occur if the caesarean section scar has grown together with underlying tissue layers and exerts tension on this due to the increase in size of the abdomen. It should not be forgotten that the visible skin scar is not the only scar that occurred during the caesarean section; the uterus was also sutured. This can also lead to pain from stretching processes.
In addition, it can lead to a scar pregnancy, i.e. implantation of the embryo in the scar tissue, and thus become symptomatic.
A scar rupture, i.e. a tear in the area of the scar, can also lead to pain. At 1%, the probability of this is very low, but it is a serious complication.
Pain in the pregnancy scar after exercise
Physical activity can lead to pain, especially with fresh scars that have not yet fully healed. For example, the caesarean scar can be irritated by the friction of clothing and vibrations when running or the tension of the muscles during abdominal exercises and thus be painful.
Therefore, care should be taken to rest physically for a long enough time after the caesarean section to allow the wound enough time to heal.
Longer, slightly faster walks can be a good and gentle way to start physical activity again.
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Pain in the pregnancy scar area when coughing
When coughing, increased pressure conditions are built up in the abdominal area for brief moments in order to be able to convey swallowed (food) particles out again through this reflex.
Due to the pressure wave, the tissue of the caesarean section scar, but also of scars from other abdominal interventions, can be briefly pressed outwards and thereby tightened. This impulse can sometimes be painful, even if simultaneous movement creates an additional mechanical stimulus and the scar is stressed more.
In the case of chronic cough, the scar tissue can be so stressed that it can lead to an incisional hernia, i.e. a rupture of the scar with parts of the tissue and sometimes organs that turn outwards.
This can also lead to pain, but it can also be completely symptom-free.
C-section scar pain after years
It can rarely happen that the caesarean scar continues to be painful for months or years after the procedure.
In such situations, a doctor should be consulted for a thorough physical examination.
This is important because the deeper muscles under the cut or nearby organs can lead to pain in the event of illness.
Possible causes of the pain and treatment options can be discussed with the doctor.
Diagnosis of pregnancy scar pain
The diagnosis of caesarean-associated pain is primarily based on anamnestic, that is, by questioning the patient.
Here the intensity, the duration of the complaints and the ostensible time of occurrence are asked.
During the subsequent inspection, the size, shape and color of the caesarean section scar is assessed, whether it closes sufficiently and what the wound edges look like.
By scanning the scar, the examiner can try to reproduce the pain and assess the intensity of the pain. It is also checked whether the scar can move against the underlying tissue and whether it has hardened.
Ultrasound is the method of choice for assessing the uterine scar.
Concomitant symptoms
In some cases, the caesarean scar not only causes pain, but also brings further discomfort and restrictions.
For example, connective tissue adhesions with lower tissue layers or excessive scar growth can lead to increased contraction of the skin and thus to impaired movement.
Scars can also be “weather-sensitive”, which means that certain weather or changing temperatures can be reacted to with abnormal sensations in the area of the scar.
The severing of small skin nerves can lead to sensory disturbances and even numbness in the area of the scar, which usually regress over time.
The caesarean section scar can also itch uncomfortably and subsequent scratching increases the risk of additional irritation to the scar tissue.
Furthermore, the appearance can be reduced by a scar that heals poorly and this can burden some women.
If the scar pain is very great or if it persists over a long period of time, it can affect the psyche. These include impaired participation in everyday life, depressive moods or avoidance behavior in which situations in which the scar could be exposed, for example when swimming, are avoided.
Treatment for pain in the caesarean section scar
It is important not to additionally irritate the caesarean section scar in the event of pain and therefore to wear clothes that are as loose as possible to prevent friction.
The scar should also always be kept clean. It should be tried out on an individual basis whether cooling compresses provide relief due to their slightly numbing effect or warming compresses due to their relaxing effect.
There are also a variety of gels, creams and emulsions that provide moisture and thus improve the elasticity of the scar. This can not only provide relief from pain, itching and sensitivity to the weather, but also promote the healing process, especially with fresh scars.
In the case of severe pain, painkillers with ibuprofen or paracetamol, for example, can be taken or creams that contain pain reliever ingredients can be used.
If breastfeeding is taking place, the tolerability of the drug and the possible transfer of active substances into breast milk must be considered and checked. If the pain is caused by inflammation, antibiotics should be given. In the event of a hernia or incisional insufficiency, surgery may be necessary.
Duration of pain at the caesarean section scar
The duration of the pain at the caesarean section scar is very individual, no general prognosis can be made.
Superficial layers of the skin take around two weeks to heal, while the deeper layers of skin and the nerves in them that cause pain take longer. Usually the scar hurts for a few weeks and the pain intensity is steadily decreasing. After a few weeks, the pain has mostly disappeared and only occurs occasionally with greater physical exertion.
Numbness around the scar can last for several months, but even then it is usually less. Weather sensitivity can last a lifetime.
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