Osteopathic Tips for Cesarean Section Scars

By Florence Bowen, DOMP

The Facts

Caesarean sections account for 18.6% of all deliveries worldwide; in North America the incidence has been reported to reach as high as 32.3%. Which is to say that 1 in 3 women will deliver via caesarean section. Increasing rates of caesarean sections worldwide, suggests that more women will endure an invasive surgical procedure, followed by a long recovery period and inevitable scarring will result. Scars, especially a rigid scar, are of top priority to Osteopathic Manual Practitioners. Before we dig into exactly WHY that is, we first have to understand the importance of the fascial system in our body.

What is Fascia?

The fascial system is a large portion of the all-encompassing connective tissue of the body. The fascia lies beneath the skin, beneath the first layer of fat, and surrounds the muscles, bones, nerves, and organs of the body. I like to think of fascia as the ‘cling wrap’ of the body. It intimately wraps around structures to provide reinforcement and compact strength. It is more than just connective tissue that attaches one structure to another. Fascia is pliable and adapts to slow sustained forces by flattening and expanding. It functions very much like muscle tissue or fibers by lengthening and contracting. It is vital that each fascial layer is free to slide, glide and dissociate from one another. A mobile fascial system is what allows for free range of motion in all planes, within the body.

Osteopathic Manual Therapy and Fascia

Osteopathic manual practitioners view the body as one integrated system, one which relies on the proper mobility, position and vitality of all structures in the body to function optimally. The inter-webbing of the fascial system is viewed as one cohesive, continuous unit, which serves to protect and support the skeletal framework of the body (Bordoni & Zanier, 2014). The integrity of the fascial system depends on ‘tensegrity’, which means that the fascia strives for balance and equal force distribution across the entire system. Likewise, it means that while some structures are under tension, others structure must be able to compress and accommodate the new forces applied to the fascia. This concept of push and pull is what allows for the equal dissipation of force across the entire body (Stone, 2007). What that means is, that an injury of the fascial system in one part of the body will render that area less adaptive, creating new tension and lead to compensation elsewhere in the body. 

Caesarean Section and Fascia

The most common approach for caesarean sections involve a horizontal incision just above the pubic bone of the pelvis. The surgeon will make an incision, in order from outside the body to inside the pelvic cavity, through the skin, subcutaneous tissue, rectus fascia, and the midline linea-alba, the fascial layer where your six-pack muscles meet. The six-pack muscles are separated to gain access to the pelvic cavity. The bladder is often redirected and the uterus is also incised horizontally (Uzoigwe & Jeremiah, 2006). As we heal, these different layers of fascia do not heal individually, layer by layer (that of course would be too easy!). Rather, the fascial layers overlap, interlace and scar tissue forms. Scarring will occur with any type of surgical incision or laceration, it is part of the remarkable restorative nature of the body.

If we recall the physiology of the fascial system and the concept of tensegrity we can see why a scar is problematic in the body. The formation of the scar establishes a new “anchor” or fixation in the body and the fascial layers are no longer able to glide or dissociate freely. Scar adhesions disturb the fascial continuity and generate congestion between the different layers of fascia.

So, what can you do about these sticky fascial layers?

Treatment of  Scars

1. Time
GO SLOW and give your body the appropriate amount of time to heal. The time frame typically allocated for optimal healing post-surgery or labour and delivery is six-weeks.  This time frame is critical, as your cells work really hard to lay down new connective tissue, like a scaffolding for future stronger cells. Allow for your body to work its magic before progressing to the next steps.

Please note:  that all of these techniques should NOT be performed until your incision has completely healed. This means, you have seen your doctor for a follow-up post-surgery, you have no signs of infection, your stitches are out or dissolved and you have no more open lacerations or scabs in the area. These techniques can be applied to any abdominal scars, like laparoscopic scars, appendectomy scars etc…

2. Self-Massage
Self-massage is a great place to start for new mothers who have had a caesarean. After you are beyond your critical six-week post-op recovery time, you can start to mobilize the scar on your own. I recommend after a warm shower, applying some organic oil on your fingertips, coconut, almond or castor oil will do. Lie on your back, knees bent so that your belly is in a relaxed state, take a little 1-2tsp of oil on your fingertips and warm the oil by rubbing the fingertips together. Apply a gentle but sustained pressure with your fingertips and begin self-massage by just moving side to side over the skin above your scar and below your scar. This may feel weird at first, take your time and be gentle! Try to stick with it for 5-10 minutes a day.

As the weeks progress and you are well practiced at this ritual, you can begin to apply more pressure and direct massage to the scar itself. Still using your fingertips and oil, go up and down, side to side over the scar and lift or pinch the scar. This will help break down irregular connective tissue and built up scar tissue.

3. Castor Oil Hot Packs

After you have become accustomed to the self-massage techniques try this! Castor oil PLUS heat will increase circulation to the area you are trying to target. The castor oil hot pack will draw more blood to the area and encourage the breakdown of old scar tissue, improve the mobility and the appearance of the scar.

Once you have spent 5-10minutes with self-massage, apply an old towel or pillowcase over the abdomen and use a hot water bottle or heating pad to warm the area. This will improve circulation, promote elimination and healing to the tissues underneath. It is one of my favourite tools for home-care.

 4. See a Manual Therapist!

Out of the subjects recruited for my recent research, “The Effects of Global Osteopathic Treatment on Diastasis-Rectus Abdominus in Postnatal Women”, 30% delivered via caesarean. Mobilization of the C-section scar was always how I began to treat osteopathically. In the literature, scar adhesions disturb the fascial continuity of the core canister and have been recognized as one of the greatest aggravators of Diastasis-Recti Abdominis (DRA). If you feel uncomfortable doing any self-massage,seeking an Osteopathic Manual Practitioner or Pelvic Floor Physiotherapist for scar treatment is a great alternative. They will assure that all the different layers of fascia are mobile, all the way down to the deepest layer of your scar formed on the uterus!