North London Massage, Doula, Pregnancy Massage, Baby Massage

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Treating Scar Tissue. 9 Tips For A Good Recovery After Caesarean Section

As one of my passions is anatomy and physiology, in this post I will specifically focus on treating scar tissue, and give you 9 tips for a good recovery after caesarean section. All you can do to speed recovery.

TREATING SCAR TISSUE

I want to share with you the ‘secrets’ I discovered about scar tissue and what you can do to enhance cell regeneration. What you are about to read is ‘true’ for every type of scar tissue. However, the article focuses on things to consider when having a C-section and lists 9 tips focused on abdominal scar tissue after a C-section.

What is scar tissue?
It’s connective tissue that forms when, and where, there is a wound. It protects the area from further damage. If you compare the scar to the skin in surrounding areas of your body, it is usually denser in consistency because of fibrous tissue and paler in color because of its limited blood supply, and also because of differences in pigmentation of new cells. A ‘fresh cut’ may be redder because of the presence of blood in the layers of tissue surrounding the incision.

I could not put it better than Ruth Duncan, an expert on Myofascial release
( http://www.myofascialrelease.co.uk/What%20is%20MFR/ ), when she describes scar tissue:

“Imagine you have laid a sheet flat out on a wooden floor or table. If you pull this sheet from one of its corners you can clearly see a strain pattern through the sheet to its other corners and the sheet moves fluidly when pulled. Now imagine you have nailed a huge nail somewhere through the sheet to the wood below and try to pull the sheet at one of its corners. Due to the nail, the sheet has lost its fluidity and can now only pull around its restriction. The same thing happens to the body’s soft tissue when a scar is introduced expect that it is a complex 3D structure composed of multiple layers of tissue both horizontally and vertically. Scar tissue and adhesions are very much more solid a less fluid than normal tissue so, like the nail, it acts as a fulcrum of resistance to normal fluid movement.” – Massage World Aug-Sep 2011-

When such a restriction is present, your body will compensate by tightening or weakening other parts of the body. An imbalance starts to be present and subsequent discomfort or pain may occur.

For ‘perfect’ body movement and function, the fibres and structures need to be able to glide smoothly alongside one another.

Sometimes, the range of movements (ROM) around the affected area decreases. If this is not addressed early enough, scar tissue will thicken and adhere to more surrounding tissue.

When a fibrous area has formed there may be little or no fluid movement (lymph flow, blood circulation) running through it. Breaking down the adhesions, through professional massage or self-massage, frees the blood flow which, in turn, helps the healing process.

When does a scar heal properly?
The difference between a scar that heals well and one that doesn’t is mainly (apart from infections of course) about how smooth and elastic the soft tissues remain afterwards and how much the muscles are free to glide ‘independently’. You want to avoid the scar becoming a fibrous tissue with lack of movement, creating adhesion and lack of energy flow when restricting meridians points.

When fibres stick together, creating a hard lump/knot, the tissues and surrounding structures cannot stretch or contract properly. They need to work their way around the restriction.

I once was at a workshop with a chartered physiotherapist who mentioned a very interesting fact about scar tissue. This was about the regeneration of new collagen fibers: when re-generating themselves, the new collagen cells ‘don’t know where to go’ and distribute themselves randomly around the wound. If this is left untreated the scar will become hard, creating restrictions on some layers. While if you gently rub over the scar along the muscle fibres, the new cells will evenly distribute themselves along the fibres. This, in turn, helps the scar to heal well, creating a much smoother structure. (N.B. this is to be done once the superficial cut has closed and it is dry. Stitches removed)

PS./ (Note) 1. In the specific case of lower abdominal (supra-pubic, uterine, peritoneal) surgery, with subsequent sutures, a good recovery is also essential for later pregnancies.

PS./ (Note) 2. In the case of a previous operation (e.g. to remove fibroids) some scar tissue may have formed internally in the uterus. This should be kept in mind during labour/birth. In some cases where the original scar hasn’t healed properly, restricted tissues may be a barrier for a natural delivery, as it may restrict the uterus contracting effectively or the cervix to fully dilate. Magnesium intake is key to muscle smoothes, as well as zinc and vitamin C for cell regeneration and antioxidants. 

9 PRACTICAL TIPS FOR A GOOD RECOVERY AFTER CAESAREAN SECTION:

The tips below are indicated after the incision has closed, appears dry and stitches are removed, usually by day 10 sometimes much earlier. Before that, you may feel you ‘don’t want to do anything’ anyway. Just move gently, rest and bond with your baby.

Have lots of pillows available and experiment with what is the best position for you. It may change hour by hour. You may also find that it is easier to cough or sneeze while supporting your core with your hands.

Keep your wound and surrounding areas clean and don’t overdo things during the 6 to 8 week recovery period.

1. Give yourself time while being very kind to yourself
This means allowing yourself time to rest, don’t worry about ‘things that need to be done’. Your health is the most important thing and it needs your ‘attention’. Just focus on you and your baby with your partner/ family for love and support. Do invest in someone that can help you either with cleaning, cooking or breastfeeding support as it will save you energy, stress, time and possibly sending more money later on. (e.g if you have to pass on formula for instance).

2. Go for walks as soon as you can
This is the most important exercise for you right now. Start with a few steps and build up to longer walks. Walking promotes lymph and blood flow, which in turns means more oxygen and nutrients throughout your body. It speeds up recovery and wound healing. It also helps in maintaining normal breathing function as well as strengthening muscle tone. It boosts systems such as the gastrointestinal and urinary tract, where normal function usually slows down after surgery.

3. Massage
Gently and gradually begin self-massaging the area. Stroking along the muscle fibres will help new collagen cells to evenly distribute themselves within the tissues. Stroking across muscle fibres can break down the adhesion by gently ‘separating’ the adhering bond apart. Use a gentle but firm touch. You can use deeper pressure with each subsequent massage, respecting your own body’s individual time to heal. (If you are in doubt refer to a pregnancy massage specialist for professional massage. She/ he can also show you how to self-massage). You can use Pure, organic aloe vera gel or coconut oil. IN both cases take a little product in your (clean) hands first and warm it or soften it in your hands before applying.

 

4. Consider a warm water bottle or warm compress
Warmth increases blood circulation to the area where it is applied. Blood circulation means more oxygen and nutrients to the site, promoting faster healing.

5. Breathing techniques
Slow, deep diaphragmatic breathing helps to internally massage organs and relax the muscular-skeleton system. Together with walking, this is the most important form of exercise post-surgery.

6. Your core
Do not do crunches! It can make the abdominal separation worse.  Start with your lateral abdominal muscle for support. The abdominal wall, lower back and pelvic girdle may feel tender and have some degree of discomfort/ pain. It is better to focus on the whole core, including pelvic floor, rather than only one area. It is important you start slowly. You may want to consider post-natal Pilates classes or simply take 3/5/10 minutes and gradually build it up every day on the floor at home, while your baby is also on the floor with you or sleeping in his nest. In any way; appropriate exercise does make the difference.

Start with core exercises after the first few weeks, say around week 3, or when you feel is right for you. Definitely, after you feel comfortable walking without being too tired from it.
Pelvic floor exercises: Kegels and pelvic tilts. (Plenty of this on the web)
Lateral abdominal exercises: You can begin to strengthen the abdominal area by gently working on the sides of your waist (external and internal oblique muscles as well as transverse abdominals). You can do this while comfortably lying on the floor, slowly going to one side, back to the centre and then the other side, keeping in contact with the floor at all times. After a few weeks, once you are comfortable with this you can then slightly lift the sides off the floor. as you do the lateral movement. The rectus abdominis (front of tummy) will then follow much more easily in time. Do not do crunches for at least the first year! Also, look at exercises and stretches for your
Lower back exercises: a simple one is to lay down (ideally on a futon or a yoga mat on the floor) flex your knees and bring them together towards your chest. Find your balance in this position and slowly start to draw circles in the air with your knees. One direction first, and then the opposite direction. You can start this with someone helping you lifting the legs and supporting your knees as you draw circles. (Ask an osteopath or physiotherapist for help and more tailored exercises)

7. Have friends and family for practical support around you. (Or hire a post-natal doula)
For the first few weeks after birth, you may find household chores difficult. These can include: changing duvet covers; vacuuming; lifting (laundry baskets, toddlers); carrying something up and down stairs; stretching up to reach high cupboards or peg out the washing. While movement is a good thing to enhance recovery and avoid complications such as blood clots, it is better avoiding housework or lifting. This will allow you time to listen to your body and be in tune with it. You can go back to your normal routine of things to do once your core is strengthened.

When someone comes to visit, ask if they can bring a cooked meal or if they can stop at the supermarket on the way. If they are coming to visit it means they care, and as hard as it is to ask for help sometimes, *that’s what human beings like to do (the majority of the time)*. Remember people often like to please and have the opportunity to be useful and help others!

8. Diet, Magnesium, Zinc and Vitamin E
Of course, a good diet is always the path to wellbeing. A protein-based diet with plenty of vegetables and some complex carbohydrates is key to muscle recovery.
Also, make sure your mineral intake is good.
Magnesium is a good component for muscle smoothness and elasticity. If you crave chocolates or suffer from cramps it may be a sign of a lack of magnesium.
Vitamin E promotes collagen fibres and soft tissue’s healing. (As well as or together with vitamin C, antioxidant)
Zinc essential for the normal growth of cells, is needed in the formation of connective tissue.
You may also find Arnica helpful. It has anti-bacterial and anti-inflammatory qualities helping to reduce pain and swelling while improving wound healing.
You may want to consult a nutritionist.

9. Use positive thoughts

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Nowadays, neuroscience tells us plenty about the power of the mind, so we can use this knowledge in our favour.

The brain doesn’t recognise fiction from reality, whatever you think the brain takes it for true and start releasing hormones that go with that thought. For a practical example of this, think of a lemon…think of squeezing the lemon and drinking its fresh juices… if you think of it with the same intensity you think at thoughts that ‘really’ are in your mind, you are most probably releasing saliva or the gland in your throat are feeling a little squeezed too! You don’t have the actual lemon with you, you only thought of it and your brain is taking it for the true experience, starting to release hormones that help digest it etc.

So you can use your thoughts to help you in the post-partum period. (Or any other event in life). With every thought your brain sends ‘messengers’ around the body’s organ, telling them what hormones to release in response to that thought/feeling.

You can use positive ‘healing’ thoughts to help after c-section. If you accept the fact that you had the operation and think it is possible to recover well and be as your normal self, the scar will heal better and probably faster. A few examples to get you started:

“I know my body has trillions of cells, each one of them regenerates every day and a new me is formed with it. I feel my body knows what to do and I respect it’s time”

“ I feel uncomfortable today but I know I can do things to improve my situation and feel better. In fact, this exact thought is one of them. So many women recover well after a c-section and I am one of them”

“Even though things don’t go according to plan sometimes, I trust my body and its wisdom and I am tuning in to recover fully”

It’s really important to keep thoughts positive because the other interesting fact about the brain is that it doesn’t recognise negatives. If I tell you to think of all the animals you can possibly think of but do not think of a white bear …. what is the result? The brain needs a second step to delete, or reframe negatives or forced to think of something else. But this is a second needed process and it requires energy and effort. The reason why it is so difficult to say no or don’t to children, their brain doesn’t recognise this and they need to learn its meaning through the experience. So do yourself a favour… think positive!!!

THINGS TO CONSIDER AFTER CAESAREAN ABDOMINAL SURGERY

RECOVERY TIME
Contrary to what is unfortunately often perceived, delivery by Caesarean section is far from an ‘easy’ option to give birth, and it surely has its disadvantages the most obvious being the post-operative recovery period.

I would generally say a good recovery time ranges between 6 to 8 weeks. During this time there is a lot you can do. See tips below.

Most of all, be kind with your self and surround yourself with supportive people.

ITCHY SENSATION
Itching is a sign of healing. Try to not scratch directly. You may find that applying pressure over the itchy area with your hands helps. Avoid any lotion/oil for the first few days until the incision is well closed. Afterwards, you may want to apply good organic cold-pressed vegetable oil rich in vitamin E, such as wheat germ oil.  (See tips below for vitamin E properties)

Keep it dry. If you take a shower don’t apply direct soap or water directly, let the water run over it. Use a separate clean towel to dab over it and use a hair-drier to dry it well before covering it.

INFECTIONS
Every wound carries the risks of infection if overlooked.

In the case of C-section, there can be a superficial infection of skin or stitches, or more internally, in the uterine wall and/or uterus lining (endometrium). Hygiene and diet are the first components to prevent infection.

Garlic is a natural antibacterial, antifungal and diuretic. But of course, anything you consume that boosts your immune system such as vitamin C is good post-recovery.

Colloidal silver (spray) for topical application is also a natural anti-microbial; you may want to look into it for appropriate use.

I encourage you to look at your scar from day one for signs of infection such as: redness, swelling, hot skin around the incision or pus. A little odourless leak can be quite normal but thick pus is not. Also, look out for signs of a fever (although this may be due to different reasons), rapid breathing or increased heart rate, chills, particularly unusual smelling urine or if you are having difficulties in passing water.

Being in tune with your body is always going to be an advantage.

BLOOD CLOTS
One of the many physiological changes during pregnancy is the blood’s clotting factor that increases. This is nature’s plan to prevent haemorrhages during labour.

To avoid blood clots post-surgery, walk from as early as you possibly can, step-by-step a little more each day. Walking boosts blood flow and lymph flow, which in turn helps prevent blood clots, as well as constipation, gas build-up in the abdomen, etc.

WIND
After pregnancy birth and/or surgery, your bowel may be more sluggish than it used to be. This may cause constipation and/or trapped wind. The internal discomfort can press on the diaphragm, and that pain can refer to other parts of the body.

Breathing exercises, walking, a healthy diet and plenty of fluid will help.
Drink room temperature or warm water instead of cold.

A last important note:
If you are a mum who has had to have c-section because of ‘complications’ or ‘lack of progress during labour’ please remember the medical profession has failed you and not vice-versa. You still have all the capabilities to give birth naturally if you so wish!

Posted in Anatomy and physiology, Caesarean section, Massage, Post-Natal Recovery, Pregnancy


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Author Info

Eleonora Lawson

Deep tissue pregnancy and postnatal massage specialist. Birth and post-natal doula. Baby massage instructor and Sling consultant based in North London. CThA, Doula UK, AIMS, IAIM