Aftercare after caesarean section: affected women had the courage to ask questions!

Many women know or have heard statements like “I just have the typical pregnancy complaints” or “I have back pain. But that’s because I’m carrying my child so much now”.

I am very concerned to debunk these as fairy tales. My aim is to spread the knowledge that both many physical tensions and pain conditions are often related to past surgeries, and that scars after abdominal surgeries (+ their accompanying symptoms) can be treated effectively, quickly and sustainably.

A flexible, relaxed and mobile body has all the capacities to deal with the demands of pregnancy, birth and baby without pain! In this respect, every move that helps to release scars, fascial and peritoneal adhesions and embed them into the body in the best possible way makes sense!

I still have a tearing sensation after a year when I stretch. What can I do about it and where does it come from? My suture is still red and itchy.

Answer by MICHAELA LIEDLER: During a caesarean section, fascial and peritoneal adhesions form in the lower abdomen during the healing process. You can imagine these as “ropes” or “knots” that are now stretched between tissue layers that were previously free to move in relation to each other. This results in restricted movements. The “ropes” and “knots” create tension. When you stretch, you need to be able to move all the structures along with you in order to lengthen well. If this is not possible because it is prevented in the scar area by “ropes”, “knots” and dense adhesions, then you feel this as pulling or tearing.

This also applies to the itchy and reddened suture. Dense adhesions in the tissue prevent the blood flow and fluid circulation from resetting and the tissue signals via itching that something is not quite right there.

When I move suddenly, something in my abdomen cramps up. Could this be the scar? It’s been 9 months since my caesarean.

Answer by MICHAELA LIEDLER: During a caesarean section, fascial and peritoneal adhesions form in the lower abdomen during the healing process. You can think of these as “ropes” or “knots” that are now stretched between layers of tissue that were previously free to move in relation to each other. The “ropes” and “knots” create tension and restrict the movements that your organs normally need in the abdomen. You may now have adhesions due to the surgery that attach the scar to other tissue layers and to internal abdominal structures. If you then move in a jerky way, this knot tears at it and your abdomen cramps. It may be that when you move more slowly, your body has enough time to compensate or initiate new movement patterns so that you don’t cramp.

The suture is still numb after several years. Is there anything that can be done? Or do I have to live with it? My caesarean was almost two years ago. I have a keloid scar. Is it still possible to do something with silicone plasters? What would you recommend as an alternative?

Answer by MICHAELA LIEDLER: During a caesarean section, fascial and peritoneal adhesions form in the lower abdomen during the healing process. You can imagine these as “ropes” or “knots” that are now stretched between tissue layers that were previously free to move in relation to each other. This also affects the tissue layers under the scar, which then become compacted and allow less movement. In these condensations, the sensitivity and conduction of the nerves is altered and prevented. This can leave numbness. If the information “rigidity” is changed back to “mobility” in these tissue layers, the conduction of the nerves and the sensations can return to normal.

Now the good news: these fascial and peritoneal adhesions can be changed! Even years later. And so can all the symptoms associated with them! With the help of the Liedler Concept often within 1-3 units. The pain and pulling around the scar disappear and do not come back. Numbness, redness and a possible scar bulge decrease, as well as tension and back pain. The feeling of well-being in the body increases again!

This would be one alternative to silicone plasters. Alternatively, some dermatologists also loosen the superficial scarring on an outpatient basis with a small knife and thus increase the mobility of the tissue layers. Also injections with cortison could bring relief.

I have heard that you should not massage the scar because this increases the risk of getting an overshooting scar. Is that right?

Answer by MICHAELA LIEDLER: It is true that you should not massage the scar firmly until the wound edges are well connected and healed. The point is that tensile stress, which pulls the wound edges apart during a massage, leads to delayed wound healing and more scar tissue is deposited as a result. However, once the scar is well closed and healed, it is quite important to move and massage the scar tissue to restore suppleness!

When can I start using a scar roller? It’s been 2 weeks since my caesarean section. Or is there a good alternative?

Answer by MICHAELA LIEDLER: Please use the scar roller only when the wound is well closed and healed. After that, it is important to touch the scar and the scar area, to move the skin in all directions around the scar and to move the tissue layers against each other. The scar roller may also be used. Wherever the tissue retracts or does not move easily with the scar, adhesions are present. These should be softened by continuous movement and mobilisation.

My scar gets inflamed and sometimes weeps even after a year. Is this normal?

Answer by MICHAELA LIEDLER: Actually, it shouldn’t be. During a caesarean section, fascial and peritoneal adhesions form in the lower abdomen during the healing process. You can imagine these as “ropes” or “knots” that are now stretched between tissue layers that were previously free to move in relation to each other. This results in restricted movements. The “ropes” and “knots” create tension. If these tensions are too high inside, it is possible that the superficial tissue layers are constantly kept in tension and that these constant stimuli lead to the scar healing not being completed.

Should I care for the scar with ointments or healing cotton? My caesarean was 5 months ago and is still quite numb and red.

Answer by MICHAELA LIEDLER: In any case, it is good to keep the skin and the scar supple with creams. However, it is more important to restore the suppleness and mobility of the tissue layers in relation to each other. This means: It is important to touch the scar and the scar area, to move the skin in all directions around the scar and to move the tissue layers against each other. Wherever the tissue retracts or moves with difficulty, adhesions are present. These should be softened by continuous movement and mobilisation. Numbness and redness indicate adhesions in the underlying, deeper tissue layers.

Deep tensions and adhesions should be treated after a caesarean section by an osteopath or physiotherapist who specialises in the aftercare of scars and peritoneal adhesions or in the gynaecological field.

What is allowed or should be done as sport? Is sport harmful to the scar?

Answer by MICHAELA LIEDLER: Basically, a period of six weeks after the caesarean section is considered a period of rest. When doing sport, it is then important to know and maintain your own personal limits. This means ALWAYS orienting yourself to your own sense of well-being. Everything that feels good, pleasant and pain-free is allowed. At the same time, it is okay if a pulling sensation occurs in the scar area during certain movements during sport. However, this should gradually become lighter as the movements are continued and should not cause any “after pain” when finished. If persistent pain and swelling remain during and after the end of the sport, then the limit of endurance has definitely been exceeded!

In general, exercise and sport are recommended to restore and maintain the suppleness and flexibility of the scar tissue.

My scar hurts after 4 months, but only when I lie on my stomach. Should I avoid the prone position?

Answer by MICHAELA LIEDLER: During a caesarean section, fascial and peritoneal adhesions form in the lower abdomen during the healing process. You can imagine these as “ropes” or “knots” that are now stretched between tissue layers that were previously free to move in relation to each other. This also affects the tissue layers under the scar, which then become denser and allow less movement. Basically, a scar is considered good if it is free to move in all directions and does not restrict you in any movement to such an extent that you can no longer do it.

If you cannot lie on your stomach, this indicates that fascial and peritoneal adhesions are causing restrictions in your lower abdomen that mean you are not free to move in all directions. You should not have to avoid the prone position.

Please make an appointment with an osteopath or physiotherapist who specialises in scars and peritoneal adhesions or gynaecology for treatment!

My scar has moved inwards. It looks like a groove. Why is it like that? I don’t have any pain, it’s just that visually it’s not so nice.

Answer by MICHAELA LIEDLER: During a caesarean section, fascial and peritoneal adhesions form in the lower abdomen during the healing process. You can imagine these as “ropes” or “knots” that are now stretched between tissue layers that were previously free to move in relation to each other. This also affects the tissue layers under the scar, which then become denser and allow less movement. Because the scar tissue has the task of closing the wound, scars contract in the course of the healing process, also inwards. These tensile tensions and the “ropes” become visible as retractions of the scar itself.

Is there anything I can do to support the healing of the inner sutures, as the massage is more about caring for the skin suture, or? I haven’t had a c-section yet but have an elective one coming up.

Answer by MICHAELA LIEDLER: You are absolutely right. During a caesarean section, fascial and peritoneal adhesions form in the lower abdomen during the healing process. You can imagine these as “ropes” or “knots” that are now stretched between tissue layers that were previously free to move in relation to each other. This affects both the tissue layers under the scar and inside the lower abdomen, which then become denser and allow less movement.

It is important for you to know: Since the uterus sits deep in the pelvis and all layers up to and including the uterus are cut or torn during a caesarean section, these adhesions may extend deep into the pelvis. The abdominal cavity is also torn open on the inside all the way to the navel to create enough space for the baby to be taken out. This means that the invisible, inner scars extend into the uterus on the one hand and up to the navel on the other. Be aware that it is a major surgery!

What you can do: You can support the healing process by always (from day 1) breathing well into your abdomen! The abdomen should bulge out on the inhalation and be slightly pulled in on the exhalation. Make sure that you can straighten up well when breathing. As the diaphragm and your pelvic floor work together during breathing, you mobilise all the peritoneal layers deep into the pelvis.

Furthermore, you can and should sleep and lie in all positions. Move as normally as possible – in consultation with your doctor – and avoid one-sided movements and positions. Be accompanied by an osteopath or physiotherapist who specialises in the aftercare of scars and peritoneal adhesions or in the gynaecological field!