Internal Pain After C-Section: What Every Mom Should Know
Internal pain is common and normal after a c-section. Your surgeon has to cut through 7 layers of tissue (skin, fat, fascia, muscles, and the uterus) to get to the baby, so scar tissue and pain with healing is expected. After 12 weeks, your tissue is about 80% healed and pain should be improving. So if you’re struggling with internal pain after c-section and it’s been over 12 weeks, it’s time to start asking an expert.
This blog will go over what could be causing the internal pain after a c-section, ways to improve the discomfort, and where to seek help.
What Does Internal Pain After a C-Section Feel Like?
Internal pain may include:
Lower abdominal pain
Deep pulling
Sharp or shooting sensations under the scar
Pain around your belly button
Aching in the front of your hips
Vaginal pain
Pain may happen:
Going from sitting to standing
Cough or sneezing
During ab workouts
During twisting movements (like reaching in the back of your car)
During heavy lifting
While running
During sex with deeper penetration
You may notice the pain feeling changes: it can vary from burning to itching or sharp sensations. These sensations are normal within the first 6-12 weeks, but should lessen significantly once the tissue has healed.
Remember, we just see the visible scar. There’s also scar tissue along the uterus and deep structures that we can’t see. So give yourself time to heal!
Six Possible Causes of C-Section Scar pain
A typical inflammatory response to help heal the tissue: Swelling and pain is very common early postpartum.
Scar tissue or fascial restriction: scar tissue is necessary, but can cause tension and/or pain if not addressed
Muscle weakness or lack or coordination: the deep core and pelvic floor muscles can lose their ability to stabilize the trunk together.
Nerve irritation: nerves regenerate, but can cause sharp, shooting pains OR itching while growing back after surgery. Scar tissue may restrict nerve mobility, so working on your scar is important to prevent prolonged nerve irritation.
Nerves that could be impacted during a c-section: Cutaneous nerves (sensory nerves around the scar) can cause numbness, tingling, or pain along the scar, Iliohypogastric nerve, Ilioinguinal nerve, or the Genitofemoral nerve.
Scar tissue adhesions: scar tissue that occurs internally, but can adhere to the bladder or surrounding structures
Pelvic floor dysfunction: after a c-section, the pelvic floor often becomes overly active trying to do the job of the surrounding core muscles. This can frequently cause internal pain, and is clinically what we see A LOT in postpartum women
What's Normal During C-Section Recovery?
Early postpartum (0-2 weeks): Some bleeding at the scar. Pain with coughing, sneezing, or standing.
Mid postpartum (2-6 weeks): Bleeding/fluid from the scar should be resolved. Scabs and signs of healing should be present. The pain should lessen week to week.
Late postpartum (6-12 weeks): Scar should be fully closed and free of scabs. It should not be excessively raised (keloid). It is typical to have mild discomfort until close to 12 weeks.
When Is Internal Pain a Cause for Concern?
Odor from the scar
Heavy bleeding that won’t resolve
Swelling and redness that’s consistent past 6 weeks
Fluid coming from the scar after 2 weeks of healing
If you’re concerned about infection, or have these symptoms, contact your OB/GYN or midwife.
Tips to Support Your Recovery
Gentle walks as early as 1 week postpartum (if tolerable)
Knee rocks side to side at 2 weeks postpartum to improve early scar mobility
Gentle core work at 2 weeks postpartum
Starting gentle skin circles around (not on) the scar starting at 2-3 weeks postpartum
Ask your provider to assess your c-section scar at your 6 week postpartum appointment
Starting circles directly on that scar at 6 weeks
Consider silicone strips starting at 6 weeks until 4-6 months postpartum
Desensitization with a bath towel for 1 minute after a shower or bath with your towel daily starting at 6 weeks
If you would like guidance on different c-section scar techniques, check out our free guide below!
How Pelvic Floor Physical Therapy Can Help
You should consider seeing a pelvic floor physical therapist for preventative care at 6 weeks postpartum for scar tissue mobility or if any of these reasons describe your symptoms:
The internal pain after c-section doesn’t resolve after 12 weeks postpartum
Wearing tight clothing irritates your scar
You have pain with sex after your c-section
You have back pain or hip pain postpartum
You struggle with urinary leakage, urgency, or frequency after a c-section
You want to prevent long-term scar issues before it becomes chronic
You stopped exercising because of symptoms
Symptoms return every time you try to be active
A pelvic floor PT can assess:
Core strength and coordination
Scar mobility and sensitivity
Bladder mobility and irritation
Nerve movement and sensitivity
Pelvic floor mobility
Pelvic floor tension and strength
Treatment May Include:
Scar tissue work including cupping and/or dry needling
Myofascial release around the abdominal wall and pelvic floor muscles
Pelvic floor muscle relaxation techniques
Nerve mobilization techniques
Deep core strengthening exercises
Education on scar desensitization and movement
A comprehensive postpartum exercise program
If you’re wondering how my “internal pain after c-section” can be resolved, you are definitely not alone.
Pelvic floor physical therapy can help you get back to the things you love without internal pain or irritation around your c-section scar limiting you.
Revive Rehab in Columbia, Missouri, is a pelvic health practice that specializes in pregnancy and postpartum care.
If you are in the Columbia, Jefferson City, Fulton, Boonville, or mid-Missouri area, we’d love to work with you! Click here to learn more about our in-person services.
We offer hour-long, one-on-one, individualized appointments with a physical therapist to get to the root cause of your concerns. We provide a holistic approach for your care. Click the link below if you’d like to book an appointment with us and a member of our team will reach out soon. We’d love to help you on your postpartum journey!
Written by: Dr. Sarah Miller, PT, DPT
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