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What You Don’t Get Told About Your C-Section Scar

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I’ve written before about returning to exercise post C-section, but I didn’t touch on one important area of C-section recovery: the scar. Because I think this deserves a blog of its own.

I meet a lot of C-section mamas, and issues such as poor sensation/numbness, ongoing pain and a feeling of tightness in the area are common. Which is hardly surprising: even from a small cut I’ve felt tightness in the area as it’s healed.

But this rarely gets talked about- why not?! There’s been trauma to muscles, nerves, blood vessels, right in the hugely important area of the abdomen no less. Your core muscles (we want those functioning well, right?) and a number of organs are potentially affected by this. And massage can make a huge difference to the healing process.

So why aren’t all C-section mamas told to massage their scars as part of their recovery?

 

Advice is all about the appearance of the scar, such as looking for signs of infection, yet the effects of your C-section can go beyond what you feel in the scar itself.

This may sound severe, but remember the scar is far deeper than what we can see: if you think about how deep the incisions are, and how scar tissue is formed, this isn’t surprising.

After surgery scar tissue forms as part of the healing process, but the fibres go in all different directions, can feel tighter, and it can adhere to other tissues, such as skin, muscles and even organs. This is when problems can occur.

You can view a video here of what these adhesions look like.

So what issues can arise?

Low Back and Pelvic Pain

Adhesions in this area can affect the sacrum, which is where your spine meets your pelvis, so anything that interferes with its movement or function can have a knock on affect to your low back too.

Frequent urination

I think this one is self-explanatory! You should be urinating every 2-5 hours, but many women find themselves having to dash to the toilet far more often. Again adhesions in the area can affect the bladder’s expansion and sensitivity, interfering with normal function.

Pain with intercourse

This comes back to adhesions around the organs again: if it limits their movement, then they can’t get out of the way during intercourse, which can be very painful.

Obviously not every woman who’s had a C-section will experience these symptoms. But it’s worth knowing about because sometimes it can be years before any issues occur, as adhesions continue to form. And while massage won’t prevent all of this, it can definitely reduce the risk and severity of symptoms should they occur. So you’ve got nothing to lose from trying it!

So how do I massage my scar?

When to start:

Ideally as soon as it’s fully healed to prevent the formation of deeper adhesions. But it’s never too late to start, even years later!

How often:

More regularly to start, when the tissues might not be moving very freely, but once they are it’s still a good idea to revisit it once every so often, in case it’s getting tight again.

If you have difficulties doing this or notice your tissues don’t seem to be responding to your efforts, then you should see a Women’s Health Physiotherapist for treatment.

How?

This is the best video I’ve seen of how to massage your scar, by Lynne Schulte at Intuitive Hands PT.

However there are also therapists who specialises in scar tissue massage. Emma Holly from ScarWork at Restore Therapy told me about a recent client and how scar massage helped her:

After a long labour she ended up with an emergency c-section. After a few months she started to try some exercise videos and found she had bladder weakness and sought out an amazing women’s health physiotherapist and has started a course of exercise to strengthen her pelvic floor.

Her c-section scar had left her with little feeling and a disconnect with the pelvic area. She came to me for treatment where I worked along the scar tissue, using ScarWork therapy to stimulate further healing. Deep stretches loosened some adhesions caused by surgery and using massage to release the pelvis and hips post pregnancy.

After one 45 minute session she walked out of the appointment and said “oh, my hips feel different” in the days that followed she noticed her feeling of the pelvic floor improved so she could be more aware when drawing up the muscles and is now finding her exercises from the physiotherapist and in restorative pilates much easier.”

In addition, if you are having any issues with pelvic pain, or that might be associated with adhesions to your organs (including bowel problems) many Women’s Health Physios are trained in visceral manipulation, so can assess you and work deeper than you might be comfortable doing yourself.

WH Physio Becky Aston explains how this can affect breathing patterns (read this blog for more on the breath and core strength) and result in pain elsewhere:

 

An amazing fact about the diapraghm (muscle below the lungs) is it moves up and down 20,000 times a day. We think of the ovaries, kidneys, liver, pancreas etc just existing in our pelvic and abdominal cavity but they move in a synchronised fashion with the diaphragm.

Now imagine that you have something restricting this movement i.e. adhesions from a scar. However small, they will limit this movement and other structures will have to accommodate. This can cause pain or dysfunction anywhere else in the body.

Releasing abdominal adhesions can relieve IBS symptoms, menstrual pain, back pain, help the pelvic floor muscle and deep core work more effectively and many more things.

Visceral release work is a gentle therapy with mobilises visceral and myofascial structures which can release those adhesions and allow the body to be synchronised again.

And finally…

A note on numbness and loss of sensation in scars, as this is what I most commonly get asked about.

Nerve damage can be permanent, but nerves do regenerate. The speed of this is slow though, about a mm a day (it depends a bit on the size of the nerve in question) so it can take months and even years to regain feeling. The same goes for feeling such as tingling or itchiness.

I find that the impact of a scar can reach far beyond its immediate area. Tight quad muscles (on the front of the thighs) for example can pull on the scar, so massage and release work here can be beneficial to the C-section mama. And any scar can have a huge impact on muscle function too.

If you’re interested in booking a postnatal massage with me to help with your recovery, and with your scar massage, you can find out more about what it involves here.

And if you’re one of the many women who finds the thought of touching your scar makes you feel ill, you’re not alone. The comments I received after first writing this blog prompted me to write a second about scar aversion. You can read it here.

 

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Is Balance Bullshit?

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When we talk about reducing stress, we often talk about balance. Because we’re all trying to juggle everything- family, running a house, seeing friends, work, exercise, eating well.

And that’s not even including the little things like painting your nails, reading a good book (right now it’s The One I Was by Eliza Graham) and getting a haircut. The list goes on right?

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See how stressful it is juggling everything? And the state of that worktop! The strain I’m under here.

When training clients, whether it’s postnatal mums on Restore My Core or 1-2-1 sessions working on weight loss, I always ask about stress. It’s important to consider the effect stress could be having on your recovery or fat loss goals. Because increased stress (and therefore increased cortisol) does affect these things.

And most of us try to juggle too much. Inevitably something gives. We let some balls drop (snort). Which then feels like failure because we haven’t lived up to our unreasonable expectations of ourselves.

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See how sad I am at my juggling failure?

But is it really possible to achieve balance?

Because I feel like balance is bullshit.

Has anyone REALLY ever attained a state of perfection where all these things run in harmony? Getting their fair share of your attention?

Because I fucking haven’t.

But do we need to? I think part of the problem is that we think we should be able to do it, and put too much pressure on ourselves. Probably because there’s always some other mum who looks like she does. I guarantee she doesn’t. I would bet good money she’s either a screaming mess behind closed doors, hyper-controlling with her children, or drinking a lot more wine than you.

So what’s the answer?

I don’t know. It’s a Friday night and I’m writing this, that’s how good my work-life balance is. And I haven’t even had any wine yet. Surely you don’t expect answers to life’s problems from a fitness blog? But since you’re here I’ll tell you the best I’ve come up with.

Prioritise.

Or rotate. Rotate your priorities, that’s better.

You can’t fit it all in. But you can concentrate on what’s important, at least for a while, then something else will need your attention, so you focus your energies there for a bit.

Let me explain. For me, my biggest priorities are family, work, and taking care of my health. I struggle to do all 3 as best I’d like, at once.

So when I feel particularly productive and motivated, I’ll have a period where I focus on my business. I’ll study, write blogs, develop the content I give to clients (videos, education) and generally try and move it forwards.

And I can just about manage this around childcare. But it means late nights, which means exercise is scaled back. I need the extra hour in bed so can’t get up for the gym. I don’t have as much ‘me time’.

Parenthetically I cringe a bit whenever I use that term, mainly because of Man Who Has It All. But while I know its clichéd I’ve yet to come up with a better term that everyone knows- suggestions below please.

So I start to feel a bit crappy, lose motivation and decide to focus on myself for a bit. Which means work takes a back seat. I’m still doing everything I can for clients, but webinars and business plans? Not so much.

But now I can get some early nights, train a bit more, spend a bit longer cooking. And then maybe I’ll use some of my pre-school hours to see some friends.

The idea that you can divide your attention equally to every aspect of your life, every day, is bullshit.

So stop trying to.

Because the more I try to do or balance everything, the more stressful it is.

Ask for help. Let some balls drop (still chortling). You don’t have to juggle them all.

So what if this mean sometimes I forget to order food and we need take away? Or I skip the gym (I make sure I have enough activity with the kids to stay healthy though, or fit in home mini workouts- this is when the fitness knowledge comes in handy!)

Basically stop worrying so much about balance.

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Look how much happier I am now zero fucks are given. The kitchen’s still a mess, a small child has materialised and will probably start to whine soon, but I’m zen and can handle it all. (Note- I am not suggesting wine solves everything. If that’s what you choose to take away from this then that’s all on you.)

Self-care really is important though

I find litte things can help when everything is getting too much. Again, you don’t have to be too ambitious here. Whilst I love a good Epsom Salt bath, new mums might find that aiming to get dressed and have a shower is enough to feel a bit more human. Maybe go crazy and brush your teeth before midday.

Carving out even a small amount of time for yourself each day can make a difference. Ideally you can do this without having to lock yourself in the bathroom, but if it comes to it, my money says that your OH gets away with the odd 30 minute session in there. If that’s the case then so can you. Just make sure he’s at home to deal with the fallout when you do it.

And on the exercise front, if you want to find out more about how to make the most of your time with your postnatal training, get my 10 tips to getting back to exercise after baby here.

 

 

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I have #noexcuse. Because I don’t fucking need one.

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This is old news. I did a post about it on Facebook a while ago after I saw this photo on Instagram:

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But despite the fact that a lot of fitness professionals spoke out against it, I still see it happening.

I’m talking about #noexcuses.

I’ve just seen this picture being used to promote a local gym to mums:

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And that’s why I’m writing this blog.

In all honesty I think (hope) they were just using it because of their creche, to say ‘that’s one barrier to your gym attendance that we’ve removed.’ But that’s not what the picture says. The picture takes her body, and says ‘what’s your excuse?’ Are we seriously going to pretend none of us has a valid ‘excuse’ for not looking like that?

Well here are what I think are 6 perfectly good reasons for not having visible abs.

1. Not wanting visible abs.

This may come as a shock to some, but not everyone wants a six pack.

Having goals is great. But having abs is HER goal, and there’s no need to judge others because they don’t live up to it. They’re not the be all and end all. They will not bring you happiness. They are not necessary in order to look attractive.

2. Not being a fitness model.

These women get paid to look like this. Well done to them for all the hard work, but for the rest of us, who don’t get paid, and may even have other jobs that take up our time, it’s not such a priority.

Also, the fact that they were fit before they had children makes things a lot easier. Are we really going to turn around to the mum who hasn’t done a workout in years and say, ‘hey, this mum who has 10 years training experience got her figure back in 6 months, what’s your excuse?’

3. Having a life.

Yes, I could exercise more and eat less, but having body fat low enough to show your abs has trade offs. Those trade offs for me include less time with my children and feeling more stressed when I am with them as I struggle to squeeze in a workout around running a house and a business.

This doesn’t mean I don’t exercise. I train, I stay fit, but my goals at the moment are health related, I’d rather not waste time and energy worrying about a few pounds or inches here and there.

4. Not having obsessive/ disordered eating habits.

Otherwise known as having a healthy relationship with food.

This means when you have to consume food outside your own home it comes on a plate in a restaurant/ cafe, not in a Tupperware box filled with chicken and broccoli from the steaming marathon you had on Sunday evening.

And you don’t feel guilty afterwards.

See here and here for a couple of examples of the damage competitive fitness can do to your relationship with food.

5. Genetics.

People come in different shapes and sizes. Some people are naturally slim and can quite easily get visible abs. For others it just isn’t going to happen. So let’s stop this message that certain physical attributes or body types are better than others. Let’s stop comparing ourselves to others.

6. You don’t need a fucking excuse.

You’re an adult. Not a child turning up late for class. You do not answer to the gym police about your appearance.

Are you healthy? Happy? Then good for you.

Stop worrying about the rest.

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As a trainer, I feel it would be irresponsible of me to post these ‘no excuses’ pictures. I don’t want to tell women they should look a certain way and I don’t want to play on their insecurities to get clients. I want them to learn to be happy with their bodies and to stop comparing themselves to others. To train to feel good physically and mentally, because a happy mum means a happy family!

I started writing this blog because I felt annoyed about the message the fitness industry send out sometimes. Hopefully I’m finishing it on a more positive note.

But even when I’m being body positive, I still feel a bit sad. Because it’s still about bodies.

How we look.

And we’re more than that. If you really want to feel better about yourself, step away from the scales/ mirror. Learn a new skill. Laugh with friends. Develop yourself inside as well as out.

Because your children don’t love you for your dress size or well applied mascara. They love you for the comfort in your hugs and words, the fun you have playing games, the safety of knowing you’re there when they need you, putting them first.

Because you’re a mum. And you don’t need an excuse.

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