October 15, 2019

By Kimberly Langdon, M.D., OB/GYN

If you delivered your child by cesarean section, you are not alone. As of 2014, 32.2% of pregnant women in the United States had a cesarean delivery. However, just because they’re common does not mean they are not a big deal. A c-section is major abdominal surgery, but unlike most other major surgeries, you may not have had time to prepare yourself for it. And you might be left with a lot of questions afterward.

During a cesarean delivery, your doctor makes two incisions (cuts). The first is through the skin of your lower abdomen and the second is on your uterus. The cuts could be either horizontal (more common) or vertical, and two might not be the same. The incision on your uterus will be closed with sutures (stitches) that dissolve on their own. The outer incision may be closed with either staples (fastest and most common), sutures, or surgical glue. Sometimes, you will go home with the staples, but many times, they are removed in the hospital on day 3 of 4 after your cesarean. The sutures and glue dissolve on their own.

How to clean your c-section incision

The best way to care for the incision is to keep it clean and dry. You can shower immediately with warm soapy water and rinse well. Pat the area dry. If the area gets gooey or crusty, you can use cotton-tipped swab dipped in a solution of hydrogen peroxide mixed with water (50/50) and gently clean the area. It will bubble with the release of oxygen.

If the incision stays moist, you can place a menstrual pad over the incision—soft side down and attach the adhesive side to the inside of your underwear. Otherwise, the incision will stick to your clothes. It is best to wear high-waisted underwear and loose-fitting clothes for a few weeks.

What if my incision doesn’t seem to be healing properly?

In rare cases, a cesarean incision will get infected. Signs of infection include redness, increased swelling or pain, foul odor or discharge, watery discharge, bloody discharge, separation of the scar, achiness, fever, or chills. An abscess can form if left untreated. It is important to call your doctor with concerns. It would be rare to get an infection 10-14 days or later. They tend to develop fairly quickly. The uterus can become infected, too. That’s called endometritis and may show up as abdominal pain, increased vaginal bleeding, and fevers or chills.

Related: Childbirth complications and warning signs

When will the pain and numbness go away?

Pain from the incision tends to get better over time, but sometimes you can get numbness, which can extend towards your belly button or towards the pubic bone. This pain is because the fat tissue was cut away from the fascia (the strong membranous support for the abdominal wall that keeps the intestines inside the body cavity). Numbness gradually disappears but sometimes takes a long time.

Why is my incision itchy?

As your incision heals, you may experience itchiness. This is normal and common, but try not to scratch so you don’t get an infection. To reduce the itchiness, try holding a pillow tightly over your incision for a few minutes or apply ice (wrapped in a towel).

What can I do to treat my c-section scar?

Like any other cut, your c-section incision will leave a scar. Scarring is largely dependent on hereditary factors and whether an infection or hematoma (collection of blood under the skin) developed. It may be flat or raised, and the color may vary.

Sometimes a keloid or a hypertrophic scar will develop.Keloids or hypertrophic scarring is when the tissue around the incision grows outward and looks like a raised, fleshy red or pink swath of tissue. Even when they are removed, they can reform.

There are a number of creams and oils available over-the-counter that claim to help reduce the appearance of your scar. Several doctors and other healthcare professionals endorse ingredients that include medical-grade silicone, onion bulb extract, allantoin, vitamin E, aloe vera and the oils of emu, safflower, sunflower, and jojoba.

If you have hypertrophic scars or keloids, there are treatments available, including:

• Occlusive dressings such as silicone or Cordran tape, which is a clear surgical tape that contains flurandrenolide, a steroid that is uniformly distributed and may soften and flatten keloids over time
• Compression therapy corticosteroid injections into the keloid
• Cryosurgery (freezing therapy)
• Surgically removing it
• Radiation therapy
• Laser therapy
• Interferon (IFN) therapy
• Phototherapy
• Injections and creams (5-fluorouracil (5-FU), retinoic acid, imiquimod 5% cream, tamoxifen, tacrolimus, and botulinum)

Your scar should be fully healed before any treatment, so talk to your doctor and get the go-ahead before starting any treatment plan.

Sources

Smaill FM, Gyte GM. Antibiotic prophylaxis versus no prophylaxis for preventing infection after cesarean section. Cochrane Database Syst Rev. 2010 Jan 20. CD007482.

Duff P. Pathophysiology and management of postcesarean endomyometritis. Obstet Gynecol. 1986 Feb. 67(2):269-76.

Kischer CW, Brody GS. Structure of the collagen nodule from hypertrophic scars and keloids. Scan Electron Microsc. 1981. 371-6.

Hsu KC, Luan CW, Tsai YW. Review of Silicone Gel Sheeting and Silicone Gel for the Prevention of Hypertrophic Scars and Keloids. Wounds. 2017 May. 29 (5):154-158.

Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg. 2006 Jul. 32(7):907-15.