What Causes A C-Section Scar Shelf & What You Can Do About It
A note from Rebecca:
As a physical therapist I’m always hesitant to focus my treatment on concerns that are based on aesthetics. I am a firm believer that all bodies are beautiful and feel even more strongly that this applies to bodies that just grew a human. The reality is that bodies change after pregnancy and birth. They change as we age. If we’re lucky, we get to live a long life full of adventure which ensures that we don’t leave looking the same as when we entered. My role as a physical therapist is to support you and your body as you heal from major life events and to help you get back to the life you want to live. Additionally, one of the biggest determinants in how a body looks after childbirth is a factor we have no control over: genetics.
With all of that said, a c-section scar shelf is a physical appearance that can impact your bladder, bowel and sexual health. So know that no matter how your body looks, you’re perfect, and I’m also here to support you if you want to know more.
Last week, I evaluated a patient who was 3 years postpartum after a cesarean birth. She was having some pain with sex and a little bit of leakage with sneezing, but her main complaint was her c-section scar shelf. She started noticing the shelf-like appearance a few months after her youngest was born and it hadn’t changed too much over the following few years. Until recently she assumed there was nothing that could be done to address her scar restrictions, but then she read something that made her think maybe that wasn’t true. Now she was worried she waited too long.
Here is what I told her:
It is never too late to start working on your c-section scar. Whether you’re still experiencing pain and sensitivity or you’re noticing decreased movement or a shelf-like appearance, working on your scar even years later can make a difference.
Now, what is a c-section scar shelf?
A c-section scar shelf is a shelf like appearance resulting from scar restrictions. Because a c-section creates scar tissue in multiple layers deep to the skin, restrictions in any layer of the scar can contribute to this appearance. Scar tissue does lives deep in your body, not just on your skin. Just like a scar can become restricted or “stiff” on the skin, the same can happen in deeper layers. When scar restrictions exist in these deep layers, a scar can get pulled down, creating a shelf like appearance above the tissue. See the video below for a visual!
While the shelf itself isn’t necessarily problematic, scar restrictions can contribute to a number of common postpartum bladder and sexual pain symptoms. Because your c-section scar sits over your bladder and extends all the way through your abdominal muscles to your uterus, common symptoms associated with restricted c-section scar mobility can include urinary urgency, urinary frequency, urge incontinence, pain with sex, painful cramping, abdominal weakness, pelvic floor tension and pelvic pain. Fortunately, despite the laundry list of symptoms c-section scars can contribute to, we typically see improvement in symptoms within 2-4 weeks of physical therapy treatment.
So what can you do about a c-section shelf and decreased cesarean scar mobility?
1. Scar massage: 5-10 minutes a day can make a huge difference. Starting once the scar has healed, you can apply your favorite lotion and massage the scar. Don’t get to technical - just move the scar tissue around. Scar massage brings blood flow to the area and can help tissue mobility in the scar and surrounding structures.
Check out this blog post for videos of my 3 favorite scar massage techniques. And if the idea of touching your scar gives you the ick, scar desensitization may be a better place to begin.
2. Stretch: Soft tissue surrounding scars can get stiff, too. Stretching your quads, hip flexors and abdomen can help remind these structures that your body is safe and they can relax. Check out the video above for a couple of my favorite stretches!
If working on your own scar feels overwhelming, pelvic floor physical therapy can help. Contact us here to learn more about working with our pelvic floor physical therapists who can help address your pain, support your postpartum healing and help you confidently return to all the things you love to do! We can work with folks in central Texas in person in our Austin, TX PT clinic and we can work virtually with folks all over the world.
Want to learn more about c-section scar pain and recovery?
Click here to learn about our self-paced, c-section recovery program to help you reduce pain and sensitivity around your scar while regaining strength and confidence after your cesarean. It’s never too late or too early to start supporting your body through your recovery.
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.