Why is my C-Section Scar Sore?
Experiencing pain around a healed C-section scar, especially when touched or during movement, is not uncommon—but it is not normal. As a pelvic floor physical therapist, I often encounter individuals who believe that discomfort in this area is an inevitable part of recovery or that it is normal for more than a couple of weeks.
However, persistent pain can indicate underlying issues such as scar tissue adhesions, nerve sensitivity, or pelvic floor dysfunction. You may be wondering, “Why is my c-section scar sore?” In this blog, we will will discuss the anatomy of scars, the healing process and why you may feel soreness or pain around your c-section scar as well as what to do to decrease pain and limitations associated with your scar.
The Anatomy of C-Section Scar Pain
A cesarean section involves a horizontal incision through multiple layers of tissue, including skin, fascia, and muscle. As these layers heal, scar tissue forms. While scar formation is a natural part of healing, it can lead to several complications:
Scar Tissue and Adhesions: Scar tissue can form not only at the surface but also deeper within the fascia, the connective tissue surrounding muscles and organs. These adhesions can restrict movement and cause pain, especially when the affected area is touched or stretched
Nerve Sensitivity: The incision may disrupt nerves in the abdominal area, leading to hypersensitivity or altered sensation around the scar. This can result in pain during activities that involve pressure or movement near the scar site
Pelvic Floor Dysfunction: The pelvic floor muscles can be affected by the surgical procedure and subsequent healing process. Tightness, weakness, or poor coordination of these muscles can contribute to pelvic pain, urinary incontinence, and discomfort during movement
The healing process of a C-Section Scar and the Surrounding Tissues
Healing from a C-section is a layered process—literally and figuratively. While the outer skin incision typically appears closed and healed within 2–3 weeks, full recovery of the deeper layers (including fascia, muscle, and connective tissue) takes significantly longer.
General Healing Timeline:
0–6 weeks: Initial tissue healing occurs. Skin and superficial layers begin to close, but internal healing is still in the early phases. Pain, swelling, and limited mobility are common.
6–12 weeks: Deeper tissues continue to repair. At this stage, many people are cleared for light physical activity, though scar tissue may still be forming and tightening.
3–6 months: Most of the structural healing of the abdominal wall and surrounding fascia is complete. However, scar adhesions and nerve sensitivity can emerge or persist if not addressed.
6–12+ months: For some individuals, especially those experiencing pain, tightness, or limited range of motion, full functional recovery may take up to a year or longer—especially if therapy is delayed or scar tissue becomes problematic.
According to a 2020 review in the International Urogynecology Journal, incomplete recovery of fascial layers and myofascial adhesions are frequently overlooked contributors to chronic post-C-section pain—especially in those who do not receive follow-up rehabilitation care.
Even though external scars might look fine, internal layers may be restricted, inflamed, or improperly healed. If you’re still experiencing pain months after delivery, this is not a sign of weakness—it’s a signal your body needs support.
Early Scarring Prevention Includes:
Proper hygiene
Appropriate time of suture removal
Reduction of mechanical forces- appropriate ways of changing body position, without tensing the abdominal muscles, stabilizing the wound during activities that activate the abdominal pressure (coughing, sneezing, laughing, pushing)
Evaluation of the wound healing process (4–8 weeks after surgery)
Use of silicone-based products or onion extract products on the scar
Avoiding exposure to sunlight
Use of sunscreens with a protection factor > 50 until the scar has matured
It is imperative that you do your part to allow the scar to heal and prevent it from adhering, which can contribute to pain and limitations in movement.
Physical therapy treatment can also be used to control and treat problematic scarring, improve cosmetic outcome, reduce pain, discomfort and sensitivity, change the physical and mechanical properties of the scar and promote tissue remodeling.
Management of excessive scar formation or adhesions includes techniques such as:
Manual techniques (massage, myofascial release, soft tissue release, trigger point release, active release techniques)
Instrument assisted soft tissue mobilization
Superficial dry needling
Cupping therapy
In our practice, we have seen significant reductions in pain and limitations with only a few sessions of superficial dry needling on c-section scars with adhesions. Research shows that superficial dry needling around scars can decrease pain and appearance of scars and improve mobility.
We have found that treating the scar with superficial dry needling and following up with exercises to improve range of motion has helped with the perception of pain and soreness in the scar, especially in C-section scars.
The Role of Pelvic Floor Physical Therapy
Pelvic floor physical therapy is a specialized form of rehabilitation that addresses the muscles, ligaments, and connective tissues of the pelvic region. For individuals experiencing persistent pain around a healed C-section scar, therapy may include:
Scar Tissue Mobilization: Techniques such as superficial dry needling, myofascial release, and gentle massage can help break down adhesions, improve tissue mobility, and reduce discomfort.
Nerve Desensitization: Gradual exposure to different textures and sensations can help recalibrate nerve responses, reducing hypersensitivity and pain.
Core and Pelvic Floor Training: Exercises targeting the deep abdominal muscles and pelvic floor can enhance stability, alleviate pain, and improve overall function.
Breathing Techniques and Postural Re-education: Proper breathing and posture can reduce tension in the pelvic region, supporting healing and reducing pain.
When to Seek Professional Help
If you experience persistent pain around your C-section scar, especially during touch or movement, it's important to consult with a healthcare provider. A pelvic floor physical therapist can assess your condition and develop a personalized treatment plan to address your symptoms. Additionally, early intervention can prevent long-term complications and support a more comfortable recovery.
While some discomfort following a C-section is normal, persistent pain around a healed scar is not. Understanding the potential causes and seeking appropriate treatment through pelvic floor physical therapy can significantly improve recovery outcomes and quality of life. If you're experiencing such symptoms, don't hesitate to seek professional guidance.
Looking for pelvic floor physical therapy in Jacksonville Beach, FL?
If you’re looking for personalized, one-on-one sessions to address your postpartum pelvic health concerns or you are looking to get back into workouts after having a baby and don’t know where to start, we provide pelvic health physical therapy services to women in the Jacksonville Beach area.
If you’re looking for providers who will listen to you and help you get to the root cause of your pelvic concerns, we’ve got you. We’re here to help you if you’re experiencing pelvic pain, pelvic heaviness, leaking, or are pregnant/postpartum and want to continue safely working out/running/lifting during your pregnancy and get back to your sport after birth.
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References:
B., M.V. and C., R. 2020. Cesarean scar defect and its association with clinical symptoms, uterine position and the number of cesarean sections. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 9, 10 (Sep. 2020), 4091–4096. DOI:https://doi.org/10.18203/2320-1770.ijrcog20204293.
Wasserman, Jennifer B. DPT, PhD1; Abraham, Karen PT, PhD2; Massery, Mary DPT, DSC3; Chu, Jennifer PT, MS, WCS4; Farrow, Alicia DPT5; Marcoux, Beth C. DPT, PhD6. Soft Tissue Mobilization Techniques Are Effective in Treating Chronic Pain Following Cesarean Section: A Multicenter Randomized Clinical Trial. Journal of Women's Health Physical Therapy 42(3):p 111-119, September/December 2018. | DOI: 10.1097/JWH.0000000000000103
Agata Michalska et al, Optimization of the cosmetic appearance of skin scar after caesarean section — part II physiotherapy practice. Ginekol Pol 2024;95(2):156-166. 23.01.2024 | DOI: 10.5603/gpl.98523
Rozenfeld E, Sapoznikov Sebakhutu E, Krieger Y, Kalichman L. Dry needling for scar treatment. Acupuncture in Medicine. 2020;38(6):435-439. doi:10.1177/0964528420912255