In March 2018 my office received a phone call from Julianna Pena who is a professional mixed martial arts fighter for the UFC (Ultimate Fighting Championship). Julianna endured an unexpected cesarean section in which to deliver her breech daughter. Isabella is Julianna's first child so trying for a breech vaginal birth is frowned upon due to the riskiness of baby getting caught in the pelvis during the delivery.
We met mid March to discuss her medical history to include details of her pregnancy and birth. Upon my initial evaluation of her c-section scar and situation underneath the scar was that her uterus was adherent to her bladder and completely immobilizing all pelvic structures. This is typical due to the shear nature of what a c-section entails.
During a surgical birth the skin in incised down to the muscle. Muscle is opened and bladder is carefully dissected and pulled into a position of safety to ensure that it is left intact. The surgeon will make a lateral low incision on the uterus and retract into the uterus to rupture the amniotic sac and remove the baby. Once baby is delivered the placenta is removed, uterus is irrigated with saline and pulled out of the pelvis than placed on the woman's abdomen for repair. Think about what happens when you cut an apple into slices and allow it to sit on the counter......it becomes brown due to oxidation which is exposure to room air. This happens when our internal organs become exposed to room air. Our organs are perfectly compact in to our body and when opened and exposed the self protective healing mechanism is for the body to make scar tissue. C-section is no exception. This is major surgery. Typically post major surgery we are instructed to seek out therapy for rehabilitation. No physician is telling women to seek out post c-section therapy until symptoms of obstruction and immobility ensue and even then the c-section scar may not be looked at as problematic.
Post c-section issues can be mild to serious in which more surgery would be the only recommendation. What would require more surgery you ask?
Bowel resection to remove invasive scar tissue. I've spoken to several women that are 10-30 years post c-section and complained of severe abdominal pain. CT scan reveals scar tissue adherent to the abdominal wall which requires surgery to remove it or the intestinal loop may become completely obstructed. While few and far between it is still not unlikely and this scenario can be life threatening if left untreated.
In addition, the scar may cause a slight postural change, a sort of “pulling forward” that along with a decrease in the support of the back from the abdominal muscles could result in back pain.
But the possible consequences don’t stop there. The scarring can cause the adjacent muscles to develop trigger points that refer pain to areas like the clitoris or urethra. In addition, the adjacent connective tissue can become restricted also causing pain. Lastly, the scarring can irritate superficial nerves in the area of the scar.
What’s more, the round ligament that attaches from the sides of the uterus to the labia can be caught in scar tissue after a C-section because the incision is also right over the area where the round ligament crosses the pelvic brim. If this happens, a woman can experience labial pain, especially with transitional movements like going from a seated position to a standing position.
Another symptom I've seen of those women who have had C-sections is that they may have issues with lower digestion such as irritable bowel syndrome or constipation. This occurs because of the tightening created by the scar tissue pulls within the abdominal cavity and thus affects the organs.
The good news is that the problems caused by a C-section scar can be treated with Mercier Therapy. So how do we address a c-section scar?
Most problems caused by C-section scarring can be improved or corrected altogether by making the scar more flexible by manipulating the scar tissue. The more scar tissue is moved and manipulated, the softer and more similar to the tissue around it it becomes. This reduces tightness and breaks up adhesions (an “adhesion” occurs when scar tissue attaches to a nearby structure).
So if a scar is pulled in all directions, the body will lay down the fibers of the scar tissue with more organization, and in a similar alignment to the tissues around it. This results in the scar blending in better and behaving more like normal tissue.
During your Mercier Therapy session we will manipulate your c-section scar and the area around it. Scars (internal and external) can be pushed, pulled, pinched, rolled, and rubbed. (Warning: manipulating a scar can be painful. That’s because tissue that has restricted blood flow is super-sensitive to touch, so treatment can be painful.)
But, this is a pain that comes with gain. Ultimately, scar mobilization promotes collagen remodeling, which increases pliability of the tissues and reduces uncomfortable sensations, such as itching or sensitivity.
It’s best to start c-section scar mobilization early in the healing process, usually six to eight weeks after the procedure. The reason that early intervention is ideal is because the tissue will respond quickest during this period.
However, the body remodels scar tissue constantly, so your tissues are being replaced with new tissue all the time, just at a much slower rate when scar tissue is older.
Working with Julianna to help her get back to training and ultimately back into the ring has been rewarding. She is passionate about shining a light on c-section recovery work and allowing all women to learn about Mercier Therapy. I want to help her feel like she is training to come back strong and unencumbered by nothing.