The suture that remains after a cesarean section is a subject of special attention and concern for women who have undergone surgical delivery. The seam is not always smooth and neat, and sometimes it heals slowly and hurts for a long time. In this article, we will consider how long the suture should heal, when it stops hurting, and what to do if the scar looks strange.
How does healing take place?
A woman's sutures after a cesarean section are not one, but at least two - external, which most often raises questions, and internal, which cannot be seen visually, since it is located inside, on the front wall of the uterus.
The external suture can be placed vertically across the midline of the abdomen from the navel to the pubic region, or it can be horizontal, located low, parallel to the pubic line. In this case, the seam does not always have to be straight - there are both crescent shapes and J-shaped seams. The exact length and shape of the suture depends on the tactics of the operation, which for one reason or another the surgeon chose. Up to 90% of all surgical deliveries today are performed with a horizontal low incision, which in medicine is called the Pfannenstiel section. And only a small percentage of interventions, mainly emergency ones, are performed with a vertical incision through the entire abdomen.
The recovery times for different seams differ from each other. Internal seams that are not visible to the eye take longer to heal than external ones. It takes about 2 months to restore the dissected uterine walls, and then the scar continues to form until about 2 years. The sutures used for suturing the reproductive organ are self-absorbable and thin, these sutures do not need to be processed and removed. It should be noted that they do not hurt, because the walls of the uterus are not rich in nerve receptors capable of capturing and transmitting pain impulses to the brain.
It is important that during the period of formation (within two years) the woman adheres to the doctor's recommendations. Then the scar with a high degree of probability will be strong, elastic and full-fledged, consisting mainly of muscle tissue.
The timing of the healing of the external postoperative suture depends on its length, shape and dissection method. Small horizontal sutures in the lower abdomen — straight or lunate — heal best. If there are no complications, then after 7-9 days a woman can safely remove stitches or braces, and after another 2 weeks we can talk about the end of the healing of the outer seam. After a month, the outer scar begins to gradually lighten, and after a year, on average, it becomes less noticeable.
It is more difficult and longer for a vertical scar to heal through the middle of the abdomen. It is more susceptible to inflammation, complications, and its healing takes up to 60 days. For years, such a scar can remain quite bright and noticeable.
The outer seams hurt during the healing process, and you can't go anywhere. The nerve receptors of the skin, the muscles of the abdominal cavity injured during the operation cannot but signal their temporary ill-being, therefore, during the period of the most severe pain, they try to anesthetize a woman with anesthetics while still in the hospital.
After discharge, there is no need for anesthesia with normal scar formation - the pain is not so severe.
What sensations can it be?
Pain in the first weeks after surgery in the area of the postoperative suture is normal. They decrease gradually. The faster the restoration of tissues, blood vessels and nerve endings at the site of the surgical incision proceeds, the faster the pain will stop.
Often, under the concept of "pain" women mean a wide range of unpleasant sensations that can persist even after the scar is formed. It is not entirely correct to call them painful, rather, they can be described as moderate burning sensation, tingling. The seam can remain firm to the touch for quite some time.
A certain hardness is associated with the process of repairing damaged cells. When they heal and start producing enough collagen, the scar will gradually become less tough. But within 2-6 months, a hard postoperative scar is considered quite normal.
In some women, the scar does not soften until a year later, and in some, even a few years later, it remains firmer than the surrounding tissue. Much depends on the size, weight, rehabilitation abilities of the body, age and lifestyle.
If there is no discharge from the suture, we can say that the restoration is proceeding without features. A small amount of bloody discharge is considered normal only during the first days after surgery. If, after discharge, several weeks have passed and discharge has appeared, there are complications that require a mandatory examination by a doctor and treatment.
At first, women pay attention to the almost complete lack of sensitivity in the lower abdomen and pubic area. Until the nerve endings are fully restored, numbness will be completely normal and natural. Itching in the area of the scar speaks of intensive healing processes, but only if this itching is not strong, obsessive and pronounced.
Possible problems
The slow pace of healing of the postoperative suture can be associated with a variety of factors. Some develop complications while still in the hospital and are considered early complications. There are also late complications that may appear several weeks or even months after surgery.
Infectious inflammatory processes are considered early. An unhealed suture is a wound whose edges are brought together using suture material or medical alloy staples. Everyone is at risk of infection. Bacteria, viruses, fungal microorganisms, even those that are not pathogenic, that is, conditionally pathogenic, will not cause inflammation when they hit the whole skin, but in the wound they quickly turn into pests and begin to actively multiply, causing inflammation.
Infection can be the result of poor-quality or improper processing of the postoperative suture. Internal seam infections can lead to poor hygiene, uterine contractility and medical advice.
Temperature and pain in the abdomen, abnormal discharge from the genitals indicate an inflammatory infectious process of the internal seams. External infected sutures can be recognized by a rise in body temperature, by redness, swelling of the scar area, by secretions from the scar of sacral or purulent discharge of all shades from yellow to gray and green. The scar itself becomes hot. Touching it causes pain.
If the scar is bleeding even though it has been a long time since the operation, it may indicate damage to the blood vessels. The scar turns red, deep purple, hematomas appear around the scar.
The presence of unhealed areas in the scar, which women describe as "holes" in the seam, indicates the presence of fistulas. They are difficult to treat. Hernial formations on the scar can be the result of neglect of recommendations and excessive early tension of the abdominal muscles.
The suture may not heal for a long time, not only due to infection, but also due to immune factors - the woman's body, for some reason, rejects the suture material used to suture the edges of the wound.
The seam divergence is considered the most dangerous. This is a rare complication, but it can happen too. Most often, such a problem qualifies as a late complication, when the inner seam diverges during the second pregnancy. The outer seams remain intact.
Woman's actions
On the one hand, problems with stitches do not arise so often, but on the other hand, each of them does not tolerate any self-medication or connivance - a woman must see a doctor. When planning a repeated pregnancy, it is imperative to conduct a preliminary examination of the condition of the scar on the uterus, do an ultrasound scan, if necessary, hysterography and hysteroscopy.
If the pain continues for two months after the operation and after this period, an ultrasound of the postoperative suture should be done. To do this, you should contact the gynecologist at your place of residence. Any complications from internal and external seams should be excluded.
After discharge, the woman should definitely continue to process the suture and wear a surgical gauze bandage. Brilliant green is suitable for processing. It is used to lubricate the area around the wound, since many pathogenic and opportunistic bacteria are afraid of this particular antiseptic like fire. You can dry the seam with hydrogen peroxide.
If any abnormalities are found, it is important not to hesitate to see a doctor. Sex is not recommended for 2 months after the operation, and then the couple must be protected with a condom, even if sexual intercourse takes place during menstruation. During the formation of internal scars, it is important to exclude even a small possibility of infection penetrating into the genital tract. Then you should protect yourself, because the next pregnancy should occur no earlier than 2 years later, when the inner seam will get stronger and will be elastic.
A woman should avoid douching and using hygienic female tampons for six months.
After discharge, in order to avoid problems with seams, you should not squat, jump, make sharp turns, and swing the press. For six months, a woman is shown a sparing mode of activity.
For information on how to care for a suture after a cesarean section, see the next video.
