After a cesarean section, scars always remain. This is an abdominal and very serious operation, and stitches after it, alas, are inevitable. About what they are, how to take care of them, what complications can be, we will tell in this article.
Kinds
The obstetric caesarean section is performed with the obligatory opening of the abdominal cavity, incisions are also made in the adipose and muscle tissue, on the uterus itself. Through them, the baby and the placenta are taken out into the light. After removing the baby and the "child's place", all incisions are sutured. To do this, use different suture techniques and different surgical suture material. The sutures on the uterus are called internal, and turn into a scar, and the sutures on the abdominal wall are called external, and turn into a postoperative scar.
Internal
If a caesarean section is done routinely, doctors usually try to make a horizontal incision in the lower segment of the uterus. For emergency surgery, a vertical incision can be made to speed up the process. The uterus is dissected in the same way as the outer layers.
The ways in which such sutures are applied can be different - each surgeon has his own method of suturing, the main requirement for such sutures is the most accurate coincidence of the wound edges. This is important for the formation of a full-fledged scar in the future. The materials used for suturing dissolve on their own; of course, it is not necessary to remove such sutures. They do not require any special care, it is enough to follow the doctor's recommendations on the exercise regimen and the prevention of infections.
A single, continuous suture is usually placed on the uterus. Muscles are sutured with stitches. The connective tissue of the peritoneum is also sutured with self-absorbable suture material.
External
The external seam depends on the choice of the surgical technique. If it is carried out urgently, the appearance of a not very beautiful scar from the navel to the pubis is possible. Such a suture is sutured with especially strong threads and connected by a nodular method, because it is more difficult to keep the edges of the external wound with a corporal longitudinal dissection than with a small transverse suture along the pubic line. Fortunately, today all planned operations and a good half of emergency operations are performed according to the Pfannenstiel method - the German doctor who was the first to practice this type of incision.
With a relatively small size, such a suture may well be cosmetic, which cannot be said about corporal dissection. To fasten the edges of the wound from the outside, different types of surgical sutures or metal staples can be used.
Classification of external seams
Naturally, the woman herself is unable to see the internal seams. But external ones can be quite noticeably disturbing. Indeed, different types of external postoperative scars have their own characteristics.
Horizontal
The Pfannenstiel section is considered the least traumatic. The surgeon's scalpel runs only along the edge of the abdominal cavity, in the natural skin fold above the pubis. Such an operation is considered not only less dangerous, but also more favorable for women planning their next pregnancies by caesarean section. The lower uterine segment, where the incision will take place, is the least subject to stretching.
The seam looks pretty neat. If you take proper care of him, that after one and a half - two years he will be almost imperceptible. It is very convenient to mask the location of the seam with underwear. The seam is perfectly closed by panties or swimwear. The woman's belly does not disfigure.
The seam length with this cut is no more than 10 centimeters. There is another type of horizontal dissection - extreperitoneal, when the incision is made very small - 2-3 centimeters under the navel line. But such a cesarean section is extremely rare, since the operation is technically very difficult and involves certain risks for the mother and fetus.
Vertical
A vertical or corporal seam is always an urgent need. This type of operation is performed if the child needs to be removed as soon as possible - profuse uterine bleeding has begun, the baby has a state of acute hypoxia, in which he is threatened with death or the onset of severe health consequences.
It is impossible to hide such a seam under the line of panties or swimming trunks. It is coarser because the suturing technique is nodular. Moreover, over time, such a seam tends to thicken and become more noticeable and unpleasant.
Healing mechanism
The healing time and the likelihood of complications also depend on what type of incision and what type of suturing was used by the surgeon.
Interior
Internal sutures will heal in about 7-8 weeks. On the first day after the operation, the so-called adhesion zones are formed, consisting of fibrin bundles. This is why it is important to limit abrupt movements, although early, gentle verticalization will be beneficial.
A week after the operation, the internal scar on the uterus already has new cells of the uterine tissue, and the blood network is restored. If healing proceeds normally, without complications, then myocytes will prevail in the scar, and collagen will be produced, which will provide the scars with usefulness and elasticity. This is very important for the subsequent pregnancy.
If the recovery process is disrupted, a scar will form with a predominance of coarse connective tissue, defective and heterogeneous, which will greatly complicate the subsequent pregnancy and childbirth.
The inner seam cannot completely disappear, the scar remains forever, and the more wealthy he is, the higher the chances of having a second child on his own, without the help of surgeonsif there was only one caesarean section in the history. The complete scar formation is completed 2 years after the operation.
External
The healing depends on the type of scar. A vertical suture left after an emergency corporal section heals longer, and the likelihood of complications with such a scar is higher. The external suture after horizontal dissection in the lower uterine segment begins to tighten on the next day after the operation, after 7-8 days the sutures can be removed.
Previously, when women were in the hospital for up to 10 days after surgery, the stitches were removed in the maternity hospital. Now, when a woman and a child are discharged on the fifth day after the operation (in the absence of other complications), the sutures are removed in the antenatal clinic for 7-8 days. The procedure is painless, although not the most pleasant. After the sutures or staples are removed, the suture continues to form and it can take up to 21 days for complete healing. The vertical suture heals up to 60 days.
A year after the operation, the horizontal suture in the lower segment of the uterus brightens and becomes almost invisible.
Recovery features
Since the seam is the junction of the dissected tissues, one should be aware that during the surgical intervention, not only the skin, muscles, but also the nerve endings are dissected. Therefore, two postoperative sensations are quite normal - numbness in the upper abdomen (due to loss of sensitivity after nerve dissection) and pain (for the same reason). What else can a woman face in the postoperative period?
Pain sensations
The pain is most severe in the first 2-3 days, which is why the woman is injected with painkillers at this time. This is necessary to make it easier to endure the contractions of the uterus with the incision. But after 2-3 days, the nerve fibers damaged during the operation are replaced by new neuromuscular connections, which appear when the integument and their internal structures are restored at the cellular level. The pain decreases, but the discomfort does not go away, the woman has a feeling that the seam area is constantly pulling, sometimes stinging, the scar itself is hard.
Certain unpleasant painful sensations may be present even after being discharged home, and only after 6-8 weeks the woman will almost stop feeling the scar.
If a woman has severe pain, then only the doctor should prescribe additional pain medications for her.
Hardness
While the healing of tissues damaged during the operation is proceeding intensively, some hardness is quite characteristic of the scar. Then, when more collagen is produced, it should become softer. Therefore, a woman should not worry at all that the scar is hard for at least two months. This is normal.
Complete softening of the scar, if it is horizontal above the pubic line, can take several months, and sometimes several years. This is individual, given that the fatty layer on the abdomen in women of different build and constitution is different.
If the hardness is uniform throughout the entire scar, don't panic. But the appearance of a keloid fold over the scar, as well as the appearance of purple, crimson, dark brown seals over the seam, bumps of different sizes in certain areas of the scar is an alarming sign that may indicate a fistula or tumor. An ultrasound examination and a doctor's consultation are imperative.
Discharge from the scar area
A good scar with no signs of inflammation should not excrete any fluid, mucus, ichor or blood. Only in the first few days is this considered acceptable and is explained by the tissue healing process. If the discharge lasts more than a week, if the seam has festered, any liquid is released from it, the ichor, if the area of the scar festers, becomes wet, itches, it itches strongly, that is, there is every reason to believe that the seam is inflamed.
What to do in this case is clear to everyone - urgently consult a doctor, since the development of an infection is possible. Caesarean section itself is associated with an increased risk of infection, and therefore cannot be ignored.
Sensitivity, itching
It is necessary to distinguish well between tolerable itching, which, by and large, does not bother the puerpera too much in about 8-10 days after the intervention, and unbearable itching, in which the seam burns, burns and becomes inflamed. Mild itching speaks of healing, since the scarring process itself is associated with the formation of low-elastic sections of connective tissue, it is this that creates a slight internal tension and causes itching. This process is physiological, it goes by itself, and does not need treatment.
If you experience severe itching and burning, be sure to consult a doctor. Much in the specifics of wound healing after a cesarean section depends on how well the suture is taken care of.
Treatment
They begin to process the suture zone from the first day in the maternity hospital, the treatment is shown once a day. Then the woman receives advice on how to care for the scar at home. Let's take a look at the features of each care.
In the maternity hospital
After the incision is sutured, the area is treated with an antiseptic solution and a sterile bandage is applied, which is attached with pieces of a bactericidal plaster. In the future, the bandage is changed once a day, not forgetting to process the seam with brilliant green. Zelenka is necessary in order to avoid one of the most severe bacterial lesions - staphylococcal, since this microbe is afraid only of this antiseptic, it is completely insensitive to the rest.
The nurse conducts the treatment, the doctor on the round in the hospital can visually inspect the scar.
If something raises questions, the woman is prescribed an ultrasound scan to examine the scarring area.
After discharge
Home care for the operated abdomen is more versatile, it includes a whole range of activities. In order to avoid discrepancies, it is important for a woman to follow all the recommendations, and besides, continue to process the seam daily.
At home, the seam is treated with brilliant green. And here you cannot do without outside help. It is impossible to wet the scarring area, so you need to try and wear a gauze bandage at home, at least until the sutures are removed. Zelenka is applied with a cotton swab to the area around the wound. This will avoid bacterial contamination.
It is strictly forbidden for a woman to lift weights, since any tension of the abdominal muscles can be detrimental to scars - internal and external. The optimal weight, which is not forbidden to lift, is 3-4 kilograms.
But there will be much less adhesions and irregularities in the seam if the newly-made mother does not lie in bed all day - adequate movement, walking at a leisurely pace will only benefit.
After the sutures in the antenatal clinic are removed, it is recommended that the dressing be removed so that the suture heals faster upon contact with air. Try not to wet it for another five days; if there is a small discharge from the rumen, you can use hydrogen peroxide to soak the dried crusts. Continue to smear green paint around the scar.
After the scar has healed, it is allowed to use "Contractubex", which reduces scars and scars, making them invisible. But before using the gel, it is necessary to consult with two specialists - with a gynecologist about the condition of the scar (the drug is not used on an inflamed scar), and with a pediatrician about breastfeeding. Most often, nursing mothers are advised to buy "Contractubex" in the form of special plasters.
Treating the scar area with "Bepanten" does not make much sense, it does not dissolve, but only softens and moisturizes. For the same reason, you cannot use Bepanten on wet and inflamed surfaces.
Avoid wearing panties that have elastic bands along the scar, the pressure on this area will interfere with the healing and resorption of hard nodules. After bathing and showering, do not rub scars with a washcloth.
Complications
Depending on the time of the occurrence of negative consequences, all complications of the condition of the postoperative suture are divided into two types: some appear immediately after the surgical delivery, others - much later. Let's look at both of them in sequence.
Early
Early complications usually include a wide variety of infectious processes that can occur at the suture site. The infection can even get into the operating room, and a woman is warned about a possible complication of this kind, with her signature under the informed consent to the intervention.
Infection is usually manifested by a traditional clinical picture, which includes an increase in body temperature, suppuration, and swelling in the area of the scar. The seam itself can fester, bleed.
If the suture bleeds excessively in the first days after the operation without signs of inflammation, then the surgeon's mistake is not excluded, who did not suture too carefully, due to which the blood vessels were damaged. Usually, the condition is accompanied by the formation of hematomas of various sizes and numbers on and around the suture.
Early complications include a dangerous, albeit rather rare, seam divergence today. This can happen if the stitches were removed too early, hastily, if the healing of the postoperative wound was complicated and slowed down by the infection. There are also immune reasons - the woman's body rejects the suture material, which is imposed on the incision both inside and outside.An autoimmune complication is considered one of the most unpleasant and difficult.
Symptoms of the divergence of the external suture are quite obvious - an open wound will appear in the part of the scar that has not healed, bleeding may resume. It is much more difficult to understand that the inner seams have parted. An already incipient rupture is accompanied by symptoms such as a sharp drop in blood pressure, a woman becomes covered with sticky sweat, and there may be severe abdominal pain or painful shock. And the accomplished gap is accompanied by loss of consciousness, massive internal bleeding, discharge from the genitals.
The woman needs emergency medical surgical care, or she may die.
Late
Late complications also include the risk of rupture of the uterus along the old scar. The outer seams are not torn during subsequent pregnancy, but the inner seams may come apart. The symptoms and signs of discrepancy will be similar. A too thin suture on the uterus in a second pregnancy is a subject of special observation. The risk of such complications increases if a woman does not wait for the recommended period of abstinence from a new pregnancy, and doctors advise carefully protecting herself for two years if the scar has formed insolvent.
A complicated postoperative period creates the risk of forming an abnormal scar, women with multiple operations on the uterus, with systemic diseases, weak immunity, and women leading an unhealthy lifestyle are also at risk. If the scar has split during pregnancy, the babies and their mothers may die. If this happened already in childbirth (when a woman decides to give birth with a scar on the uterus in a physiological way), then the chances of salvation are significantly higher - an emergency caesarean section will be performed.
Ligature fistulas are also late complications - areas of a necrotic nature around the places of contact with surgical threads. This can happen when the female body rejects the suture material, as well as when infected.
Even a few months after the operation, a hot to the touch, red seal on the seam may appear, which, when touched, will deliver severe pain. Quite often, ligature fistulas have a small hole through which pus and ichor can flow out with light pressure. There is no point in treating them with brilliant green, iodine or anything else - this will have no effect. We need the help of surgeons who will remove the fistulas.
Another long-term complication is a hernia in the suture area. Most often it appears in women after a corporal (vertical) incision. But occasionally it also happens with a low horizontal cut. It is manifested by the formation of a subcutaneous hernial sac, pain during movement, palpation. The condition also requires the provision of surgical care in a hospital setting.
A hernia can develop due to non-compliance with recommendations, especially regarding physical activity. An early return to gym work, an early return to active sports, abdominal exercises, and lifting weights can cause the development of a hernia.
Ways to remove a scar
Removing a scar from the abdomen, if a woman wants it for aesthetic reasons, is quite difficult, but possible. The most effective are the early use of ointments, the same "Kontraktubeks", but if time is lost, and more than a year and a half has passed after the operation, then other methods will help to "figure out" with an ugly scar and a roller of skin over the seam expensive and troublesome.
You need to understand that None of the existing techniques will offer complete removal of the scar, but it is possible to make it less noticeable. Silicone patches, ointments, and gels are relatively inexpensive and available, but they won't work at all if the scar is over a year old. And in an earlier time period, they do not work for everyone.
There are injection methods that involve the administration of certain drugs that reduce the growth of the scar. But for a nursing mother, they are contraindicated, for a non-breastfeeding mother, they are dangerous by severe allergies and a malfunction of the female cycle, and after a year has passed since the operation, such methods are generally considered ineffective.
Grinding of the scar area is considered acceptable at any age of the scar itself. This is a pretty effective way to reduce a scar. During the period of breastfeeding, the procedures are extremely undesirable, their tangible disadvantage is the high cost of sessions, and several sessions will be required to achieve a visible result.
You can also turn to a plastic surgeon for help. There are several techniques for removing old ugly scars and forming new, more accurate ones. However, no one can guarantee that the healing of new scars will go well and without complications, especially if a woman has a tendency to keloid growths. In addition, a new dose of anesthesia and the entire possible spectrum of potential postoperative complications are again possible. The surgical method is suitable only for those who have large scars; small scars are not corrected in this way.
There is also a completely exotic way - to tattoo the scar area. But no one can guarantee that such a disguise will always look aesthetically pleasing. If a woman gains or loses weight, the skin will stretch or sag, as a result of which the pattern will lose its appearance.
Reviews
Often, women who have experienced problems with sutures after a cesarean section note that (partial) discrepancy after the operation occurred mainly when self-absorbable sutures were used for external suturing.
But the reviews about the method of gluing the outer seam are only good, after this method of fastening the edges of the wound, there are almost no traces left, and the stomach looks very aesthetically pleasing. However, this method is rarely used.
Many of those who have encountered complications claim that the lion's share of the pain was experienced after the operation from the adhesions that had arisen in the postoperative area.
Gels and ointments are considered effective by no more than a third of women who have tried them. There is usually no time for young mothers to observe the dynamics of scar regression by months, but many note that the scar has become unnoticeable after a year.
For suture care after a cesarean section, see the following video.
