The baby is crawling now, and the horizontal incision above the pubic bone has faded to a thin line. At the postpartum check-up, the doctor looked it over and said it had healed well. And yet every time she bends to lift the baby out of the crib, one end of the scar gives a sharp, needle-like jab. When her waistband rubs against it, it burns. After standing at the stove making dinner for a while, her lower back aches, and on some days the discomfort spreads down to the groin, though she is not sure whether it has anything to do with the scar. There is nothing on the skin to show the family, so many women put up with it in silence, thinking every mother feels this way after giving birth.
Skin that has closed only tells you the surface has healed. Beneath the incision run very small nerve branches, and a branch caught in scar tissue can still cause pain many years after the operation.
How many women have lasting pain after a cesarean section
Ciechanowicz and colleagues (2025) pooled 50 studies covering 13,149 women. Chronic pain at the surgical site was still present in 16.7% of women after 3–6 months, 11.4% after 6–12 months and 8.8% after one year or more.
More than half of those still in pain said it disrupted their daily life. At 3–6 months, about two in three had trouble walking. At 6–12 months, nearly seven in ten felt their work was affected and about eight in ten felt they had lost some of their enjoyment of life. The authors estimate that roughly 10% of women who have a cesarean section develop pain that lasts long enough to change everyday life. The certainty of these figures was rated very low, so take them as a reminder that this is not rare.
Why a scar that has healed well can still hurt
Lasting pain after surgery has many causes, and nerve entrapment is one of them. A cesarean section usually uses a low horizontal incision just above the pubic bone. A review by Charipova and colleagues (2021) names the three nerves most often trapped as the iliohypogastric, ilioinguinal and genitofemoral nerves, small sensory nerves of the lower abdomen and groin.
The authors describe how a nerve can be injured: it may be cut, with the cut end growing into a small nerve tumor (a neuroma); it may be caught in a stitch when the layers of the abdominal wall are closed; or it may later be squeezed by bands of scar tissue (adhesions). The pain then sits in exactly the patch of skin that nerve supplies and can spread along the nerve’s path. This condition is often missed, so it is frequently undertreated.
After a low horizontal incision, about 2–4% of women develop chronic lower abdominal pain from entrapment of the iliohypogastric or ilioinguinal nerve (Loos and colleagues, 2008), and lasting groin pain may affect up to 8% (Verhagen and colleagues, 2018).
Common sensations around the scar
Pain from a trapped nerve branch feels quite different from the wound pain right after surgery:
- Numbness or loss of feeling in a patch of skin above the scar or at either end of it;
- Burning, prickling, or a jab like an electric shock with a light touch or when clothes rub against it;
- Pain that gets worse when you change position, bend over, straighten up or carry your baby;
- A tight, stiff scar that feels as if it is being pulled from inside;
- Pain spreading down to the groin and pubic area, sometimes down to the thigh.
Some women also describe lower back ache or pelvic discomfort that comes with the scar pain. The studies above have not measured this link directly. Loos and colleagues note that lumbosacral nerve root disease and endometriosis can be present at the same time, and that surgery to cut the nerve is less successful in women with these conditions. So when scar pain comes with back pain, the doctor will examine both the spine and the pelvis.
If you still have back pain or leak urine after giving birth, the cause may lie elsewhere; see our Postpartum Recovery series.
When to see a doctor
You should get checked if:
- Pain or burning around the scar is still there from the third month after surgery;
- The pain is getting worse instead of easing;
- The pain makes you hesitate to pick up your baby or to walk around, or keeps you from sleeping well;
- The scar pain comes with back pain, pain spreading down the leg, or pain that gets worse during your period.
See a doctor the same day if the scar area is swollen, red, hot or oozing, or if you have a fever.
How the doctor examines the scar at the clinic
The doctor asks what year you had surgery, how many cesareans you have had, when the pain started, where exactly it is and where it spreads. The doctor touches lightly along the scar and the skin around it to find numb or burning spots, comparing both sides. The doctor examines your lower abdomen and back, along with looking, listening, asking and taking the pulse. Ultrasound is still the way to look at a lump in the abdominal wall or pelvis, so if something needs to be ruled out, you will be asked to have an ultrasound before treatment.
For the nerve pain in the scar itself, Dr. Pham Tran Dan Tam (MD, Specialist Level I in Traditional Medicine) uses Applied Kinesiology. The doctor picks a muscle that is testing strong, asks you to place your hand on one section of the scar at a time, and tests that muscle again; this is called therapy localization. In the Applied Kinesiology reading, a section that makes a strong muscle suddenly go weak is a section that is disturbing the nervous system. The doctor treats exactly that section with Applied Kinesiology techniques, then touches and tests again to see whether the response has gone. See also why doctors use muscle testing.
In traditional medicine, a horizontal incision across the lower abdomen cuts through the Conception vessel (Rèn mài) and the Kidney, Stomach and Spleen meridians. Thick scar tissue is seen as a place where qi and blood flow poorly and, over time, stagnate. Depending on your condition after giving birth, the doctor may combine this with acupuncture or an herbal decoction, modified according to whether you are still breastfeeding. This approach has not yet been studied specifically for cesarean scar pain, so the doctor follows each person’s response.
When the pain does not ease, the clinic works with a pain clinic or a surgical team, where a nerve block injection or surgery to cut the trapped nerve can be done. In the series of 186 women reported by Verhagen and colleagues (2018), an injection at the painful spot helped 13% of them; among those who needed the nerve cut and answered the follow-up survey, after nearly five years of follow-up, 54% had no pain or only mild pain.
Frequently asked questions
My surgery was several years ago and I have only just noticed the pain. Can it still be examined?
Yes. Nearly 9% of the women in the Ciechanowicz review were still in pain after the one-year mark. Try to recall after which cesarean the pain began and how it has changed, so you can tell the doctor.
Is a numb patch of skin above the scar something to worry about?
Some women notice mild numbness around the incision. Get checked if the numb area also burns, jabs, spreads pain, or bothers you in daily life.
Worth keeping
- Note which spot on the scar hurts, where the pain spreads and what time of day it gets worse;
- Notice whether the pain gets worse during your period;
- Choose pants with a soft waistband that does not press right on the scar while you wait for your appointment;
- Find your hospital discharge papers that show the type of surgery and how many cesareans you have had, to show the doctor;
- See a doctor the same day if the scar is swollen, red or oozing, or if you have a fever.
When the numbness and burning around your scar have lasted for a few months, you can see Dr. Pham Tran Dan Tam to have the scar checked together with the back and pelvic areas that go with it.
References
- Ciechanowicz S, Joy RR, Kasmirski J, Blake L, Carvalho B, Sultan P. Incidence, severity, and interference of chronic postsurgical pain after cesarean delivery: a systematic review and meta-analysis. J Clin Anesth. 2025;104:111832. https://doi.org/10.1016/j.jclinane.2025.111832
- Loos MJA, Scheltinga MRM, Roumen RMH. Surgical management of inguinal neuralgia after a low transverse Pfannenstiel incision. Ann Surg. 2008;248(5):880-885. https://doi.org/10.1097/SLA.0b013e318185da2e
- Verhagen T, Loos MJ, Mulders LG, Scheltinga MR, Roumen RM. A step up therapeutic regimen for chronic post-Pfannenstiel pain syndrome. Eur J Obstet Gynecol Reprod Biol. 2018;231:248-254. https://doi.org/10.1016/j.ejogrb.2018.10.045
- Charipova K, Gress K, Berger AA, et al. A comprehensive review and update of post-surgical cutaneous nerve entrapment. Curr Pain Headache Rep. 2021;25(2):11. https://doi.org/10.1007/s11916-020-00924-1
