A healed C-section scar that still hurts, and breastfeeding

A woman came to the clinic because whenever she sat for about an hour at a stretch, her lower back started to ache dully. The ache had been there since her previous birth. That time her waters broke, the doctor decided on a C-section, and she was given spinal anesthesia. Since the birth she had felt that she walked leaning to one side, and when she sat, one shoulder was higher than the other.

On examination, the doctor found her pelvis tilted and several muscles around the pelvis and hip on one side weak. The C-section scar was also still tender when pressed, and to the touch it felt tethered rather than gliding smoothly. Asked about the surgery, she clearly remembered that the anesthetic injection that day was very painful, that she was frightened, and how tense she was during the hours in the recovery room.

She was treated for several problems at the same time: mobilizing the pelvis and the spine, working on the scar area, releasing the emotions still lingering around the surgery, along with mineral supplements. She had four visits, about ten days apart at first and then a week apart. At the second visit she felt about 30% less aching. At the third, she rated her lower back pain as having dropped from 80% to about 20%. By the fourth visit she said her lower back no longer hurt. Her shoulders were still uneven, and she was given exercises to do at home. Her records do not show how she did after the fourth visit.

Because several problems were treated together, there is no way to tell which part of the improvement came from treating the scar. The scar was only one of the things the doctor found.

How common is long-lasting pain at the incision

Most mothers stop having pain at the incision after a few weeks, but some do not. Pooling the studies together, about one in every six or seven mothers who had a C-section still has pain at the incision or in the surrounding belly area at three months (Ciechanowicz 2025; Wang 2025). At one year, the figure is about 5 to 9 in 100 mothers, mostly mild to moderate pain.

These two reviews give quite different figures, and the studies they pooled were each done in a different way, so the authors rated the certainty of the figures as very low. Three months is the point researchers use to call pain long-lasting. A mother whose surgery was less than three months ago but who is in a lot of pain should still see a doctor.

Mothers with severe pain in the first day or two after surgery are more likely to have pain later on (Jin 2016; Eisenach 2008). So are mothers who had depression beforehand, or who tend to think about pain in the worst possible way (Jin 2016; Espinós Ramírez 2026). This is only an association; it has not been shown which causes which. Even so, in the first few days a mother should take enough pain medicine and not try to tough it out.

What may lie beneath the scar

The medical literature names a few causes, and each one explains only some of the cases.

A horizontal incision in the lower belly runs close to the nerve branches that travel down to the groin. Loos and colleagues (2008) surveyed 690 women who had had surgery through this incision, including both C-sections and hysterectomies. Two years later, about a third of them still had pain at the scar. Of the 32 women with moderate to severe pain who were examined closely, 17 had a nerve trapped at the end of the scar. Women with numbness around the scar were more likely to have pain later on. This kind of pain has its own ways of being diagnosed and treated, so the mother needs an examination.

Numbness around the scar is common, because the small nerve branches in the skin are cut during the incision (Huikeshoven 1998). We have not found any study measuring how long it takes for the numbness to go away after a C-section.

Rarer is scar endometriosis. Tissue from the lining of the uterus is left behind in the incision and forms a small lump that swells and hurts during each period. Most women who have it have had a C-section, and it is often diagnosed late (Gruber 2024). Xia Guicheng also describes it in his book: a small nodule can be felt in the incision in the abdominal wall, it grows larger during the period, and it is clearly tender when pressed.

The part of the scar in the wall of the uterus sometimes does not heal fully, leaving a gap (a niche). Careful ultrasound in women who have had a C-section finds this niche quite often, and the most common sign is light spotting for a few days after the period has ended (Bij de Vaate 2014). Whether it is linked to pelvic pain still needs more research (Tulandi 2016).

Can the anesthetic injection cause back pain later on

The woman at the start of this article remembered the anesthetic injection as very painful, and it is easy to suspect it led to her lower back pain. But the trials available were done only on mothers given an epidural (an injection in the back) for pain relief during labor. A 2018 Cochrane review (a summary of the existing studies) pooled two trials with 814 mothers and found that mothers who had an epidural did not have long-term back pain more often than mothers who did not (Anim-Somuah 2018). Howell (2002) re-interviewed mothers from a trial in the UK, on average more than two years after birth, and found the same. In both groups, nearly a third of the mothers had back pain in the week before the interview.

The data on pain relief in labor do not show that the anesthetic injection causes long-term back pain. For C-sections there is no dedicated trial yet, so if your back has hurt for months, besides the injection you also need to look at posture, muscles, the pelvis and the scar. Soreness where the needle went in during the first few days after surgery is a separate matter.

Fear around the surgery is real and should be talked about. The C-section guideline from the UK’s National Institute for Health and Care Excellence (NICE) also says that mothers who had an unplanned C-section should have the chance to ask staff why they needed it, or to ask at another time if they prefer.

Pain that lasts for months rarely comes alone. Some mothers get a sharp jab whenever they turn over at night, so they sleep lightly; they hesitate to hold their baby for long, feel tired during the day, become forgetful and get irritable with their family. These things are part of the illness too, not just the pain.

How traditional medicine books and Applied Kinesiology see the scar

Traditional medicine books have no specific entry on C-section scars, so what follows is what the clinic’s doctors have pieced together from general principles. In his Handbook of Gynecological Diagnosis and Treatment, at the opening of the chapter on postpartum illness, Xia Guicheng includes "surgical injury" among the causes of blood stasis (stagnant blood) after birth. That passage is about pain after birth, not about scars. The Vietnamese Ministry of Health’s technical procedures for acupuncture (Decision 792/QĐ-BYT) explain pain after surgery as qi and blood being out of harmony and the channels and collaterals (the pathways that carry qi and blood throughout the body) being blocked, or as qi and blood being insufficient so that the channels and collaterals are not nourished.

The traditional medicine textbook on internal medicine has the saying "long illness enters the collaterals, long pain enters the collaterals" (久病入络，久痛入络 / 久病入絡，久痛入絡, jiǔ bìng rù luò, jiǔ tòng rù luò). It means that illness and pain that last a long time go deep into the collaterals (the small branches of the channels), so the method to use is to activate the blood and unblock the collaterals (活血通络 / 活血通絡, huó xuè tōng luò), that is, to get the blood moving and open up those small branches. The idea goes back to Ye Tianshi of the Qing dynasty, writing about long-standing bi syndrome (痹证 / 痹證, bì zhèng: aching, numbness and heaviness in the muscles and joints). The clinic’s doctors apply that principle to a scar that has hurt for many months.

Some modern acupuncture books have a section on needling around a scar, with the needles pointed toward the scar but inserted into healthy tissue. A review by Chmielewska (2024) found only 11 studies on needling for scars, mostly single case reports. Decision 792 advises against needling areas that are inflamed or ulcerated, and pain suspected to have a surgical cause (a condition that may need an operation to fix) must be examined first.

Applied Kinesiology (AK), a method of examination based on testing muscle strength, looks at the incision including what lies beneath the healed skin. The incision passes through nerve endings (the smallest tips of the nerves), which include sensory receptors and pain receptors (the "sensors" that detect touch and pain). When an area hurts, the nervous system often turns down the strength of a few muscles nearby to protect it, even though the pain is not in those muscles themselves (Lund 1991). According to AK, even after a scar has healed, some receptors there can keep sending faulty signals, and this compensation pattern stays in place: a few muscles in the belly, around the pelvis and in the back work below their capacity, and other muscles have to take up the load (Schmitt 1999; Garten 2016). A mother may notice this as back pain, trouble bending or twisting, or getting tired quickly when holding her baby or doing housework.

The doctor tests muscle strength by hand while the mother places her own hand on the scar. If the muscle’s response changes when she touches the scar, that is a sign the scar is contributing to the muscle weakness and the aches (Walther 2000). To treat it, the clinic uses two techniques that have been brought into AK: Injury Recall Technique (IRT), and Proprioceptive Deep Tendon Reflex (P-DTR; proprioception is the body’s own sense of where the arms and legs are) developed by José Palomar. The doctor re-triggers exactly the signal that is faulty, together with a gentle movement at the ankle or a tap on a tendon reflex, so the nervous system can correct itself. This can be done once the stitches are out. If the incision is red, swollen or oozing, the mother should see a doctor first. In the clinic’s experience, many mothers find their back feels lighter and they move more easily after the scar is treated together with pelvic mobilization and exercise. For the woman at the start of this article, the scar was also one of the places the doctor treated.

Caring for the scar at home

All the care below should only start once the incision has fully closed, is dry, not red and not oozing, and the doctor who did the surgery has given the go-ahead. If the incision is still open or inflamed, do not rub it, do not needle it, and do not stick anything on it.

Silicone sheets or gel are the most studied way to care for a scar yourself. A Cochrane review found that silicone may help prevent thick (hypertrophic) scars and keloids in people prone to them, but the evidence is weak and the studies are at high risk of bias (O’Brien 2013). On C-section scars, silicone did only slightly better than paper tape on scar appearance as rated by the mothers themselves, a difference so small that the authors considered it not meaningful in practice (not clinically significant) (Lin 2020). In one group of mothers who applied silicone from the second month after surgery, nearly half had itching (Ito 2021). These studies rated how the scar looked and recorded side effects; there are no data yet on whether silicone eases scar pain.

Asian people are more prone to thick scars and keloids than white people (Tulandi 2011; Sugita 2025). A mother who has had a keloid somewhere else may want to ask her doctor about silicone early.

Scar massage is recommended in many places. Shin (2012) reviewed 10 studies and found the evidence still weak; each study massaged in its own way, some starting right after the stitches came out, others after more than two years. We have not found any trial on which week after a C-section is best to start massaging. In France, a research team wrote that self-massage is currently the only treatment recommended for mothers whose C-section scar is still painful. The team is running a trial in 120 mothers whose scar still hurts 6–8 weeks after the birth, comparing Tecar therapy (a device that passes high-frequency current through the skin to warm the tissue underneath) with a sham device that gives no current; mothers in both groups are also taught to massage their own scar. The paper is a study protocol, so there are no results yet (Grampayre 2025). Once your doctor allows it, gently massage with your fingertips around and along the scar. Stop if massaging makes the pain worse.

Numb skin around the scar senses heat poorly and can burn without you noticing. So do not put a hot pack or a hot roasted-salt pack on that skin, and do not warm it over heat or use moxibustion (warming points with burning mugwort) right on it. Decision 792 advises against moxibustion on areas that have lost sensation because they burn easily, and numb skin around a scar should be treated the same way.

Breastfeeding while you still have an incision

NICE recommends helping mothers who had a C-section to have early skin-to-skin contact with their baby, and helping them breastfeed as early as possible.

The information pages of the UK’s National Health Service (NHS) suggest a few breastfeeding positions that put less pressure on the incision:

• The underarm hold, also called the football hold: the baby lies along your side with legs stretched out toward your back, and your hand supports the back of the baby’s neck; this hold does not press on your belly or the scar;
• Lying on your side: you and your baby lie on your sides facing each other, the baby’s tummy against your body, which is handy for night feeds;
• In the cradle hold across the front of your belly, the baby lies close to the incision, so it can easily hurt. If you want to use this hold, place a pillow over the incision and lay the baby on the pillow.

These positions have not been compared in any trial; this is advice from practice. Extra pillows behind your back and under the arm supporting the baby usually help you sit longer without getting tired.

Breastfeeding mothers can usually still take pain relief after surgery. NICE recommends combining paracetamol (acetaminophen) with an anti-inflammatory such as ibuprofen, taken regularly at the times your doctor advises. The Academy of Breastfeeding Medicine (ABM) notes that when the mother’s pain is well controlled, breastfeeding also goes more smoothly (Martin 2018).

Medicines containing codeine should not be used while breastfeeding, because they can make the baby very drowsy and breathe weakly. NICE, the U.S. Food and Drug Administration (FDA, 2017) and the European Medicines Agency (EMA, 2013) all advise this. For tramadol, the FDA advises avoiding it while breastfeeding; if you are prescribed it, check again with your doctor. Codeine can be hidden in cough medicines and combination painkillers, so before buying, read the ingredients on the box carefully or ask a pharmacist. When pain is severe and stronger medicine is needed, the doctor will weigh this and allow it only for a short time. If you go home still taking a strong opioid painkiller (an addictive type of pain medicine) prescribed by your doctor, watch whether your baby is unusually drowsy, has trouble breathing, feeds poorly or is constipated, and if so, tell the doctor right away.

In the first few days, babies of mothers who had a C-section may get less milk than babies of mothers who gave birth vaginally, but by about day six the amount is the same (Evans 2003).

When to see a doctor about the scar

Based on the studies above, the clinic advises mothers to see a doctor when:

• Pain at the scar is getting worse instead of better, or after many months it still hurts so much that you avoid bending or holding your baby;
• You can feel a lump in the scar, or the lump gets bigger or more painful with each period;
• There is a sharp, burning pain, or one like an electric shock, at one end of the scar, sometimes spreading down to the groin;
• There is light spotting for a few days after your period has ended;
• Pain in the back or lower belly goes on and rest does not ease it, especially when the scar is also still painful.

A lump in the scar that hurts with your period should be checked first with a gynecological exam and an ultrasound; do not assume it is ordinary blood stasis and treat it yourself. If the incision is red, swollen or oozing, you have a fever, or you have a cough, shortness of breath, or a swollen, painful calf, see a doctor right away; other danger signs are in the article "Warning signs after birth that need care right away".

When you go for a check-up, bring the hospital discharge papers from that C-section if you still have them.

References

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