In this article:
What Are Adhesions and Why Do They Form After a C-section
After a caesarean, your body rebuilds layers that were surgically opened: skin, fat, muscle, peritoneum, and uterus. As each layer heals, fibrin, a natural protein involved in clotting, acts like biological glue.In uncomplicated healing, enzymes dissolve fibrin once tissue repair is complete. But if inflammation lingers or blood supply is disrupted, the fibrin doesn’t break down fully. Instead, it forms bridges between neighbouring organs such as the bladder, uterus, bowel, or abdominal wall.
Typical adhesion sites include:
- The area between the uterus and bladder.
- Between loops of the small intestine or between the intestine and the abdominal wall.
- Around the fallopian tubes or ovaries, in women who’ve had multiple C-sections.
How Adhesions Feel: Symptoms That Don’t Always Add Up
Because adhesions don’t show up on the skin, their symptoms are often mistaken for unrelated issues. You might notice:- Pain that persists or worsens months after surgery. It can feel like sharp twinges near your scar or a deep pelvic ache during movement.
- A pulling sensation when stretching or standing up straight.
- Bloating or altered bowel habits. Adhesions can subtly affect intestinal motility, leading to constipation or trapped gas.
- Pain during intercourse. Especially if adhesions involve the uterus, bladder, or vaginal apex.
- Infertility or complications in future pregnancies. In rare cases, adhesions may distort the uterine shape or block the fallopian tubes.
Why Adhesions Matter Beyond Pain
Unaddressed adhesions can impact multiple aspects of health and recovery:- Mobility: Restricted abdominal wall movement may affect posture and back alignment.
- Digestion: Adhesions involving the intestines may slow bowel movement or, in severe cases, cause obstruction.
- Fertility: Post-surgical adhesions are a known cause of secondary infertility due to tubal blockage or uterine distortion.
- Emotional health: Chronic pain or discomfort can lower confidence in physical recovery and intimacy.
Who Is More Likely to Develop Adhesions
Adhesion formation isn’t random; several factors increase the risk:- Multiple C-sections or abdominal surgeries. Each incision adds new scar tissue, increasing the chance of overlap.
- Infection or bleeding during or after surgery. Inflammatory responses intensify adhesion development.
- Emergency or prolonged surgeries. Longer operating times increase tissue handling and trauma.
- Obesity or diabetes. Slower wound healing encourages abnormal scar formation.
- Genetic tendency to form thicker scars (keloid-prone skin). The same hyper-healing tendency may extend internally.
How Doctors Diagnose Adhesions
Adhesions are tricky to confirm because they don’t appear on routine imaging.Common evaluation methods include:
- History and physical examination: Your doctor may correlate pain with movement, menstrual cycle, or scar location.
- Ultrasound or MRI: These can rule out other causes like hernias or endometriosis, though adhesions themselves are often invisible.
- Diagnostic laparoscopy: A minimally invasive surgery that allows direct visualisation of adhesions and, in some cases, their treatment.
Treatment and Management Options
There is no single fix for adhesions, but several approaches can reduce pain and restore mobility.1. Gentle scar mobilisation therapy: Trained physiotherapists use soft tissue techniques to free tension and improve blood flow around the scar. Starting after complete wound healing (usually after 6–8 weeks) can prevent long-term stiffness.
2. Pelvic physiotherapy: Targeted exercises, deep breathing, and posture correction improve abdominal wall mobility and organ glide.
3. Adhesiolysis surgery: In cases of severe or bowel-related adhesions, laparoscopic adhesiolysis may be done to separate scarred tissues. However, surgery can sometimes lead to new adhesions, so it’s reserved for specific medical indications.
4. Ayurvedic postnatal massage and abhyanga: When performed by trained practitioners after full healing, warm oil massages using sesame or castor oil can soften tissue and reduce Vata-related pain.
5. Pain management and anti-inflammatory care: Short courses of NSAIDs, under medical advice, can relieve flare-ups.
6. Nutritional and lifestyle support: Hydration, fibre-rich foods, and mild movement prevent bowel stagnation and promote circulation, key to preventing adhesion tightening.
Always consult your obstetrician or physiotherapist before starting any therapy. Self-massage or premature manipulation of healing tissue can worsen pain or delay proper recovery.
Pain after a C-section should never be dismissed as “just part of recovery.” Internal adhesions are a tangible, biological cause, and acknowledging them is the first step toward healing. With the right combination of medical care, physiotherapy, and self-awareness, you can regain comfort, mobility, and trust in your body again.
Whether you’re pregnant, a new mom, or navigating postpartum, you don’t have to do it alone. Join our support group to connect, share, and support one another.
FAQs on The Hidden Complication After a C-section: Internal Scar Adhesions
- Can adhesions dissolve on their own?
Mild adhesions may soften with physiotherapy and time, but once dense fibrous bands form, they don’t completely disappear without surgical intervention. - How can I prevent adhesions after my C-section?
Early mobilisation, good hydration, and supervised scar massage (after healing) reduce risk. During surgery, doctors may also use adhesion-barrier gels to minimise tissue sticking. - Are adhesions dangerous for future pregnancies?
Usually not, but they can make repeat surgeries more complex or increase the chance of placenta accreta. Discuss your surgical history with your obstetrician before your next pregnancy. - Is it safe to have another C-section if I already have adhesions?
Yes, though your surgeon may plan a longer procedure. Inform your medical team in advance so they can anticipate and manage any challenges safely.