Whether planned or not, a C-section can take an enormous toll on your body. Delivering a baby by C-section involves your doctor cutting horizontally through layers of your nerves, muscles and tissue.
Naturally, your stomach and core are likely to look and feel very different in the weeks, months and even years after surgery.
Along with a C-section scar, one of the most common challenges you might face after this kind of surgery is stubborn fat deposits and excess fat along your lower abdomen.
Plus, you might notice a pouch of excess skin above your incision scar, often referred to as a C-section pouch. While there's no silver bullet to prevent a C-section pouch, there are ways to reduce its appearance and treat it, too.
Let's run you through everything you need to know about C-section scars, what causes scar tissue and practical steps to take care of your postpartum belly.
What is a C-section pouch?
In a nutshell, a C-section pouch is a 'shelf' of scar tissue that can protrude from your stomach after a C-section delivery.
It usually appears near your incision scar and is often made up of a combination of scar tissue, body fat and excess abdominal skin.
For women who have been used to a flat stomach prior to pregnancy and birth, this shelf can come as a surprise.
However, it's important to remember that this bulge is completely normal and experienced by the vast majority of women who deliver by C-section.
What causes a C-section pouch?
To really understand a C-section pouch, let's take a step back and explain what happens during a C-section [1]. This surgical procedure is a way to bring your baby into the world, without going through vaginal delivery.
It involves a doctor making an incision through your abdominal wall and uterus, either horizontally (the most common kind of cesarean section) or vertically (only used in emergency C-sections).
The decision to have a C-section can be made ahead of time (an elective C-section birth), usually if your baby is in the bottom or feet first position or if you're pregnant with more than one baby.
On the flip side, you might have an unplanned or emergency C-section if your labour isn't progressing, your baby is showing signs of distress or there is a complication during labour.
During surgery, your doctor will make a 10cm cut to lift out your baby, before cutting the umbilical cord and removing the placenta. Then, layers of muscle, fat and skin will be stitched back together and a dressing will be placed over your wound.
This incision can cause a C-section shelf to appear and present as a bump or a stubborn pouch of fatty tissue. For some women, this scar tissue can't be removed with exercise or diet changes alone (which may mean surgery is the only way to eliminate a postpartum pouch).
For others, following an exercise program and focusing on core exercises can be enough to flatten the appearance of this pouch.
Plus, some women find wearing belly bands and compression underwear a helpful way to strengthen their core muscles after a C-section delivery.
No matter how pronounced your pouch might seem, it's important to be kind to yourself during your postpartum recovery. Your body has worked so hard to bring your baby into the world and you've just been through one of the biggest events many women ever face: childbirth.
Along with many changes that happen to your body after birth, this pouch is completely normal. Try to focus on giving your postpartum belly the time and space to recover after giving birth.
What is the difference between diastasis recti and a C-section pouch?
While the two might seem similar, a C-section pouch is different from diastasis recti [2]. Also known as abdominal separation, diastasis recti is a condition some women experience during pregnancy and after birth.
It's caused by your growing uterus and can cause your abdominal muscles across your stomach to separate from each other.
This separation is caused by the pressure of your growing baby and hormonal changes you might experience during the second half of your pregnancy.
It's a condition most commonly experienced by women who are carrying multiple children, mothers over 35 or women who have had a previous pregnancy.
The common signs and symptoms of abdominal separation include:
- Noticing a gap between the two bands of your abdominal muscles (it might be more noticeable if you lie flat on your back and lift your head up).
- Noticing a canoe-shaped bulge in the middle of your stomach near your belly button, particularly when your core muscles are activated.
- Some lower back pain, as this condition stops your stomach muscles from properly supporting your back.
While diastasis recti is experienced by 1 in 3 women in the 12 months after birth, it usually improves within 8 weeks of giving birth [2].
While both conditions can make your stomach bulge, the key difference is what causes these pouches to occur. In the case of abdominal separation, this is caused by your muscles separating and becoming weakened during pregnancy [3].
A C-section pouch is actually caused by scar tissue left behind by your C-section scar. In some cases, the way your body recovers after surgery can cause excess fat to accumulate in your lower belly area.
Ultimately, this has nothing to do with your muscles separating and is all about excess skin and scar tissue.
Is it possible to prevent a C-section pouch?
All of our bellies will recover differently after birth.
However, if you have experienced a C-section, there are steps you can take to lower your chances of developing a C-section pouch.
Wear a postpartum belly wrap
One of the best steps you can take is to use a purpose-built belly band — like Kin's Belly Band — which is designed to help your abdominal muscles and incision heal from surgery, while also reducing swelling.
The band is placed above your incision area to avoid irritation and has been shown to aid postpartum recovery by reducing pain, bleeding and discomfort [4].
Kin's Belly Band uses a two-layer wrap decision with elastic velcro bands to deliver targeted compression where you need it the most.
Move your body (gently)
Introducing gentle exercise, walking and targeted core exercises can be beneficial in rebuilding your tummy's strength after surgery.
Unsure how to start working out after a C-section? Check out our comprehensive guide and learn when it is safe to do so, the best exercises for the postpartum period, exercises to avoid, and more.
Eat a healthy diet
Eating a varied, nutritious diet is essential not only to help your body through the recovery process but to ensure you provide your little one with all the nutrients, vitamins and minerals they need to grow healthy and strong.
Collagen-rich foods, in particular, will support your body as it restores connective tissues — think foods like bone broth, fish, chicken and berries.
Remember as well, to drink enough water throughout the day.
Practise scar massage
Once your wound has healed (and with the OK from your doctor), incorporate scar massage into your routine [6].
This will help prevent excess scar tissue from accumulating, while also promoting recovery, managing swelling, and reducing muscle restriction.
Plus, it can help soften the appearance of the scar over time, relieve uncomfortable symptoms like itching and pain, and stimulate blood flow to the area, aiding in collagen formation [7][8].
It's important to chat with your GP before using a belly band or starting a new diet and exercise routine to ensure you're taking care of yourself and doing what's best for you.
How to treat a C-section pouch
Again, a belly band that uses compression can be a practical way to treat this pouch. Plus, eating a healthy diet and incorporating exercise into your routine can be beneficial in supporting your postpartum recovery.
However, due to the way C-section scars are caused, it might not be possible to totally remove a pouch without some plastic surgery (such as a tummy tuck).
Depending on how your scar has healed, it might have found itself stuck to your muscles and could be causing overhanging tissue above. If so, you might notice a red, rigid scar along with overhanging loose skin and excess tissue.
If this is the case, diet and exercise alone won't be enough to resolve it.
Before considering plastic surgery or a tummy tuck, make sure to chat with your doctor and carefully understand what this process involves.
While this surgery will help to reduce the appearance of a pouch, it does come at a hefty cost (anywhere from AUD $9,000 to over AUD $30,000) [5].
No matter what kind of birth you experience, your body is going to look and feel different after pregnancy and labour.
But rather than jumping straight into weight loss mode, it's important to prioritise your rest and recovery. Bringing new life into the world is a massive feat, and your body will take a while to recover after delivery.
It's totally understandable if the changes to your body can feel uncomfortable at times but try to remember that it took nine months for your body to change in pregnancy, so it'll take a significant amount of time for it to heal on the other side.
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