Caesarean Recovery and Scar Management
Reviewed by Cheryl Long, AHPC-registered physiotherapist, Goji Physio
A Caesarean section is a major abdominal operation — seven layers of tissue are incised and sutured. Recovery involves not just the skin scar but the healing of the uterus, bladder reflection, fascial layers, and abdominal muscles. Physiotherapy supports that process: from early mobilisation and pain management to scar tissue work and a safe return to exercise.
What happens physically after a C-section?
In the immediate postoperative period, the priority is pain management and early, gentle mobilisation. Walking short distances within 24 hours of surgery is typically encouraged by the ward team, and this is appropriate. What many women are not prepared for is what happens over the following weeks and months:
Scar tissue formation: the body lays down collagen fibres during healing. These fibres are not as organised as the original tissue and can cause the scar to feel tight, numb, hypersensitive, or raised. Internal adhesions can form between the scar and the bladder, uterus, or fascia, sometimes causing a pulling sensation with certain movements or a visible overhang above the scar ("shelf" or "ledge").
Abdominal muscle and fascia changes: the multiple layers of muscles and fascia are affected by the surgery. Re-establishing function in these muscles is important before returning to load-bearing activities.
Pelvic floor: even without a vaginal birth, the pelvic floor has been under increased load for 9 months and is affected by the hormonal and structural changes of pregnancy. Pelvic floor assessment is still relevant after Caesarean birth.
When should I start physiotherapy after a C-section?
An initial postnatal assessment is appropriate from around 8 weeks post-surgery, once the outer wound has healed. However, there are things a physiotherapist can advise on earlier — including safe movement strategies, how to roll, sit, cough, and lift without straining the scar, and when to start gentle abdominal rehabilitation. If you are experiencing significant scar pain, numbness, or pulling sensations, or finding movement more restricted than expected, an earlier assessment is warranted.
What does scar management involve at Goji?
Scar management is typically introduced from around 6–8 weeks post-surgery, once the scar is fully closed. It aims to improve the mobility of scar tissue relative to the layers below it, reduce sensitivity, and address any adhesions that are restricting movement or causing discomfort. At Goji, this may include:
Scar desensitisation: graded tactile stimulation around and on the scar to normalise sensation in areas of numbness or hypersensitivity
Scar tissue mobilisation: hands-on techniques to improve the mobility of the scar and address superficial adhesions
Patient-led massage technique: our physiotherapist will teach you a technique to continue at home as part of your daily routine
Scar management is not only cosmetic — it is functional. An immobile scar can contribute to bladder symptoms, pelvic floor dysfunction, diastasis recti, and pain with movement.
What does a full postnatal assessment look like?
Your first session begins with a conversation about your birth experience, your current symptoms, and what you want to return to. The assessment covers:
Scar assessment: appearance, mobility, sensitivity, and any palpable adhesions
Abdominal wall function: including diastasis recti screen
Pelvic floor assessment: offered as appropriate
Movement and load advice: what is safe to start, and what to introduce progressively
You will leave with a structured plan that takes your specific surgery, recovery, and goals into account.
Frequently asked questions
How long does a C-section scar take to heal fully?
The skin surface typically heals within 6 weeks. However, internal tissue remodelling continues for up to 12 months. Scar management is most effective when started early but remains beneficial throughout this remodelling window.
My scar is numb. Is that normal, and will it recover?
Numbness around a C-section scar is very common and results from the injury of small superficial nerves during surgery. Sensation often returns partially over 6–18 months. Desensitisation techniques can help the nervous system process sensation more normally in the area.
I have an overhang or "shelf" above my scar. Can physio help?
A C-section shelf (sometimes called a "C-section pouch") can result from a combination of scar adhesion, skin fold, and fat redistribution. Physiotherapy — specifically scar mobilisation and core rehabilitation — can address the adhesion component and improve posture and abdominal function, which may reduce the prominence.
When can I return to running or the gym after a C-section?
Guidance based on current evidence recommends a graduated return to impact exercise: low-load exercise from 6–8 weeks, progressive strengthening from 3 months, and impact activity (running, jumping) from around 4–6 months — following assessment and provided there are no ongoing symptoms. This is a guide; your physiotherapist will advise based on your individual presentation.
Do I need pelvic floor physiotherapy after a C-section?
Yes. The pelvic floor has been under load for the duration of pregnancy regardless of the mode of delivery. Pelvic floor assessment after Caesarean birth is recommended — particularly if you are experiencing any leakage, heaviness, or urgency.
Can I have physiotherapy for a C-section scar from a previous pregnancy?
Yes. Scar mobilisation and desensitisation can be helpful at any point after surgery, not just in the immediate postnatal period. Women come for scar management years after their last Caesarean, particularly when planning further surgery or when adhesions are contributing to ongoing symptoms.
Tell us about your surgery and what is bothering you now — we'll help you figure out what your recovery should look like.
Reviewed by Cheryl Long, BSc (Hons) Physiotherapy, AHPC-registered
Clinical Director, Goji Physio — Women's and Family Physiotherapy, Lentor, Singapore
Related conditions:
Diastasis Recti | Urinary Incontinence | Pelvic Organ Prolapse
