10 April, 2025
What is post-cesarean fibrosis?
Post-surgical fibrosis is a natural response of the body after surgery, such as a cesarean section. It involves the formation of excessive scar tissue that can create adhesions between different layers of tissue that normally should slide smoothly over each other: skin, muscles, fascia, peritoneum, or internal organs. Although this process is part of healing, it can cause functional problems, pain, and limitations if not properly addressed.
Why does fibrosis form after a cesarean?
After a cesarean, the body triggers an inflammatory process to repair the damaged tissues. Fibroblast cells are involved in this process, producing collagen to close the wound. If collagen production is excessive or disorganized, dense scar tissue forms, losing elasticity and causing movement restrictions. These adhesions can develop between the skin scar and deeper layers of the abdomen, and may even affect internal organs such as the bladder or intestines.
Common symptoms of post-cesarean fibrosis
Adhesions after a cesarean don’t always cause immediate symptoms, but over time they may lead to:
- Persistent abdominal or pelvic pain
- Tightness around the scar when coughing or moving
- Lower back pain or pain radiating to the hip
- Digestive difficulties (bloating, gas, constipation)
- Pain during sexual intercourse (dyspareunia)
- Feeling of “blockage” or stiffness when moving or stretching the abdomen
- Pelvic floor dysfunction
Consequences of not treating adhesions after a cesarean
If untreated, adhesions can harden over time and affect quality of life. Some long-term consequences include:
- Chronic pain or persistent inflammation
- Postural alterations and limitations in daily movements
- Difficulties in future pregnancies or deliveries
- Increased risk of complications in future surgeries
- Functional urogynaecological or digestive problems
How physiotherapy can help with post-cesarean fibrosis
Specialized post-cesarean physiotherapy is essential for treating fibrosis and preventing complications. Some of the most effective techniques include:
- Percutaneous electrolysis (EPI): to remove fibrotic tissue and restore functional tissue mobility
- Percutaneous neuromodulation: to modulate pain, improve neuromuscular function, and accelerate tissue regeneration, especially in early stages
- Radiofrequency and cupping: to improve tissue quality
- Manual therapy and myofascial mobilization: to increase tissue flexibility
- Therapeutic abdominal and pelvic exercises: tailored to each patient
Additionally, physiotherapy educates patients on scar care, breathing, and activation of deep muscles, helping to safely restore abdominal and pelvic floor functionality.
When to seek physiotherapy after a cesarean
Ideally, a woman should consult a physiotherapist specializing in women’s health within 6 to 8 weeks after a cesarean. Percutaneous neuromodulation can help reduce fibrotic tissue formation if applied from the first week post-surgery. However, it’s never too late to start, even months or years after the surgery.
Conclusion
Post-cesarean fibrosis is a common but treatable condition. Recognizing the symptoms and addressing them with appropriate physiotherapy can make the difference between living with pain or regaining function and well-being. If you’ve had a cesarean and notice discomfort, changes in your abdomen, or pain, don’t normalize it. Consult a specialized physiotherapist and start caring for yourself at the root of the problem.
References and scientific evidence
- Järvinen TA et al. “Muscle injuries: biology and treatment.” Am J Sports Med. 2. 3. 4. 5. 6. 2005.
- Diamond MP, Freeman ML. “Clinical implications of postsurgical adhesions.” Hum Reprod Update. 2001.
- Tabibian N et al. “Abdominal adhesions: a practical review of an often overlooked diagnosis.” World J Gastroenterol. 2019.
- López-de-Celis C et al. “Effectiveness of physiotherapy interventions for abdominal scars: a systematic review.” Physiotherapy Theory and Practice 2022.
- Vercellini P et al. “Adhesions and pain in gynecology.” Curr Opin Obstet Gynecol. 2009.
- Hidalgo-Tallón J et al. “Tratamiento de las adherencias mediante electrólisis percutánea intratisular (EPI®): una propuesta clínica.” Rev Int de Ciencias del Deporte. 2018.