Around one in three births in the USA and one in four births in the UK, are C-sections, where the c stands for cesarean. A C-section is used to deliver babies when vaginal birth is not safe or preferred for the mother or the baby. The procedure can lead to a “C-section shelf”, also called a “C-section pouch” or “C-section bulge.” This name refers to the bulge or raised area of skin and tissue that forms around the scar after a C-section on your tummy. So what can you do about it?
I’m Wendy, perinatal pelvic health specialist. In this article, we will discuss the causes, risks, and myths about the C-section shelf. We will also cover how common it is, and how to fix it.
What causes a cesarian-section shelf?
The main cause of a C-section shelf is the healing process after a cesarean delivery. During a C-section, a cut is made through the abdominal wall at your lower tummy to reach the womb and deliver the baby. The cut is closed up with stitches by a surgeon. Then, the body uses inflammation as a healing response. This involves swelling to get more blood to the area to help heal and repair the skin, muscles, tendons, and tissues. But, in many cases, healing can cause scar tissue and changes in the abdominal shape. This creates a shelf-like appearance and a bulge sticking out on the lower tummy area.
Factors that can influence the formation of a C-section shelf
Three things can affect the shape of a C-section shelf – the type of cut, also known as the incision, how the incision is closed up, and genetics or body composition. So let’s explore these in more detail.
1. The type of incision the surgeon uses can impact the chance of developing a shelf. For example, a vertical incision may bulge more. This is compared to a horizontal or “bikini line” incision that goes from one side to the other side across the tummy area.
2. How the incision is closed affects how the C-section scar forms and how the abdomen looks. Proper closure and suturing, which is the technical word for stitches, are essential and will reduce the chances of a C-section shelf or bulge on the tummy area.
3. Body composition affects how the abdomen heals after a C-section. For example, body weight, muscle tone, and skin elasticity. Women with weak abdominal muscles or more body fat may be more likely to develop a C-section shelf.
Risk Factors
Any woman who has a C-section has a higher chance of developing a C-section shelf. But, three other things can make it more likely, too.
1. Women who have had multiple C-sections have a higher chance of developing a C-section shelf. This is due to the cumulative effect of repeated surgeries on the abdominal tissues.
2. Obesity adds strain and pressure to the abdominal muscles and tissues. It can interfere with healing and raise the chance of developing a C-section shelf.
3. Factors like diabetes, smoking, and some medical conditions cause poor wound healing. They can impair the body’s ability to heal after surgery. This raises the chance of complications like scar tissue and bulges.
Does everyone who has a c-section get a shelf?
Not everyone who has a c-section gets a shelf or bulge on their lower tummy area. It varies based on the surgical technique used to close the incision and the body composition of the mother. Exact statistics are not available, but many women who get C-sections may have some degree of abdominal bulging, or changes in shape to the lower tummy area.
A study by Nahas in 2017, found that among women who had C-sections, about 4 out of 10 had some belly bulging or shape changes in the tummy area. Another study by Avoama in 2020 also said around 3 or 4 out of 10 women had a bulge after their c-section too.
How can you reduce the appearance of a C-section shelf?
Here are six ways to help reduce the size of a C-section shelf:
1. C Section scare massage
C-section scar massage can help reduce the size of the c-section shelf. Massaging the scar promotes better blood flow, breaks down scar tissue, and improves tissue flexibility. Start massaging the area a few weeks post-surgery, using gentle circular and vertical motions with your fingers. This can improve healing, reduce swelling, and minimize the appearance of the shelf. Try to do this every day.
2. Core exercises
Core exercises can help reduce the bulge of skin and tissue above a C-section scar. Strengthening the deep core muscles will improve overall abdominal tone and support. Core exercises such as those in MUTU System will also improve posture, and reduce abdominal separation (also called diastasis recti). The right exercises will gradually increase core strength without straining the site of the c-section. Start slowly and be consistent with your core workouts.
3. Lifestyle choices
- Maintain a healthy lifestyle. Eat a balanced diet, exercise often for 20-30 minutes five times per week if you can, and try to maintain a healthy weight. These will all improve your health, support your recovery and help wound healing after a C-section.
4. Self care
Proper self-care after surgery is important. Follow your doctor or your provider’s instructions for wound care, find out how much you can safely exercise, and see your doctor at follow-up visits to check how you’re healing.
5. Postpartum physical therapy exercises
Doing postpartum physical therapy exercises can strengthen the abdominal muscles. They can also improve muscle tone and help with healing after a C-section, so you are less likely to get a C-section shelf.
6. Cosmetic surgery
Some women may choose cosmetic surgery. They may get an abdominoplasty, a surgery also known as a tummy tuck. This will help shape the belly in a way that gets rid of a c-section shelf. But, you should speak to your doctor to check if surgery is the right option for you.
C-Section Myth-busting!
Now let’s bust three myths about c-sections because there is a lot of information out there that just isn’t true.
1. Myth: All Women Who Have C-sections Will Develop a C-section Shelf. While C-section shelves are common, not all women who have cesareans will get one. Many factors affect the chance of developing a C-section shelf. These include body shape, what happens during surgery, and the healing process after surgery.
2. Myth: C-section Shelves Are Permanent. While they may be persistent, a C-section shelf is not necessarily permanent. With time and care, the belly’s appearance may improve. The tissues will keep healing and changing as you exercise and as the wound heals You may want to speak to your doctor about getting surgery to reduce the size of a C-section shelf.
3. Myth: C-section Shelves Are Only a Cosmetic Concern. Having a bulge on your belly may also cause discomfort or pain. You can see a doctor that specialises in pregnancy, obstetrics and gynaecology to give you advice and recommend treatments such as physical therapy, or plastic surgery.
Conclusion
A C-section shelf can form after a cesarean delivery. Factors such as the type of cut during surgery, body shape and composition, and care after surgery can affect if a C-section shelf forms. Not all women who have C-sections get a C-section shelf. But now you know the causes, risks, and myths can help you choose care and treatment options after surgery. By adopting healthy habits, you can improve healing and how the c-section area looks. Follow after-surgery care guidelines from your doctor and get medical care as needed to help you fully recover.
Thank you for reading.
References:
1. Nahas FX, Augusto SM, Ghelfond C. Abdominal Wall After Cesarean Section. Aesthetic Plast Surg. 2017;41(4):820-824. doi:10.1007/s00266-017-0801-8
2. Avoma AO, Ibrahim AG, Odogwu KA, et al. Post-caesarean section abdominal bulge: Incidence, risk factors and pregnancy outcomes. Niger J Clin Pract. 2020;23(11):1553-1557. doi:10.4103/njcp.njcp_24_20
