The first days of motherhood can be overshadowed by unpleasant and even painful sensations. The condition of a young mother after childbirth often depends on the course and outcome labor activity. The application of internal and external sutures to a woman in labor has already become a habit and does not come as a surprise. But if we can see the external sutures and observe the process of their healing, then with the internal sutures the situation is completely different.
Classification of internal postpartum sutures and their characteristics
The internal female genital organs, which are directly involved in the birth of a baby, are subject to mechanical stress, which leads to ruptures and cracks of soft tissue. Internal damage impossible to notice with the naked eye. The gynecologist discovers them as a result of a thorough examination with a surgical speculum, after which he applies stitches.
Depending on the location of application, internal seams can be:
- on the cervix;
- on the walls of the vagina;
- on the wall of the uterus after caesarean section.
Stitches on the cervix and vaginal walls
Tears in the soft tissues of the cervix and vaginal walls are formed as a result of improper actions of the woman in labor, as well as the physiological characteristics of the fetus and the woman’s genital organs. During labor, large tears and small cracks occur, which require surgery and suturing.
Stitching the cervix in the first hours after childbirth is a painless process Most common reasons damage to the internal genital organs:
- inelasticity of the walls;
- large fetal size;
- premature birth;
- inflammatory processes in the reproductive system during pregnancy;
- narrow vagina;
- premature attempts;
- early abortions;
- incorrect position of the fetus during labor.
It takes 12 hours for the cervix to fully dilate, this is especially true for first-time women. During the second and subsequent births, this takes less time. During rapid labor, as well as false contractions, when the woman in labor begins to push, but the cervix has not yet fully dilated, the soft tissue of the genital organs ruptures under the pressure of the baby’s head. If a gynecologist is present at the birth from the very beginning of contractions, he will advise and at the right moment stop the woman in labor from making premature attempts.
10–12 hours are needed for the cervix to fully dilate Features of applying internal sutures to the cervix and vaginal walls after childbirth
For the first two to three hours, the cervix is devoid of sensitivity, so sutures are applied without anesthesia. But when it comes to sutures on the walls of the vagina, which are strewn with nerve endings, they resort to local anesthesia with novocaine or lidocaine.
In order not to subject the body to repeated stress, when suturing the internal organs They use self-absorbable threads, which, under the influence of protein and water, self-destruct within 10 days or several months, depending on the material, and contribute to the fastest healing of wounds.
Types of self-absorbable suture material:
- catgut thread. Made from natural raw materials small intestines mammals. Dissolve within 7–10 days;
- semi-synthetic vicryl thread. Dissolves within 50–85 days;
- semi-synthetic caproag thread. Dissolves within 180–210 days.
The sutures on the cervix do not cause discomfort and do not bother the mother in labor, while the sutures on the walls of the vagina ache and hurt for several more days.
Internal sutures for caesarean section
Caesarean section involves incision of the anterior abdominal wall, fatty tissue and the anterior wall of the uterus.
Types of incisions on the uterus during caesarean section:
- transverse in the lower segment of the uterus - often used and less traumatic. With this incision there is less blood loss than with the others and fastest healing wounds;
- classic transverse in the upper part of the uterus, which is characterized by large blood loss, as it passes at the site of accumulation of blood vessels;
- vertical, from the navel to the pubis, done with incorrect location fetus
A transverse incision in the lower segment of the uterus is the most common By medical indications the seam happens:
- longitudinal from the navel to the pubis;
- transverse in the lower segment of the abdominal cavity;
- classic in the upper part of the uterus.
Scars on the uterus from a cesarean section with a transverse incision in the lower segment do not affect subsequent births; moreover, for medical reasons, delivery can occur naturally.
The transverse suture is usually 12 cm long. But depending on the position of the fetus, its size and the physiological characteristics of the structure of the uterus, the length of the suture changes up or down.
As the mother of a three-year-old girl, I also have a “smile” from a caesarean section on my body, which is far from 12 cm, although I gave birth to a child weighing 1900 grams and 30 cm tall. Despite the fact that the fetus is small, the transverse seam is 17 cm. 
The uterus is sutured using self-absorbing threads.
The incision on the uterus is usually closed with a single-row or double-row suture without interruption with special self-absorbable threads:
- dexon;
- vicryl;
- monocryl;
- caproag and others.
While the longitudinal and classic seams “decorate” a woman’s body for the rest of her life, and it is almost impossible to get rid of them, the transverse seam becomes invisible over time, as it is placed under the fat fold. 
It is impossible to get rid of a longitudinal seam even with a laser
The stitches after a cesarean section hurt during the first weeks, or even months. Immediately after the operation, the woman is prescribed painkillers: morphine and its varieties, Tramadol and Omnopon.
If pain bothers a woman after discharge from the maternity hospital, as a pain reliever, given that the woman is breastfeeding, you can take:
- Paracetamol and Panadol;
- Nurofen, Ibuprofen, Ibufen;
- But-shpu. A one-time, unsystematic use of the drug will not harm the baby.
If pain constantly bothers a woman, it is better to consult a gynecologist.
The transverse suture from a cesarean section becomes almost invisible over time It is possible that the transverse suture in the lower segment of the uterus is reduced or not depends on the complexity of the birth and the skill of the surgeon. Exactly three years have passed since the seam appeared, but a peculiar thread-like unevenness still reveals the secret of my daughter’s birth.
Caring for internal seams
Internal seams do not require special care. The optimal treatment is the complete absence of external interference in the woman’s body, rest and keeping the genitals clean.
If a woman’s genitals are severely damaged during childbirth and large tears are observed, then a course of antibiotic therapy is often prescribed to prevent suppuration and infection. The duration of the course of antibacterial therapy by injection is three days, injections are given every 6–8 hours.
Modern pharmacists have stepped forward and developed a number of antibiotics that are practically not absorbed into breast milk and do not harm the baby, so there is no need to stop lactation.
The group of safe antibiotics allowed during lactation includes:
- cephalosporins (cefazolin, cephalothin, cephalexin, etc.);
- penicillins (ampicillin, amoxicillin, etc.).
Photo gallery: antibiotics allowed during lactation
During treatment with ampicillin, systematic monitoring of liver function is necessary. Amoxicillin - antibacterial drug wide range action, refers to synthetic antibiotics penicillin group Cefazolin is poorly absorbed from the gastrointestinal tract and is therefore used in the form of injections
Rules for a woman's behavior after childbirth
After childbirth, a woman must comply certain rules to prevent the development of complications:
- It is worth getting up and walking a little 2-3 hours after delivery to prevent the formation of adhesions and improve blood circulation;
- At first, you should use postpartum pads, then sanitary pads, which are changed every 2-3 hours, since the woman will have postpartum discharge - lochia - for another two months;
- You should take a shower at least twice a day;
- You should not sit down for 2-3 days after giving birth. The main position is lying or standing; you can sit down on only one buttock;
- lifting heavy objects, including a child, should be avoided;
- It is worth normalizing your diet by including more liquids and soups in your diet. In this case, you should exclude bread and other constipating foods that cause constipation;
- It is not recommended to wear shapewear that restricts the perineum and vaginal walls to avoid rupture of the seams;
- You should abstain from sexual activity for two months until the stitches heal and the elasticity of the vaginal walls is restored.
When to see a doctor: first warning signs
Each healthy woman It is necessary to visit a gynecologist at least twice a year. Young mothers who gave birth with sutures need to undergo an examination once a month to identify pathologies and monitor the correct healing of the sutures.
Incorrectly fused sutures and scars that form can greatly affect the course of subsequent pregnancies:
- scars on the cervix may prevent it from opening during childbirth;
- a scar on the cervix threatens to terminate the pregnancy, since the cervix must be tightly closed during pregnancy, and the scar can prevent its closure.
How to speed up the healing of internal stitches and make this process less painful
For the speedy healing of ruptures, good blood circulation is necessary, so a woman needs to move as much as possible, and also perform one simple exercise a couple of times a day:
- Tighten the muscles of the vagina, perineum and anus.
- Hold your breath for 3-4 seconds.
- Relax.
- Repeat for ten minutes.
In addition to a number of painkillers prescribed by the attending physician, women take a cool shower or apply ice to relieve pain. abdominal cavity in place of the internal seams. 
Ibuprofen can be used to relieve pain during breastfeeding
Perhaps, before, girls with stitches after childbirth were looked at as sick and prescribed bed rest, but now everything has changed radically. After 10 hours in the intensive care unit after a caesarean section, I was raised and asked to go to the personal hygiene room on my own. Yes, it was not easy, and most importantly, scary. But I didn’t feel any pain at that moment, except for a feeling of discomfort from urinary catheter. Six hours later, after being transferred to the ward, I went up to the child in the children's intensive care unit from the 2nd floor to the 5th. Naturally, by elevator. But he also needed to be reached. Either I was so lucky, or from constant movement and the desire to quickly get to my feet and see the baby, but I didn’t feel pain during the first three days while the painkillers were injected, or the subsequent ones, when they stopped.
The first signs of complications after applying internal sutures
If a woman feels changes in her body and discomfort, this is the first sign that a consultation with a gynecologist is necessary.
Complications after surgery:
- the seam has come apart. As a rule, this occurs within three days after the operation as a result of lifting weights over four kilograms, exerting force during bowel movements, or due to improper suture placement;
- the seam became inflamed and festered. More often this happens if a woman in labor has infectious diseases that were not treated before pregnancy or due to non-compliance with personal hygiene rules.
Glycerin suppositories will help you go to the toilet without stress after childbirth Postoperative symptoms of complications include:
- a sharp increase in body temperature to 38–40 °C. Temperatures up to 37.5 °C are considered normal until the stitch heals;
- vaginal discharge mixed with pus and an unpleasant odor;
- heaviness and nagging pain in the lower abdomen;
- bloody issues from the vagina. The first 6–8 weeks after birth, lochia is observed - bloody discharge from the uterus. For three days they are abundant, but gradually their quantity decreases. The discharge becomes spotty and turns grayish-yellow in color. The sudden onset of bleeding, which is accompanied by weakness, dizziness, pale skin, rapid breathing and pulse, and constant chills, should alert a woman.
All these signs are a signal of suppuration or suture dehiscence and infection of the body. At the first symptoms of complications, a woman should immediately consult a gynecologist.
Natural childbirth is the desired end to almost every pregnancy. However, a woman is not always able to give birth on her own.
There are cases when it is simply necessary to perform surgical delivery in order to save the life of the mother and child. Despite the fact that caesarean section is considered commonplace and quite familiar to gynecologists, it is still abdominal surgery. And accordingly, its implementation is associated with certain risks and complications.
However, it is worth noting that the fair sex is rarely concerned serious problems health problems that may arise. Much more often the question arises whether the scar will be visible after a cesarean section. And it is very difficult to give a definite answer in this case, because everything depends on many factors. Starting from the type of incision used and ending with the correct care of the postoperative suture.
The surgical method of delivery is prescribed for certain medical indications. It happens that a woman in labor is prepared in advance for surgery, and there may be emergency situations. Depending on the reason that caused the need for surgical intervention, the tactics of the procedure and the type of incision are selected, which determines the subsequent type of suture.
Vertical
The main indication for corporal cesarean section is a direct threat to the life or health of the fetus or woman. Possible complications during pregnancy that can lead to this: acute fetal hypoxia, placental abruption, massive bleeding, critically high blood pressure.
In this case, the result of the surgical intervention is a vertical suture. It runs from the pubic area to the navel, the scar has a nodular structure and is often prone to compaction. Its appearance definitely spoils the appearance of a new mother’s belly. That is why this type of incision is not used unless absolutely necessary.
In this case, only a tattoo on a caesarean section scar can help. The decorative element will definitely divert attention from the skin defect and give the woman more confidence in herself and her body.
Horizontal
The medical name for this type of suture is Pfannenstiel laparotomy. It is carried out only in cases where the surgical intervention was planned, and not acute conditions. The incision is made in the skin fold above the pubis. Wherein important feature is that the abdominal cavity remains unopened.
A horizontal incision allows you to make a cosmetic suture. It is practically invisible on the skin, because it is applied using a special technique (intradermal and continuous).
Domestic
The method of placing internal sutures on the wall of the uterus varies depending on the condition of the organ. The main goal of proper suturing is to minimize healing time and reduce blood loss. This is also important because the course of future pregnancies and the type of delivery in the future depends on it.
For the corporal type of surgical intervention, a longitudinal type of stitching is used, for laparotomy - a transverse one.
How different types of fabrics are sewn:
- To connect the walls of the uterus, a self-absorbable durable material of synthetic origin, which is applied continuously in one row.
- For muscles and peritoneum, catgut is used, applied continuously.
- For connective tissue muscles, it is also preferable to use a synthetic type of thread.
The speed, incidence of complications, as well as features of care for the surgical area directly depend on what technology was used.
Features of the recovery period
Depending on the type of incision and the woman’s health, the recovery period will have certain features. Pain and the risk of complications are much higher with a longitudinal incision compared to a transverse one.
Pain
It is quite natural for most women to ask how much the stitch hurts after a caesarean section. In order to answer this question, it is necessary to understand the very essence of the operation being performed. After the intervention, a wound surface remains on the uterus, as well as on the anterior abdominal wall. Therefore, the occurrence of pain syndrome for weeks, or even months after delivery is quite natural. This is how the body reacts to tissue trauma. However, the pain should not be tolerated; painkillers can be used.
Of course, painkillers should be prescribed by the attending physician, taking into account lactation period. Most often, various analgesics are used in combination with non-steroidal anti-inflammatory drugs.
On average, pain persists for one and a half to two months. With a transverse incision, the healing process occurs faster. However, the presence of nagging pain and discomfort is possible for another year after the operation.
Hardness
Pain and hardness in the area of the sutured incision for two months after surgery is quite normal. This is due to the tissue healing process. However, you should not expect that the scar will immediately become soft and invisible. Sometimes this takes many months, or even years.
The longitudinal scar left after a corporal cesarean section can remain hard for up to one and a half years and only after this period begins to gradually lighten and soften.
With a horizontal incision, the process of tissue scarring occurs much faster and can be completed within a year.
In addition to the formation of scar tissue at the incision site, it can also form above the stitching site. This characterizes the process of scarring of nearby tissues and appears as a small fold above the seam. If there is no pain, suppuration or redness of the area, there is nothing to worry about. However, you can undergo an ultrasound examination to calm your own nerves.
However, the formation of a lump over the scar should alert you. Most often it has a bloody or purple tint, and the size can vary from a pea to walnut. Its occurrence can occur almost immediately, or it may be delayed for several years. In this case, it is better to play it safe and not delay visiting a specialist. Of course, this could be, but there are often cases when an inflammatory process, a fistula, or even an oncological tumor manifests itself this way.
Discharge
The appearance of ichor from the incision area in the first week and a half after the operation should not be a cause for concern. This is a healing process that is accompanied by an increased flow of platelets to the stitched area.
However, if their characteristics have changed, they have become similar to pus or blood, and especially if they have acquired an unpleasant, pungent odor, you should immediately consult a doctor. This can lead to sepsis, which can even lead to death.
Itching
Itching in the incision area a week to a week and a half after surgery is quite normal. This is an indicator that the healing process is taking its own course and there is no need to worry. However, scratching this area is strictly prohibited, as you can easily introduce an infection into the wound and develop complications.
The appearance of burning and severe discomfort in the stitched area is not normal. Therefore, you must immediately contact your doctor.
Pain relief after caesarean section
Within a few hours after the operation, as soon as the anesthesia begins to subside, the woman is given painkillers. These could be injections, tablets or even suppositories. The main feature is that the type of analgesic should not be contraindicated during breastfeeding. In addition, at the same time, the woman in labor is administered antibiotics and medications that promote uterine contraction. Thanks to this, the rehabilitation period is significantly reduced.
What are the advantages of pain relief after surgery:
- Adequate pain relief allows you to start moving as early as possible. Experienced doctors know that the sooner a woman begins to move after surgery, the less likely complications will occur.
- During severe pain, a woman’s body produces substances that pass into breast milk and negatively affect the baby.
- Currently, gynecologists use drugs for pain relief that absolutely do not interfere with breastfeeding and cannot harm the baby.
How to care for caesarean section stitches
A nurse cares for a postoperative suture in a medical facility, and therefore we will not consider this point in detail, but rather focus on care at home. What worries most women is the day on which sutures are removed after a caesarean section. This process occurs approximately seven days after application. However, in most cases, self-absorbable threads are used.
How long a suture heals after a cesarean section directly depends not only on the type of incision, but also on proper care.
Rules of care:
- Avoid carrying heavy objects (caring for a child is allowed).
- Move as much as possible whenever possible.
- Heavy physical activity is unacceptable, so don’t do it right away.
- If the scar oozes, it must be treated with an antiseptic. However, it is unacceptable to treat the wound surface itself with iodine, only the area around it.
- If there are no complications, it is enough to treat the wound a week after discharge.
- To prevent the suture from coming apart after a caesarean section, it is necessary to wear a special bandage that secures the abdomen.
- Avoid mechanical damage to the scar whenever possible.
- Shower as normal, but do not rub the incision area with a washcloth.
- Follow a diet.
- Allow the healing scar to be exposed to clothing to ensure access to oxygen.
Important! IN Lately An increasing number of doctors agree that the risk of adhesions is minimized if the peritoneum is not sutured.
What complications can there be in the postoperative period?
Complications arising after cesarean section can be divided into two main groups: early and late. However, in most cases they can be avoided with proper care.
Early
Massive bleeding due to the incision. Blood loss during this type of delivery can reach 1000 ml. The body cannot quickly cope with such a load on its own, so it is necessary to install IVs.
The formation of a hematoma in the incision area or even the appearance of blood may indicate complete medical error, during which the vessels were improperly sutured. It may also be the result of mechanical damage during dressing.
Dehiscence of the stitched area a week to a week and a half after application of the threads. Usually the cause is an infection or heavy lifting.
An inflammatory process at the site of the operation, accompanied by the formation of pus, increased temperature, and pain.
Impaired intestinal motility. Often it is enough to eat right, provide feasible physical activity, and the process will soon improve. However, with a parallel adhesive process, problems with the passage of gases, as well as the process of defecation, are possible.
Endometritis is considered a rather serious complication, which is characterized by inflammation of the endometrium lining the uterine cavity. Its occurrence is associated with insufficient compliance sanitary standards during surgery.
Late
Ligature fistula – painful lump, hot to the touch, formed several months after surgery, from a small hole in which pus flows out. Its formation is associated with the body’s rejection of the suture material, or infection of the ligature itself. Wherein self-treatment impossible, external treatment will not give results. Removal of the ligature occurs in a medical facility.
A possible but rare complication is hernia. It occurs only in patients with a longitudinal incision, subject to multiple births and repeated operations. Depending on the severity of the condition, the appropriate method of therapy is selected.
A keloid scar is an uneven growth of tissue at the healing site. The cause of the occurrence is most often considered to be the individual tendency of the skin to form such formations. It does not pose a direct threat to health, but creates a cosmetic defect. A rough, wide scar with jagged edges becomes a cause of concern for many women.
Treatment methods for keloid scars:
- Surgical excision of the scar.
- Conservative: cryotherapy, ointments, laser treatment, chemical peeling, ultrasound and others.
Methods for correcting scars after cesarean section
A cosmetic suture after a cesarean section often does not require additional correction. Its location and special stitching technique allow a woman to wear two-piece swimsuits without embarrassment.
However, longitudinal cuts often cause self-doubt. Such problems can be solved using several methods:
- plastic surgery to remove a scar;
- laser resurfacing;
- cryotherapy;
- chemical peels;
- cosmetic preparations.
If conservative methods the treatments are ineffective, and you don’t want to agree to a repeat, even cosmetic, operation, you can disguise the incision site with a tattoo. The suture after a cesarean section, shown in the photo, in this case will be almost invisible.
Video about seam care
In the video you can get comprehensive information regarding proper care of the suture after a cesarean section, as well as possible postoperative complications.
How was your birth? What were the indications for cesarean section? Have there been any complications? Have you encountered problems with the postoperative suture? Share your feedback regarding this abdominal surgery with our readers in the comments.
C-section. These two words are perceived differently by every pregnant woman. Some people think that this is the worst thing that can happen, because you really want to give birth yourself. And some say that this is a miracle, thanks to which both mother and child can be saved. But even more important questions arise about the rehabilitation period - what does the abdomen look like after a cesarean section? Will the seam be visible? How quickly does it heal? What exercises can you do and when should you start physical activity?
A website for mothers will tell you what and how to do if you give life to a little miracle through a CS (caesarean section).
Every expectant mother tries to learn more about this process before giving birth. And, of course, one of important points is an understanding of the need for CS and its consequences for the woman’s body. It’s better to be prepared for anything than to find yourself in a situation where you don’t know what or how to do.
For those who have undergone a planned CS, rehabilitation period It goes a little easier because they are psychologically ready for it. But there are situations when a CS is an emergency. In any case, when preparing for childbirth, it is worth learning more about the operation itself and what awaits you after it.
We know that a CS is an extensive abdominal operation, during which several soft tissues are dissected, which are then sequentially connected with sutures. What worries us the most is the stomach after cesarean and the stitch. At first the latter delivers a lot painful sensations, so doctors recommend taking painkillers that will help you start moving and not experience severe pain.
Condition of the suture on the abdomen after cesarean
In the first months, the seam will stand out clearly against the skin of the abdomen, having a red or purple tint and will be distinguished by relief. But don’t worry, over time it will become lighter, smoother and almost invisible. During the healing period, you can often feel numbness, itching, mild burning and tingling in the area of the suture.
The suture on the abdomen after a cesarean section can be applied with silk threads or self-absorbing ones. Silk ones are removed for 7 days after surgery, and threads such as catgut, vicryl or maxon dissolve on their own over time. This usually takes from one to 3 months, depending on the type of thread.
The seam does not require special care. Handle it carefully enough antiseptic solution and apply comfortable self-adhesive bandages. To remove them, you can soften the bandages using warm water under the shower or using a damp sponge. This will help remove them without discomfort.
To relieve abdominal pain after cesarean section, doctors recommend wearing a bandage. It helps to hold soft fabrics the abdomen is stationary, which allows you to move without pain. The wound, both internal and external, is at rest and therefore heals faster. And when feeding the baby, it is recommended to place a small pillow on the stomach after a cesarean section, which will soften the baby’s touch and make feeding less uncomfortable.
One of the delicate problems with the abdomen after cesarean is the gases produced in the intestines. Their accumulation is due to the fact that during the operation the doctor moves the intestines slightly to the side in order to get the child out. Plus, this is facilitated by air entering from outside and the consequences of anesthesia. To avoid unpleasant sensations, you should limit yourself to foods that can cause additional gas formation.
Possible problems after cesarean section
As after any operation, CS may be accompanied by complications, in which case it is necessary to immediately consult a doctor.
- A feeling of pain at the suture site or inside the abdomen that increases rather than subsides.
- Copious bloody or yellowish discharge from the suture.
- Temperature increase.
- Seam divergence.
Belly after cesarean and fitness
Recovery after a cesarean section takes every woman different times. Much depends on psychological perception, age, physique, etc. But on average, healing takes about 6 weeks.
The strength and elasticity of the abdominal muscles will return gradually after a cesarean section, so in no case should you put any strain on yourself immediately upon arriving home. physical exercise. For the first 6-8 weeks, you should only go out for walks accompanied by loved one, since walking with a heavy stroller can take a lot of effort and put additional stress on the seam.
In the first months, it is important not to rush into physical exercises for the abdomen after a cesarean section and remember that in addition to the external suture, internal ones were also applied, and they also need time to heal. According to various estimates, this may take about a year.
But you can carry out small training sessions with minimal load even 2-3 months after giving birth. By this time, you are already allowed to visit the pool - it can also help you lose weight after childbirth. In any case, for training to be effective, we must not forget that it should always be paired with proper nutrition and sufficient forces. After all, a tired mother who does not get enough sleep will be of little use both for the baby and for her own body.
Therefore, fitness trainers recommend undergoing so-called fitness testing, which helps determine the state of the body and develop your own set of exercises, just for you. After all, only then will it be truly effective. And you can practice at home. The main thing is to know your level of stress so as not to harm the body.
If you are planning a planned cesarean section or just want to know more about the possible nuances during childbirth, try to get as much information as possible without unnecessary emotions. This will help you be prepared for any situation and cope with it as quickly as possible, paying more attention (physical and emotional) to your baby.
Stitches after cesarean section are an unpleasant and inevitable consequence surgical birth. They do not always look aesthetically pleasing, and they do not always heal without problems and complications. In this article we will tell you how long healing takes postoperative sutures.
Kinds
The mechanisms of healing of postoperative sutures left after a cesarean section depend on the type of sutures, the technique of their implementation and the surgical suture material used.
Since not only the abdominal wall, but also the anterior uterine wall is subject to dissection during the operation, sutures after obstetric surgery are divided into two main types:
- internal;
- external.
Internal sutures are placed on the incised wall of the uterus immediately after the uterine cavity is free of the baby, amniotic sac and placenta. Usually, to apply them, surgeons use single-row continuous suturing and special type suture material - threads, which do not need to be removed and processed later, since they dissolve themselves as the edges of the wound grow together.
External seams are mostly made using the knot or stitch method. For them, either special medical silk threads are used, or self-absorbing threads, but thicker than internal ones, or staples made of a special medical alloy that does not oxidize.
The type of suture depends on how the surgeon performed the caesarean section. If a planned operation was performed, during which no emergency situations arose, then the incision usually does not exceed 10 centimeters in length, it is located horizontally above the pubic line. This incision is called a Pfannenstiel dissection. It heals faster and with fewer complications, since the place chosen for penetration into the abdominal cavity is least subject to skin stretching and other external influences.
If the operation had to be done due to emergency vital signs in an emergency, it is possible that the incision will be made vertically - through the navel line to the middle of the pubic area. This is necessary to quickly remove a baby who is in danger of dying. This suture is called a corporal suture; it crosses the rectus abdominis muscle, and therefore heals longer and worse.
A horizontal, low-lying suture in most maternity hospitals today is made cosmetic. It is almost invisible after complete healing and is easily masked with an elastic band of panties. The vertical seam cannot be neat and will be difficult to hide.
How is the healing process going?
Healing process different types postoperative sutures are different.
The internal scar takes longer to form than the external one, and this is quite understandable if you know what kind of jewelry and painstaking work takes place in the body after suturing the uterus. In the first 24 hours, the edges of the internal wound made with a scalpel stick together due to fibrin threads, and with each passing hour their bonding becomes stronger.
6-7 days after the operation, new cells are formed in the scar on the wall of the uterus - myocytes, which are structural cells of the uterine tissue. Collagen begins to be produced, giving the area of surgical suturing elasticity. When these fine processes are disrupted, more coarse connective tissue is formed, causing the scar to become insolvent. Then it could be severe complication subsequent pregnancy and childbirth.
In total, the primary formation of the internal scar takes about 2 months. Then the process of its development continues, and after 2 years the scar, if it is quite healthy, is considered strong and reliable enough to carry another pregnancy.
External stitches heal faster. Sutures placed on a vertical corporal scar can take up to 50-60 days to heal; the likelihood of complications is higher than with a small horizontal incision at the very bottom of the abdomen. The suture after the Pfannenstiel section can be removed already on the 7th day, and complete healing of the surgical area takes about three weeks. The external suture heals completely and becomes lighter and less noticeable about a year after surgical birth.
Why does it heal poorly?
Often women are faced with the fact that the sutures heal slowly, poorly, and certain complications arise. Based on the time of onset of symptoms, early and late complications are distinguished.
The earliest include the most various options infectious inflammatory processes. A caesarean section is always associated with the risk of infection, and there is no escape from this. Our world is populated by bacteria, viruses, fungi, some of them can survive even in a clean operating room.
Any inflammatory process will be manifested by pain, discharge of ichor from the scar, possibly even pus. Also, most often, a woman develops a fever and experiences pain in the scar area.
Excessive bleeding of the scar after surgery may indicate injury to the vascular node at the time of suturing. This can happen even to an experienced surgeon. This complication is characterized not only by bloody discharge from the suture, but also by the formation of hematomas around and on the scar.
Less often, divergence of the applied suture occurs. This can happen due to the woman’s increased physical activity at first, due to carelessness, or due to immune rejection of the suture material by the female body.
Dehiscence of the internal suture usually occurs without any special symptoms, and only when the uterus does diverge does weakness appear, there may be bleeding, loss of consciousness, or a fall blood pressure, tachycardia. The causes of internal complications are the same as those of external ones.
Failure to heal the scar completely can lead to late complications - for example, the formation of a hernia or the appearance of a ligature fistula.
Sutures on the uterus are not treated. But a woman can completely protect them if she does not lift weights, does not start having sex too early, and excludes the penetration of any infection into the genital tract, even with tap water when performing hygienic procedures. To prevent infection from occurring, early period During rehabilitation in the maternity hospital, it is recommended to use not purchased sanitary pads, but exclusively sterile hospital pads. They are changed every 3 hours.
At home after discharge, a woman can use sanitary pads, but it is advisable to change them every 2 hours in the first week and a little less often then.
External seams need care and treatment. In the maternity hospital, this is done by medical staff, but after discharge you will have to do it at home. Every day it is recommended to dry the scar with hydrogen peroxide, treat the edges with brilliant green, and continue to wear a surgical bandage until the sutures are removed. After the stitches are removed, recommendations can be individualized. If it heals quickly and well, it is recommended to remove the bandage. If there are problems, it is recommended to continue processing and wearing a gauze bandage.
A healed external seam cannot come apart, but the same cannot be said about the internal one. The scar on the uterus, if it is not stable, can disperse both during a subsequent pregnancy and during repeated births. To prevent this, a woman should remember to prevent complications from scars:
- carry out the treatment regularly, if any deviations are detected, immediately consult a doctor;
- sex after surgery is permissible after cleaning the uterine cavity from lochia - the discharge should stop, but not earlier than 2 months after the operation;
- tampons cannot be used for everyday hygiene;
- avoid douching;
- subsequent pregnancy should not occur too early, the recommended break is at least 2 years;
- do not squat, do not jump, do not pump your abs if another six months have not passed since the date of the operation.
In most cases, a cesarean section ends with the application of an external cosmetic suture, which heals with the formation of a thin, invisible scar. Duration recovery period and the quality of the formed scar largely depends on the care of the wound surface. Complications after the application of suture material are rare and can be successfully eliminated with timely consultation with a doctor. Over time, the appearance of the scar can be corrected through cosmetic, hardware, and surgical procedures.
Caesarean section (CS) is an abdominal operation, accompanied by sequential dissection of several layers of soft tissue, which, after removing the child, are connected using suture material.
In most cases, the edges of the external incision of the anterior abdominal wall are fixed by applying a cosmetic suture, after healing of which a thin, invisible scar is formed that does not cause physical and psychological discomfort to the patient.
Types of external cuts and seams
As a rule, this type of operation is carried out only in emergency situations when assistance is required. emergency care mother or baby. In this case, due to the high risk of tissue divergence under load, their integrity is restored with a regular, rather than cosmetic, suture.
Other indications for corporal caesarean section:
- pronounced adhesions and inability to gain access to the lower segment of the uterus;
- varicose veins in the lower segment of the uterus;
- significant prematurity of the fetus and the unpreparedness of the woman’s body for childbirth (unformed lower uterine segment);
- planned removal of the uterus after surgery;
- the presence of a longitudinal scar after a previous operation;
- fetal pathology: transverse position, conjoined twins, etc.;
- the need to extract a living fetus from a dead or dying woman.
Currently, for uncomplicated planned CS, Pfannenstiel laparotomy is most often used, which provides the best aesthetic effect with high scar strength. A small transverse incision is made in an arc above the pubis. The resulting scar actually merges with the fold of skin in the lower abdomen and often becomes difficult to distinguish.
Performing a cosmetic seam
The technique for suturing the edges of the wound and the type of threads are selected in accordance with the characteristics of the operation and the presence of certain diseases or complications. To apply a cosmetic suture, special atraumatic needles and other needles used in plastic surgery instruments that do not injure the skin and subcutaneous fat. Suture material is a very thin mono- or poly-fiber thread made of lavsan, silk or synthetic material.
Currently, subcutaneous sutures are most often used, which dissolve on their own within a few weeks after surgery. If their application for some reason is not possible, the integrity of the tissues is restored with non-absorbable threads. In this case, the ligature is removed approximately 7-8 days after the operation. Removal of suture material usually coincides with the day the patient is discharged home.
Features of the cosmetic seam
The cosmetic seam has its own distinctive features:
- It is performed with atraumatic needles (the thread is a natural extension of the needle) and very thin threads.
- Passes inside the skin.
- Practically not visible on the surface of the skin.
- Forms a thin and invisible scar that does not cause discomfort.
When applying a cosmetic suture, the surrounding tissues are much less injured than when using the conventional technique of sewing through all layers of the skin. This technique not only allows you to achieve an optimal aesthetic result, but also significantly reduces the risk of complications and speeds up recovery.
Thin postoperative scar is formed through the use of special self-absorbing threads: silk, lavsan, vicryl or prolene. This material is able to withstand significant loads and ensure reliable healing of the postoperative wound.
Often, after discharge from the maternity hospital, women ask the question: how to remove a cosmetic stitch on their own? Obstetricians-gynecologists answer: there is no need to remove cosmetic intradermal sutures. After 70-120 days, the suture will resolve on its own without the use of any additional procedures. If complications develop (inflammation of the suture or divergence of the threads), it is necessary to urgently seek help from a doctor.
Seam care
Women who have had a cesarean section wonder how long it takes for the stitch to heal. In the absence of complications, superficial tissue restoration occurs within two weeks, and the scar is finally formed after 12-18 months. The duration of the recovery period directly depends on the quality of care for the wound surface.
Postoperative care
While in the hospital, the wound surface is treated daily with antiseptic solutions and sterile bandages made of breathable materials are applied.
For two to three days after the operation, the woman in labor is advised to take painkillers. To prevent infectious and inflammatory complications, broad-spectrum antibiotics are prescribed.
Physical activity is increased gradually to prevent possible damage to the ligature.
Home care
For normal tissue scarring after discharge, the following rules and recommendations must be followed:
- Until complete healing, disinfect the wound surface (hydrogen peroxide, chlorhexidine and other antiseptics as prescribed by the doctor).
- Wear a postpartum bandage that limits the mobility of soft tissues and eliminates the possibility of their divergence.
- Take air baths several times a day, exposing the lower abdomen.
- Limit physical activity and lifting heavy objects weighing more than 2 kg (the child should be picked up and pressed to the chest).
- Avoid mechanical impact on the wound surface (rubbing or scratching the stomach, wearing uncomfortable clothes with tight straps and belts, using hard towels or cosmetics).
- Showering is allowed only after the suture material has been removed.
- Monitor the recovery of the uterus and muscle layer using ultrasound at the time prescribed by the doctor.
A healed scar can be lubricated with sea buckthorn, olive and other oils. After consultation with a doctor, to speed up the scarring process, you can use drugs such as Solcoseryl and Contractubex.
Feeling after surgery
The rehabilitation period largely depends on individual characteristics the mother’s body, the professionalism of doctors and the quality of the operation performed. However, for some time, the vast majority of women after surgical delivery may experience discomfort of varying nature and intensity.
The following symptoms are normal:
- Moderate pain in the anterior abdominal wall for 3-5 weeks.
- Discharge of ichor (clear or yellowish liquid) with a slight admixture of blood from the wound during the first 5-8 days.
- The scar is convex and dense to the touch (up to 2 months after surgery).
- Moderate itchy skin within 1-2 weeks after birth.
Even if the listed symptoms do not cause significant concern to the patient, they should be reported to the attending physician. If pain, itching, burning and discharge do not stop within the specified period or increase over time, mandatory medical attention is required.
Possible complications
Early complications after surgery include:
- Inflammation of the wound after infection. Accompanied by suppuration and swelling of the suture and the surrounding skin, fever, chills, and deterioration in general well-being.
- Divergence of wound contours and rupture of threads. Most often it occurs due to early removal of threads, high physical activity or injury.
- Bleeding and hematomas as a result of extensive damage to blood vessels or certain vascular diseases in a woman in labor.
The listed early complications are diagnosed in the hospital or in the first days after discharge. Treatment depends on the nature and severity of the pathology and includes taking antibiotics, hemostatic drugs, additional dressings or additional suturing of the wound.
Many of the effects of a cesarean section become apparent months after birth. The most common late complication is ligature fistulas, which form as a result of the body’s rejection of suture material or infection of the threads. Their symptoms are:
- redness and slight pain in the scar area;
- periodically occurring suppurations;
- the gradual formation of one or more holes in the skin (fistulas), in which ligature stitches are visible.
If signs of ligature fistulas are detected, you must immediately consult a doctor to surgically remove the remaining threads and treat the wound.
Other rarer long-term consequences of surgical delivery include hernias (bulging of soft tissue on the surface of the scar) and keloid scars. The seal does not pose a threat to health and is exclusively cosmetic defect. Such scars usually occur only in patients who are predisposed to excessive tissue growth.
Re-suturing
In advanced cases, surgeons are forced to completely excise the existing scar and re-apply the ligature. It depends on how badly the muscle layers, subcutaneous tissue and skin. Often, the cosmetic stitch is replaced with a regular one.
The rehabilitation period after repeated surgery increases several times, and the newly formed scar will be more convex, rougher and noticeable. Therefore, if any suspicious symptoms occur that indicate disturbances in normal wound healing, you must immediately seek help. medical care without allowing serious consequences to occur.
Behavior of the scar during subsequent pregnancies
During their second pregnancy, many women who have had a cesarean section report pain syndrome and a feeling of tightness in the scar area. Unpleasant sensations increase as the abdomen grows and are most pronounced at the ends of the arched scar. This is due to the denser structure of the skin and subcutaneous fat at the site of passage of the threads and the formation of strong adhesions in the surrounding tissues.
If more than 2 years have passed since the previous operation, the scar is considered healthy and there are no contraindications for a new pregnancy, there is nothing to worry about. To soften and increase the elasticity of the skin, the scar can be lubricated with oil or ointments and gels recommended by the doctor. Do not forget that uncontrolled use medicines can seriously harm not only the expectant mother, but also the fetus.
Cosmetic and surgical scar correction
Unfortunately, a well-executed cosmetic stitch does not guarantee the formation of a neat, thin scar in the future. Some women, years after a CS, complain of uneven width, brightly colored, bulging or depressed scars.
There are several correction methods:
- Peeling and scrubbing using special cosmetics that can be used at home. Recommended for minor improvement only appearance scar after consultation with a cosmetologist or therapist.
- Hardware polishing of a scar using abrasive attachments in specialized clinics aesthetic medicine. To achieve a lasting visible result, it is necessary to carry out several sessions of procedures.
- Laser resurfacing(fractional thermolysis), which provides a deep effect on the scar and allows you to get rid of pronounced irregularities.
- Drug injections, preventing the growth of keloid scars.
- Abdominoplasty- surgical tightening of the abdominal muscles with the formation of a new, smaller scar.
It should be remembered that each of the listed methods of influencing deep defects of the skin and muscles has a number of contraindications and does not allow you to completely get rid of scars.
