There was a lump inside on the cesarean scar. Seal on the suture after cesarean section. Signs of divergence of the uterine suture

2012-10-26 06:00:00

Elena_LS asks:

About a month ago, local itching began in the area of ​​the transverse cosmetic suture after a cesarean section; after a few days, a ball, initially painless, the size of a pea, began to be felt. which began to increase and painful sensations appeared on palpation. This morning the lump is no longer local, it is more painful to the touch. Yesterday, a doctor I knew suggested inflammation of the internal suture material...how dangerous is this?

Answers Safonov Igor Vladimirovich:

Good afternoon. It is not a fact that it is a foreign body. You still can’t do without an inspection. I recommend contacting the surgeon who operated on you or sign up for a consultation at our clinic: 044 235 00 08, 235 40 60

2014-02-16 19:07:46

Natalya asks:

After a caesarean section, at the site of approximately the beginning of the suture and at the site of the end, lumps appeared under the skin, feeling like balls. Please tell me what this could be. Thanks in advance.

Answers Safonov Igor Vladimirovich:

This could be local fibrosis, ligature remnants. It is better to contact the surgeon who performed the operation.

2012-01-22 22:27:19

Elya asks:

Hello, I have a problem after a cesarean section. On the third day after the operation, the temperature jumped sharply, they could not determine the cause for a long time, it turned out that a hematoma had formed inside, which was opened. Three years have passed, just above the postoperative suture a seal measuring 13 mm has formed, the pain is localized in one place (in the place of compaction) especially during menstruation. I did an ultrasound and didn’t really say anything, in this place the doctor noted a reduced echogenic zone. What is the likelihood of endometriosis of a scar or keloid? What additional examination should I undergo (I'm afraid of the inevitability of laparoscopy)?

Caesarean section is a rather complex delivery operation, which is necessary to remove the baby through the anterior wall of the mother’s abdomen. Naturally, it leaves a seam.

Its size and shape depend on many factors - the complexity of the operation, the skill of the surgeon, competent postpartum care, and the woman’s physique. Often a ridge forms over the scar, which is difficult to hide even under clothing. It causes discomfort to young mothers, so they are interested in how to get rid of this annoying drawback.

What's in the roller and how to get rid of it?

Often women complain about a “roller” after a caesarean section, without completely understanding what it is and what’s in it. There are many reasons for the formation of a fold in the seam area. Therefore, it is very important to determine the cause of the trouble. If the abdomen is too large and protrudes, this may be due to muscle weakness or linea alba diastasis. Occasionally, women after a cesarean section are also bothered by a hernia. But in such situations, the stomach rarely resembles a fold. And the characteristic ridges are usually formed from fat, skin, or due to swelling of the suture after surgery. Depending on the causes of the problem, the ways to solve it will differ.

Hard ridge around the scar

Many women complain that after surgery the suture looks like a hard cushion and does not want to dissolve. This is completely normal. The transverse suture, which is now used everywhere, heals completely within a year. All this time it can remain dense. A small fold is also often formed above the seam. This is how scarring of surrounding tissue occurs.

In most cases, in the absence of severe pain and suppuration, some hardness and the presence of a cushion are not dangerous and go away on their own over time. If a woman is worried, she can undergo an ultrasound.

A dangerous sign is the appearance of a lump above the seam. It can be as small as a pea or reach the size of a walnut. This can manifest itself as harmless tissue scarring, as well as inflammation, suppuration, fistula, etc. In this situation, consulting a doctor is mandatory. In other cases, the roller dissolves on its own.

Skin fold over the scar after cesarean section

Try squeezing the bead over the seam with your hand. If it is very thin, then most likely there is just skin there. In this case, it makes sense to wait a little and let the body deal with the problem on its own. Loose skin often stretches on its own, especially at a young age. A light and contrast shower will help speed up the process. You can also try special cosmetics to increase skin elasticity, although its effectiveness is highly questionable from a medical point of view.

If the roller has not disappeared in a year or a year and a half, it makes sense to contact a plastic surgeon. Perhaps during the cesarean section the surgeon made a mistake somewhere or the woman’s skin is not elastic enough.

Fat fold after cesarean section

If, when pinched, the fold turns out to be thick enough and elastic, it is there. You should try to remove it yourself, but it is very important to choose the right methods. Don’t think that only plump ladies have folds of fat. Even with a normal weight, the percentage of body fat can be increased if a woman has little muscle. Therefore, it is very important not just to start eating less, but to create the right diet and start exercising.

With a body fat percentage of 21-24% and a normal amount of muscle, the fat pad disappears in most cases.

To avoid making mistakes and harming yourself, you should consult a doctor before starting training. It is also better to conduct them under the guidance of a professional trainer, at least for the first time. You shouldn’t cut down your diet too much right away, as a woman needs energy to restore her body after pregnancy. The calorie deficit should be minimal.

If you decide to get rid of the roll of fat above the suture after a cesarean section with the help of exercises, follow simple rules:

• The first training can begin no earlier than six months after the operation, and intensive abdominal exercises - after a year.
• As soon as your health allows, you need to start moving, taking your baby for walks and walking as much as possible.
• The first exercises for a flat stomach are household bendings. Try to wash floors by hand and lean towards your baby more often.
• As soon as your health allows, start regularly doing abdominal pull-ins - this is one of the most effective exercises for strengthening it.
• Do not rush to lose weight so that the fat fold does not turn into a skin fold. Give your body the opportunity to slowly adapt to the new weight.

If something doesn’t work out right away, don’t get discouraged and don’t give up. It takes time for the body to recover. Don’t set unrealistic plans for yourself and don’t demand the impossible from your body. You can evaluate the results of working on yourself no earlier than one and a half to two years after the operation.

• In the hospital
• Home care
• Complications
• Subsequent pregnancies

A caesarean section is a delivery surgery during which the baby is removed through an incision in the uterus. Despite all its advantages and sufficient popularity today, young mothers are worried about how the suture after a cesarean section will look after a while (isn’t it ugly?), how noticeable it will be and how long the healing process will take. This depends on what kind of incision the surgeon made, whether complications will arise during the postpartum period, and how competently the woman cares for the operated area of ​​her body. The more informed a woman is, the fewer problems she will have in the future.

Kinds

The reasons why a doctor decides to perform a cesarean section can be very different. Depending on the delivery process and complications encountered during the delivery, incisions may be made in different ways, resulting in different types of sutures that require special care.

Vertical seam

If acute fetal hypoxia is diagnosed or the woman in labor begins to experience heavy bleeding, a caesarean section is performed, which is called corporal. The result of this operation is a vertical suture starting from the navel and ending in the pubic area. It is no different in beauty and in the future it will spoil the appearance of the body quite strongly, since the scars are nodular in nature, very noticeable against the background of the abdomen, and are prone to compaction in the future. This type of operation is performed quite rarely, only in emergency cases.

Horizontal seam

If the operation is performed planned, a Pfannenstiel laparotomy is performed. An incision is made transversely, above the pubis. Its advantages are that it is located in a natural fold of skin, the abdominal cavity remains unopened. Therefore, a neat, continuous (special application technique), intradermal (so that there are no external manifestations) cosmetic suture after a cesarean section is invisible on the body.

Internal seams

Internal sutures on the wall of the uterus in both cases vary in the way they are applied. The doctor is guided here by the goal of achieving the best possible conditions for faster wound healing without complications and reducing blood loss. You cannot make a mistake here, since the course of subsequent pregnancies depends on this. During a corporal operation, a longitudinal internal suture is made after a cesarean section; during a Pfannenstiel laparotomy, a transverse suture is made:

• the uterus is stitched with a continuous single-row suture made of synthetic, very durable, self-absorbing material;
• the peritoneum, like the muscles, is sutured with continuous catgut stitches after cesarean section;
• the aponeurosis (muscle connective tissue) is sutured with absorbable synthetic threads.

The speed of healing, features of care, various complications - all these important points directly depend on what kind of incision was made during the caesarean section. After childbirth, doctors advise patients on all issues that cause them doubts, anxieties and fears.

About personalities. Hermann Johannes Pfannenstiel (1862–1909) was a German gynecologist who first introduced the surgical transverse incision, which received his name.

Features of the recovery period

It is the type of incision made that will determine how long the suture takes to heal after a cesarean section in terms of pain and other consequences of the operation. With a longitudinal one you will have to tinker longer, and the risk of complications will be much higher than with a transverse one.

Pain

After childbirth, a wound remains on the uterus, as well as on the anterior wall of the peritoneum, so it is not surprising that after a cesarean section the suture hurts (even severely) in the first weeks, or even months. This is a natural reaction of the tissue to the incision made, so the pain syndrome can be blocked with the most common painkillers:

• immediately after the operation, analgesics (narcotics) are prescribed: morphine and its varieties, tramadol, omnopon;
• in the subsequent period, you can use analgin, supplemented with ketane, diphenhydramine and other anti-inflammatory non-steroidal drugs.

At the same time, do not forget that the painkillers used should be prescribed by a doctor, taking into account the lactation period. As for the question of how long the stitch hurts after a cesarean section, it depends on its type. The longitudinal one will bother you for about 2 months, the transverse one - 6 weeks with proper care and without complications. However, for another year, a woman may feel a pulling, unpleasant sensation in the operated area.

Hardness

Many people are concerned about the fact that after a caesarean section the suture is hard and painful: within 2 months this is quite normal. Tissue healing occurs. In this case, the scar does not immediately become soft and invisible. You need to come to terms with the fact that some time must pass, which can be calculated not even in months, but in years.

1. A vertical (longitudinal) hard scar lasts 1.5 years. Only after this period has passed will the tissues gradually begin to soften.
2. Horizontal (transverse) cosmetic heals faster, so hardness and compaction above the seam (adhesions, tissue scarring) should go away within a year.
3. Many people notice that over time a characteristic fold forms over the suture, which in the absence of pain and suppuration does not pose a problem. This causes scarring of nearby tissues. To avoid unpleasant consequences, it is recommended to do an ultrasound.
4. It is much more serious if a lump appears above the suture after a cesarean section. Some people notice it already in the first year, while for others it manifests itself much later. The sizes can be completely different: from a small pea to a walnut. Most often it is crimson or purple in color. In this case, a visit to a doctor and an ultrasound scan are mandatory. This can be either harmless tissue scarring or fistula, inflammation, suppuration and even cancer formation.

The hardness of the scar, all kinds of folds and compactions around it in the first year after surgery are a fairly common phenomenon. If all this is not accompanied by severe pain and suppuration, there is no need to worry. But as soon as a lump appears on the seam and the above symptoms appear, consultation with a specialist and treatment are inevitable.

Discharge

If the suture after a caesarean section oozes ichor (clear liquid) in the first week, there is no need to worry. This is how healing occurs, it is a natural process. But as soon as the discharge becomes purulent or bleeding, begins to emit an unpleasant odor, or flows for too long, you should immediately contact a specialist.

Itching

For everyone who has had a caesarean section, the scar is very itchy after a week, which frightens some. In fact, this indicates the healing of the wound and nothing more. This is an indicator that everything is going its way. However, touching and scratching the belly is strictly prohibited. Now, if the scar not only itches, but already burns and bakes, causing suffering, you must definitely tell the doctor about it.

In order for the recovery period after cesarean to proceed without undesirable consequences and complications, a woman needs to learn how to properly care for the operated area.

More details about recovery after cesarean section in our separate article.

Through the pages of history. The name of the caesarean section operation goes back to the Latin language and is literally translated as “royal incision” (caesarea sectio).

In the hospital

The first treatment of the suture after a caesarean section is carried out in the hospital.

1. After the examination, the doctor decides how to treat the seam: to avoid infection, antiseptic solutions are prescribed (the same brilliant green belongs to them).
2. All procedures are carried out by a nurse.
3. The bandage is changed daily after a cesarean section.
4. All this is done over the course of about a week.
5. After a week (approximately), the sutures are removed, unless, of course, they are absorbable. First, the knot that holds them is plucked off from the edge with a special tool, and then the thread is pulled out. Regarding the question of whether it is painful to remove stitches after a caesarean section, the answer is unlikely to be clear. This depends on different pain threshold levels. But in most cases, the procedure is comparable to eyebrow plucking: at least the sensations are very similar.
6. In some cases, an ultrasound scan of the suture is prescribed after surgery to understand how the healing is progressing and whether there are any abnormalities.

But even in the hospital, before discharge, no one will be able to tell you exactly how long the suture will take to heal after a caesarean section: the process is definitely individual for everyone and can follow its own, separate trajectory. Much will also depend on how high-quality and competent the home care for the operated area will be.

Home care

Before being discharged home, a young mother needs to find out from a doctor how to care for a suture after a cesarean section without medical assistance, at home, where there will be no qualified medical personnel and professional aids.

1. Do not lift heavy objects (anything that exceeds the weight of the newborn).
2. Avoid heavy physical activity.
3. Do not lie down constantly after a cesarean section, walk as much and as often as possible.
4. If there are any complications, you will need to treat the seam at home with brilliant green or iodine, but this can only be done with the doctor’s permission if the scar gets wet and oozes even after discharge from the hospital.
5. If necessary, watch a special video or ask your doctor to tell you in detail how to treat the seam at home. At first, it is not the scar itself that is wetted, but only the area of ​​skin around it, so as not to burn the fresh wound.
6. As for the timing of how long the suture needs to be treated after a cesarean section, this is determined by the nature of the discharge and other features of scar healing. If everything is in order, a week after discharge will be enough. In other cases, the time is determined by the doctor.
7. To prevent seam divergence, wear a bandage that secures the abdomen.
8. Avoid mechanical damage after cesarean section: so that the scar is not subjected to pressure and rubbing.
9. Many people doubt whether it is possible to wet a seam: after discharge from the hospital, you can shower at home without a doubt. However, there is no need to rub it with a washcloth.
10. Eat right for faster tissue restoration and faster healing of scars.
11. By the end of the 1st month, when the wound has healed and the scar has formed, you can ask your doctor how to coat the suture after a cesarean section so that it is not so noticeable. Pharmacies now sell all kinds of creams, ointments, patches and films that improve skin restoration. You can safely apply ampoule vitamin E directly to the scar: it will speed up healing. A good ointment for sutures, which is often recommended for use after cesarean section, is Contratubes.
12. Several times a day (2-3) for at least half an hour, expose your stomach: air baths are very useful.
13. Check with your doctor regularly. It is he who will tell you how to avoid complications, what can and cannot be done, when to do an ultrasound of the suture and whether it is necessary.

So caring for a suture after a cesarean section at home does not require any special efforts or supernatural procedures. If there are no problems, you just need to follow these simple rules and pay attention to any, even minor, deviations from the norm. You should immediately report them to your doctor: only he can prevent complications.

This is interesting! Not long ago, scientists concluded that if the peritoneum is not sutured during a cesarean section, the subsequent risk of speck formation is reduced to almost zero.

Complications

Complications and serious problems with the suture after a cesarean section can occur in a woman at any time: both during the recovery period and several years later.

Early complications

If a hematoma has formed on the suture or it is bleeding, most likely, medical errors were made during its application, in particular, the blood vessels were poorly sutured. Although often such a complication occurs due to improper treatment or careless change of the dressing, when a fresh scar has been roughly disturbed. Sometimes this phenomenon is observed due to the fact that the sutures were removed either too early or not very carefully.

A fairly rare complication is suture dehiscence, when the incision begins to creep in different directions. This can happen after a caesarean section on days 6-11, since the threads are removed within this period. The reasons why the suture came apart could be an infection that prevents the full fusion of tissues, or weights over 4 kg that the woman lifted during this period.

Inflammation of the suture after cesarean section is often diagnosed due to insufficient care or infection. Alarming symptoms in this case are:

• elevated temperature;
• if the suture festers or bleeds;
• its swelling;
• redness.

So what should you do if the suture after a cesarean section becomes inflamed and festers? Self-medication is not only useless, but also dangerous. In this case, it is necessary to consult a doctor promptly. In this case, antibiotic therapy (ointments and tablets) is prescribed. Advanced forms of the disease can only be eliminated through surgery.

Late complications

Ligature fistulas are diagnosed when inflammation begins around the thread used to stitch blood vessels during a caesarean section. They form if the body rejects the suture material or the ligature becomes infected. This inflammation manifests itself months later as a hot, red, painful lump, from which pus may leak from a small hole. Local processing in this case will be ineffective. Only a doctor can remove the ligature.

Hernia is a rare complication after cesarean section. Occurs with a longitudinal incision, 2 operations in a row, several pregnancies.

A keloid scar is a cosmetic defect, does not pose a threat to health, and does not cause discomfort. The reason is uneven tissue growth due to the individual characteristics of the skin. It looks very unaesthetic, like an uneven, wide, rough scar. Modern cosmetology offers women several ways to make it less noticeable:

• conservative methods: laser, cryo-impact (liquid nitrogen), hormones, ointments, creams, ultrasound, microdermabrasion, chemical peeling;
• surgical: scar excision.

Cosmetic suture plastic surgery is selected by the doctor in accordance with the type of incision and individual characteristics. In most cases, everything goes well, so that no external consequences of cesarean are practically visible. Any, even the most serious, complications can be prevented, treated and corrected in time. And those women who will give birth after the CS need to be especially careful.

Wow! If a woman no longer plans to have children, the scar after a planned cesarean can be hidden under... the most ordinary, but very elegant and beautiful tattoo.

Subsequent pregnancies

Modern medicine does not prohibit women from giving birth again after a cesarean section. However, there are certain nuances relating specifically to the seam that you will have to deal with when carrying subsequent children.

The most common problem is that the suture after a cesarean section hurts during the second pregnancy, especially in its corners in the third trimester. Moreover, the sensations can be so strong, as if he is about to break apart. This causes panic for many young mothers. If you know what dictates this pain syndrome, your fears will go away. If a period of 2 years was maintained between the cesarean and subsequent conceptions, a discrepancy is excluded. It's all about the adhesions that form during the restoration of wounded tissue. They are stretched by the increased size of the abdomen - hence the unpleasant, nagging pain. You will need to inform your gynecologist about this so that he can examine the condition of the scar using an ultrasound. He can recommend some pain relief and emollient ointment.

You need to understand: the healing of a suture after a cesarean section is very individual, it happens differently for everyone and depends on many factors: the process of childbirth, the type of incision, the state of health of the mother, proper care in the postoperative period. If you keep all these nuances in mind, you can prevent many problems and avoid unwanted complications. After all, at this stage it is so important to give all your strength and health to the baby.

After a caesarean section, the main complaints of patients concern the condition of the suture. Complications can arise for various reasons. The most common complication is considered to be a seal at the seam, but this complication is not always dangerous and in most cases does not require additional treatment. In order to understand whether a lump is dangerous or not dangerous, you need to consult a surgeon. Self-treatment can only worsen the situation and lead to the need for urgent surgical intervention.

Danger signs

Among the dangerous signs of a developing complication after a cesarean section, one can highlight compaction and suppuration of the sutures. This is a fairly common phenomenon that is noticeable to the naked eye when examining the seams. Problems with seams can arise for various reasons, including:

• suture infection,
• low quality suture material,
• insufficient qualification of the surgeon,
• rejection of suture material by the woman’s body.

Every woman should understand that the suture must be carefully monitored for several months after surgery, and if phenomena such as induration, pain, redness or suppuration are detected, it is necessary to immediately seek advice from a surgeon.

Ligature fistula

This complication is the most common after cesarean section. After the operation, the incision is sutured using special threads - ligatures. These threads can be absorbable or non-absorbable. The healing time of the scar depends on the quality of the ligature. If the material was of high quality, used within the acceptable expiration dates, in accordance with the norms and rules of treatment, complications are unlikely.

But if the ligature was used after the specified expiration date or an infection got into the wound, an inflammatory process begins to develop around the thread, which can form a fistula several months after cesarean.

A fistula is very easy to detect. It has such signs as a non-healing wound, from which a certain amount of pus is periodically released. The wound may crust over, but then it opens again and pus is released again. This phenomenon may be accompanied by elevated body temperature, chills and general weakness.

If a fistula is detected, the help of a surgeon is necessary. Only a doctor can detect and remove an infected thread. Without removing the ligature, the fistula will not go away, but will only increase. Local treatment will not bring positive results. After removing the thread, the suture requires additional care, which will be prescribed to you by the surgeon.

If the infection process is prolonged, or several fistulas have formed on the scar, surgery may be required to remove the scar with repeated stitches.

Seroma

Seroma is also a common complication after cesarean section. But unlike a ligature fistula, this complication can go away on its own, without additional treatment. A seroma is a fluid-filled lump on a suture. It occurs at the intersection of lymphatic vessels, which cannot be sutured after the incision. At the intersection of lymphatic vessels, a cavity is formed that is filled with lymph.

Without additional dangerous signs, seroma does not require treatment and goes away on its own within a few weeks.

If a seroma is detected, you should immediately visit a surgeon to determine an accurate diagnosis and exclude suppuration.

Keloid scar

Another most common complication after cesarean section is the formation of a keloid scar. Recognizing it is also not difficult.

The seam becomes rough, hard and often protrudes above the surface of the skin.

There is no pain, redness around the scar or pus.

A keloid scar does not pose a threat to the health of patients and is only an aesthetic problem. The causes of scar formation are considered to be individual characteristics of the body.

Today there are several methods of treating this unsightly phenomenon:

1. Laser therapy is based on resurfacing the scar using a laser. Several therapy sessions can make the scar less noticeable.
2. Hormonal therapy includes the use of special medications and ointments containing hormones. Using creams will help reduce scar tissue and make the scar less pronounced.
3. Surgical treatment consists of complete excision of scar tissue followed by the application of new sutures. This method does not guarantee that a normal scar will form at the site of the removed scar.

In order to avoid all these and other complications in the postoperative period, it is necessary to carefully care for the suture and follow all doctor’s recommendations. If any signs of complications appear, visit your doctor immediately, in this case you can avoid surgical treatment.

Many patients are faced with the problem of sealing the suture after a cesarean section. Pathology can develop under the influence of various reasons. To determine whether a lump on a stitch is dangerous, a woman should undergo an examination at a medical center. Only after this can a treatment method be selected. You also need to understand that the problem is not always pathological. In many cases, the seal does not pose a threat to the life and health of the patient.

Common causes of pathology

A caesarean section is performed by cutting tissue in the abdominal area. The postoperative incision is sealed with medical materials. The muscle tissue is stitched with a ligature. A silk thread is applied to the skin. The uterus is held together with various materials. The choice of material depends on the type of section and characteristics of the operation. After a cesarean section, a recovery period begins. At this time, the seams should be covered with scar tissue. But the process does not always go smoothly. Some patients complain that the suture turns red after a cesarean section. A lump on the abdomen after a cesarean section may appear for the following reasons:

• development of a purulent process;
• tissue infection;
• use of low-quality material;
• postoperative hematoma;
• autoimmune reaction.

A common cause of suture compaction is a purulent process. Suppuration is observed under the influence of various factors. The process is common due to improper processing of the postoperative field. Damaged tissue is accompanied by the death of some cells. Dead cells accumulate on the surface of the wound. To enhance healing, the incision is coated with white blood cells. The mixing of dead tissue, white blood cells and dead skin particles leads to the formation of pus. Pus causes inflammation of the suture. The tissues begin to thicken.

A seal occurs on the suture after a cesarean section due to infection. Many infections depend on the activity of pathogenic microorganisms. Bacteria can enter the wound during poor-quality surgery or after cesarean with infrequent treatment. Pathogenic microorganisms multiply rapidly and cause changes in tissue structure. Bacteria feed on tissue cells. The area of ​​tissue affected by pathogenic microbes becomes inflamed. The worsening of the process is accompanied by compaction. A woman discovers lumps on her wound. Bacterial infection is also determined by additional signs. The patient notices severe burning and itching. An ichor may appear on the surface of the seam. In order for the doctor to quickly select effective treatment, it is necessary to undergo additional examination.

Additional factors

The suture after a cesarean section may become thicker if low-quality medical material is used. The seal appears due to expired threads. This material causes a seal to form. To get rid of the problem, repeated surgery should be performed.

In the first days after a cesarean section, a lump forms due to a hematoma. Hematoma after cesarean section is a common problem. The bruise appears due to internal bleeding. The area of ​​the abdominal region where there is a bruise is hard and dense on palpation. This problem does not require additional intervention in most patients. A few days after surgery, it resolves.

An autoimmune reaction rarely occurs in women. It is impossible to determine the disease in advance. The pathology is characterized by the rejection of medical material by the human body.

For unknown reasons, the body perceives the threads as a foreign body. This leads to the appearance of antibodies in the blood. These are special particles designed to capture foreign microorganisms. The response of the autoimmune system is unpredictable. This problem can only be solved by selecting another material or prescribing a drug to eliminate the activity of the system.

Formation of postoperative fistula

Ligature fistulas are a common problem after surgery. Pathology gradually appears in the muscle layer of the abdominal cavity. The problem got its name because of the peculiarities of its occurrence. The culprit of the disease is a ligature that is not completely decomposed. The threads on the muscle layer should completely decompose within a few weeks after a cesarean section. But under the influence of various negative reasons this does not happen. Part of the ligature is retained in the abdominal area.

The ligature causes inflammation in the damaged tissue. The process is accompanied by the death of cells in the muscle layer surrounding the thread. Dead cells accumulate on the surface of the ligature. The body responds to pathology by producing large numbers of white blood cells. Together with the tissue, leukocytes form pus.

Suppuration causes further death of the layers of the abdominal cavity. The problem cannot be detected immediately. The woman notices that a small bump appears on the surface of the stitches.

The compaction is accompanied by the appearance of a slight swelling similar to a boil. Some time after the operation, a purulent head forms on the top of the tumor. The skin is torn. Pus begins to drain from the fistula canal.

Ligature fistula is accompanied by additional symptoms. A woman should pay attention to the following signs:

• throbbing pain in the suture area;
• redness of the skin;
• a feeling of fullness in the scar area.

The main sign of developing internal suppuration is throbbing pain in the suture area. Throbbing pain occurs due to the gradual death of tissue. You should also pay attention to the feeling of scar tissue swelling. This is also provoked by purulent fluid.

The doctor makes the diagnosis after initial treatment of the fistula canal. An antiseptic solution is injected into the lumen. Hydrogen peroxide has a good effect. Peroxide breaks down the pus and removes it from the canal. After thoroughly cleaning the fistula, the doctor examines the cavity. A ligature residue is found in the muscle layer. You cannot leave material in the channel. It will cause further tissue destruction.

Treatment is carried out through surgery. The doctor removes the remaining threads from the canal. A new suture is not placed on the wound. After the intervention, the woman remains in hospital treatment. This is necessary to further monitor the healing rate. It is also necessary to ensure that a new fistula does not form.

Neoplasm with lymph

A lump over the incision after a cesarean section may form due to the formation of a lymphatic cavity. This occurs against the background of dissection of the lymphatic channels.

All layers of tissue are nourished by the lymphatic system. During a caesarean section, several layers of tissue are cut. The channels are also damaged. After the operation, the tissues are held together with threads. Lymphatic channels and vessel walls remain damaged. In most women, the vessels and canals heal on their own. In some cases, the internal lymphatic channel does not heal. The liquid that moves through the channel enters the free space. A small cavity filled with lymph is formed in the peritoneum.

This tumor is called seroma. To determine its presence, you need to pay attention to the following signs:

• round growth on the skin;
• redness of the skin in the affected area;
• burning sensation.

The main sign of seroma is the formation of a round, red growth on the skin. In most cases, seroma does not require treatment. She is able to heal on her own. If the seroma persists for a long time, it is necessary to open the surface of the seroma and release excess lymph. The wound is washed with a solution of chlorhexidine or sterile liquid furatsilin. Gradually the damage will heal on its own.

Uncharacteristic scar tissue

The suture after a cesarean section may become thicker for other reasons. The surface of the wound after surgery is covered with a thin film, which forms a scar. Normal scar tissue should not rise above the skin. Immediately after formation, the tissue is red in color. After some time, the seam brightens and becomes less noticeable to others. But sometimes the scar does not form correctly. Under the influence of negative factors, rumen cells begin to actively multiply. A keloid scar forms on the wound. The causes of a keloid scar are as follows:

• past infection;
• disruption of the update process.

Keloid tissue cannot harm the patient's health. A psychological problem arises. The scar spoils the appearance. Doctors recommend treating keloid scars using cosmetic techniques.

A hard scar can be eliminated with a laser. The laser beam has a warming effect on the tissue. She is melting. A burn forms on the scar. It is not recommended to remove the burn crust yourself. It should disappear completely after some time.

You can resort to grinding. The working surface of the grinding apparatus rotates at high speed. Under the influence of friction, the convex part of the scar is gradually eliminated. Several treatments may be needed to achieve a good result.

Preventive measures

To avoid problems, you must follow your doctor's advice. To get a good result, you need to properly postpone the recovery period. The first days after a cesarean section, you need to follow the rules for processing the incision. The sutures are processed by medical personnel for several days. The procedural nurse can teach the patient how to cleanse the wound independently. In order for the sutures to heal correctly, it is necessary to use an antiseptic solution and a drying agent.

Initially, the seam is washed with an antiseptic liquid. Processing is carried out until the contaminants are completely removed. After removing the crust, the edges of the wound should be lubricated with a drying agent. For this purpose, you can use brilliant green or fucorcin. Treatment must be carried out at least once a day. This will help prevent the development of infection or inflammation.

It is also necessary to seal the surface of the suture with a postoperative dressing. Bandages can be purchased at a pharmacy. Manufacturers offer a large selection of dressings from various materials.

After the formation of thin scar tissue, a woman should closely monitor her health. The following should cause concern:

• the appearance of redness around the seam;
• the appearance of blood or ichor from the wound;
• changes in the characteristics of vaginal discharge;
• pain in the incision area.

Redness of the tissues surrounding the sutures may be due to the development of inflammation or infection of the wound. The appearance of blood and ichor from the wound a few weeks after a cesarean section is dangerous. This phenomenon can occur during the initial form of suppuration.

Caesarean section is a difficult and traumatic operation for a woman. After surgery, it is recommended to carefully monitor the characteristics of the suture. If palpation reveals a hard scar, you should visit a doctor. The specialist will determine the cause of the compaction and select an effective treatment.

An operative method of delivery becomes inevitable when the fetus occupies the wrong place in the uterus or complications such as placenta previa or umbilical cord entanglement are present. Sometimes there are no direct indications for a cesarean section; it’s just that a woman, for example, no longer plans to have children and wants to undergo surgical sterilization during the operation.

Regardless of the reasons for delivery through surgery, it should be remembered that cesarean is an extensive abdominal intervention. During obstetrics, in order to remove the baby from the uterus, doctors have to make several incisions layer by layer. After the operation, the woman’s abdominal cavity is also sutured in layers, as a result of which a scar will remain on the anterior abdominal wall for life.

Types of sutures after cesarean

Depending on the technique used to make the tissue incision, a woman may receive different types of sutures:

• vertical - applied when the incision is made vertically, from the navel to the pubic area;
• transverse - the incision is made along the bikini line, called in medicine Jow-Cohen laparotomy;
• in the form of an arc - the incision is made in the area of ​​the skin fold above the pubis (Pfannenstiel laparotomy).

Suture care after cesarean section: treatment, ointments, creams

Treatment of the postoperative wound and sutures is carried out several times a day in the maternity hospital, and this procedure is performed by a nurse. To prevent weeping and the development of inflammatory processes in the suture area, the incision site is treated with a brilliant green solution twice a day, and then covered with a sterile gauze bandage.

Approximately on the 7th day, the sutures are removed, but the postpartum mother must continue to treat the wound with brilliant green at home until it is completely healed. After complete healing and scar formation, the incision site can be treated with an anti-inflammatory cream, which contains components that accelerate skin regeneration.

When suturing the wound surface with self-absorbing threads, there is no need to remove the sutures, however, to speed up their resorption, the doctor may recommend the use of special ointments and creams. These drugs will prevent the formation of compactions and swelling in the suture area.

How long does it take for a stitch to heal after a cesarean section?

The formation of a scar at the incision site is observed already by the end of the first week after delivery. From about this point on, the woman is allowed to take a shower and soap the seam area without making sudden movements or pressing on the incision site with a bathing sponge.

Complications on the suture after cesarean section

Unfortunately, the incision site does not always heal and does not bother the patient; some young mothers have to face complications.

The stitch after cesarean section hurts

Pain in the area where stitches are applied can bother a woman for several months. After complete healing of the wound surface, the suture may bother the patient when the weather changes, loads, or wearing tight clothes. Such sensations are normal and do not require the use of medications. The following symptoms are a reason to immediately seek medical help:

• redness of the skin around the stitch;
• local increase in body temperature;
• swelling and sharp pain at the suture site;
• discharge from the suture of fluid mixed with blood or pus;
• a sudden increase in body temperature, accompanied by the above symptoms in the suture area.

Suture after cesarean section: festering, oozing

In the first few days after the operation, the suture may ooze clear liquid, but there should be no pus or scarlet blood coming out! Treatment with a solution of brilliant green will help prevent the development of complications.

If pus or bloody discharge appears from the suture a few days or weeks after a cesarean section, the woman should seek medical help; perhaps an infection has entered the wound and provoked the development of an inflammatory process.

Suture after cesarean: itchy

Itching in the suture area after surgical delivery occurs as a result of the formation of a postoperative scar. This process is accompanied by increased skin dryness and tissue tension, which leads to discomfort. In order not to accidentally introduce an infection into the wound, it is not recommended to touch the stitches with your hands; the use of special soothing anti-inflammatory creams and ointments will help reduce the itching of the skin.

Hematoma, lump on the suture, sealing of the suture after cesarean section

As a result of suturing and traumatizing the blood vessels in the area of ​​the wound surface, a woman may develop a hematoma. Most often this occurs on the inner surface of the uterus, and the pathology can only be diagnosed through ultrasound. If the hematoma is not treated, then over time a compaction may form, which interferes with the normal nutrition of tissues in this area and is a predisposing factor to the development of inflammatory processes.

Having gone through surgical delivery, a woman should be prepared for the fact that the suture on the anterior abdominal wall will not immediately become invisible and painless. In the first months and even years, the formation of bumps and various seals in the suture area is acceptable, which is associated with tissue healing processes. Such lumps will completely resolve only 1-2 years after the intervention, which the patient simply needs to come to terms with.

Can a uterine suture come apart after a cesarean section?

After a caesarean section, you should be extremely attentive to your health. Lifting weights, strenuous physical activity and early sexual activity can lead to suture dehiscence. A new pregnancy also poses a danger: due to the incompetence of the scar and as the uterus grows, there is a strong tension in the tissue, as a result of which the internal sutures can separate at the site of the incision. A new pregnancy after surgical delivery can be planned no earlier than 3 years after cesarean section.

Ligature fistula after cesarean section

The formation of a ligature fistula occurs as a result of the use of poor quality suture material or the woman’s individual intolerance to the used threads. The complication is characterized by an inflammatory process of the skin around the suture, which develops several weeks or months after surgery.

As the pathology progresses, a hole forms near the suture site, through which pus is released when pressed. Treatment of the hole and a course of antibiotics do not give the desired result, and treatment of this complication is carried out only surgically; during the intervention, the doctor will remove the ligature and the wound will soon heal.

Adhesions after caesarean section

Adhesions form after any surgical intervention; their formation is aimed at preventing purulent-septic processes in the pelvis. When adhesions form in excess, they speak of the development of adhesive disease, which can lead to subsequent ectopic pregnancies, intestinal obstruction, and infertility.

Aesthetic correction of a suture after a caesarean section

A scar after a cesarean section, especially if the incision was made vertically, often becomes a reason for the formation of complexes in a woman, so she tries in every way to get rid of it.

How to remove a scar after a caesarean section?

First of all, in order to make the scar less noticeable, immediately after the wounds have healed, you should begin performing cosmetic procedures - a cream containing mumiyo must be rubbed into the scar twice a day. According to patient reviews, over time the scar becomes pale and less noticeable.

Suture repair after caesarean section

If a woman is dissatisfied with the results of caring for the suture area and she is still not satisfied with the appearance of the anterior abdominal wall, she can decide on a radical procedure - plastic surgery. Before you undergo such an intervention, soberly assess the possible risks, since, like a caesarean section, plastic surgery has its disadvantages.

Is it possible to get a tattoo on a cesarean scar?

Many women decide to correct the appearance of the anterior abdominal wall by tattooing the suture area. This is not prohibited, but you should wait until a normal scar has formed and the tissue has completely healed.

Irina Levchenko, obstetrician-gynecologist, website specially for the site

Useful video

A caesarean section is a surgical procedure to remove a fetus from a pregnant woman’s body if spontaneous childbirth is impossible or for medical reasons.

The operation can be prescribed urgently when labor has already begun or planned - before the onset of contractions. Depending on this, the surgeon chooses one of 2 main types of cesarean section, which differ in the type of incision, the characteristics of the suture and the postoperative period.

There are about 10 methods for performing a caesarean section. If we consider these techniques from the standpoint of the consequences for the mother and the course of postoperative rehabilitation, There are 2 main methods:

1. In case of an emergency section or certain indications, the doctor performs an isthmicocorporal laparotomy with a lower median incision - he opens the skin, subcutaneous fat, abdominal muscles and tendons, peritoneum and uterus, making a vertical incision from the navel to the pubic region.

In some cases (corporal laparotomy), the incision may extend above the navel. After removing the fetus and placenta, a multi-level suture is applied - first the walls of the uterus, the peritoneum are sutured, then the tendons and muscle part, subcutaneous tissue and skin. The operation lasts up to 60 minutes, the mother's blood loss is up to 800 ml.

Seam features:

• seam length from 10 cm or more;
• the suture is interrupted (not cosmetic), over time it turns into a fairly thick and dense scar;
• recovery period 2 months;
• disturbing phenomena in the suture area (pain, roughness, as well as phenomena requiring qualified intervention) can be observed up to 2 years after surgery;
• To restore the aesthetic appeal of the abdominal area, women have to resort to special cosmetic procedures to reduce the seam.

2. During a planned caesarean section, the surgeon performs a Pfannenstiel laparotomy - cuts the skin horizontally in the area of ​​the suprapubic fold (at the level of the bikini line; an incision just above or below this line is used in a similar operation according to Joel-Cohen), spreads the muscles and bladder, makes an incision in the lower part of the uterus and removes the baby.

Then the uterus is sutured, and a continuous intradermal suture is made on the skin. The operation lasts 20-40 minutes, blood loss is about 500 ml.

Peculiarities:

• seam length is usually up to 10 cm;
• there is no risk of postoperative hernias and abdominal wall muscle defects;
• lower risk of postoperative complications;
• It is allowed to sit down a few hours after the operation; it is recommended to get up no later than a day later;
• recovery period is about 6 weeks;
• The scar is cosmetic, small, and resolves within 6-8 months.

Suture care in the maternity hospital

In the normal course of recovery processes, suture treatment ends with discharge from the maternity hospital. If there are any non-dangerous pathologies, the doctor, upon discharge, will tell you about the features of caring for the suture at home.

The stationary course of treatment includes 1-2 daily antiseptic blotting and wiping, and in case of complications, applying ointments and treating the edges of the wound.

Popular preparations used to treat seams in hospital and at home

The range of medications for the care of postoperative sutures is quite extensive, however, in hospital practice and the recommendations of prescribing physicians, there are usually only a few items that are the most optimal in terms of therapeutic effectiveness and economic benefit.

Vishnevsky ointment

Balsamic liniment according to Vishnevsky is an effective and inexpensive drug for the treatment of festering, inflamed, closed wounds. The ointment not only has a pronounced antiseptic effect, but also increases blood circulation in the area of ​​application, promoting wound healing.

The warming effect, as well as the restriction of oxygen access to tissues, limits the use of the drug on open and inflamed wounds and in the first 4 days after surgery. Do not use the balm if you are intolerant to birch tar, castor oil and xeroform.

Hypotheses have also been expressed about the possible carcinogenic effect of the drug components. But sometimes Vishnevsky ointment is applied to a sutured, fresh wound after surgery for lack of other means. In hospitals, the balm is applied to the seam using a tampon 2-3 times a day in the first week.

Chlorhexidine

Chlorhexidine bigluconate 0.05% is an effective and inexpensive modern antiseptic that has replaced the traditional “green stuff” and its analogues. Chlorhexidine does not cause pain or chemical burns to an open wound; it has a liquid, flowing consistency, therefore it is used to rinse and clean not only the adjacent areas, but also the suture itself.

However, sometimes Chlorhexidine causes irritation to the skin, mucous membranes and open wound tissue. The effect of the drug extends to a fairly wide range of bacterial, viral and fungal agents, as well as protozoa. Chlorhexidine is not addictive.

Bepanten

Bepanten, Panthenol and other ointments based on pantothenic acid (vitamin B5) are not antiseptics, but help to activate tissue regeneration, so they are recommended to be applied to the suture site for its speedy healing.

There are variants of the drug with the addition of some antiseptic (Dexpanthenol with chlorhexidine, Bepanten Antiseptic and others).

Zelenka

To treat the skin adjacent to the incision, use a 1% solution of brilliant green alcohol. The area around the wound, 3-4 cm wide, is lubricated 2-3 times a day for 2-3 weeks after surgery. If there are small bloody discharges at the time of discharge or if they recur some time after returning home, treatment continues on an outpatient basis.

Other drugs

Sometimes the list of prescriptions contains less common medications for suture care, which show similar and sometimes even greater effectiveness.

Home care

Activities for processing and monitoring the suture continue after discharge from the hospital and include several important points that must be observed despite the mother’s workload with housework and child care.

Security mode

A woman who has undergone a cesarean section should not lift weights over 3 kg, bend over or squat for a month. It is necessary to abstain from sexual activity for at least 2 months.

Lactation

Seam processing

Suture after cesarean section at home is necessary daily
treat with the agents recommended upon discharge until the end of the ichor (usually up to 2 weeks).

Diet

To prevent suture dehiscence and support the immune system responsible for fighting possible infections, it is necessary to follow a postoperative diet. The smooth functioning of the gastrointestinal tract after surgical obstetrics protects the woman’s body from intoxication with the products of fermentation and putrefaction.

A special diet is designed to reduce the risk of intestinal paresis and intestinal obstruction.

After a 24-hour postoperative fast, patients are allowed light broths and unsweetened yoghurts. After the first passing of gases and for a month, boiled, baked, stewed and steamed dishes from lean meat and vegetables, buckwheat, rolled oats, millet and pearl barley are offered.

A week after the section, raw fruits and vegetables of green and white color are gradually introduced into the diet - sources of vitamins, minerals and fiber. In addition, cereals, wholemeal bread, fruits, vegetables, vegetable oils and prunes regulate intestinal motility well. Fermented milk products are indispensable for restoring intestinal microflora.

For the first 3 months, fast food, smoked meats, canned food, pickled foods, mushrooms, baked goods, chocolate, fried and fatty foods are excluded from the diet; To avoid constipation, it is advisable to abstain from rice and potatoes. Food should be consumed in fractional portions 5-6 times a day and drink plenty of water. In the future, the diet is regulated by the needs of the baby during breastfeeding.

Bandage

After surgical delivery, women are strongly recommended to wear a special postpartum bandage or model for those who have undergone abdominal surgery.

This device protects the seam from divergence and creates optimal conditions for tissue fusion, protecting the incision site during muscle tension, which can be caused by carrying a child in your arms, bending over, and even breastfeeding. By reducing the mobility of fused tissues, the product promotes the formation of a neat scar.

The bandage helps avoid stretch marks (stretch marks on the skin), provides the necessary compression for muscles that have been stretched during pregnancy, and helps return the stomach to a flatter shape. A significant role is played by wearing this product in order to contract the uterus and prevent back pain.

After corporal intervention, the bandage minimizes the risk of:

The optimal models for recovery after a cesarean section are a universal bandage and a belt with rigid fixation. Models in the form of panties or a skirt should have a high waist, have a rigid insert on the stomach, and the fabric of the product should completely cover the seam.

The use of a product of a smaller size, excessive tightening of the body, redness and swelling of the skin due to impaired blood supply are not allowed.

When using a bandage, you must ensure that the fabric of the product does not injure the seam and, if necessary, apply elastic bandages or pads. It should be put on in the morning while lying down and removed only for sleep, water and air hygiene procedures, which takes approximately 20 minutes every 4 hours.

If there are no complications, you can put on a bandage or support fabric one day after surgery. It is recommended to wear the product from 3 to 6 months after surgery.

Contraindications to wearing the device are inflammatory complications in the suture area (discharge, redness, pain, suppuration, fistulas), skin rashes under the bandage area, swelling and severe abdominal pain.

Bath procedures and personal hygiene.

A week after surgery (after removing the threads) and until the suture heals, it is recommended to take a non-hot shower daily.

The wound area should not be rubbed with a washcloth or applied mechanical pressure when drying: the scar site is washed with water and mild baby soap or intimate hygiene product, and the moisture is removed by blotting movements with a disposable or clean towel, the seam is treated aseptically (for example, Chlorhexidine with protection of the peri-suture area with “green paint”).

Baths, steam baths, saunas, pools and swimming in open water are prohibited until the end of the recovery period (about 2 months).

It is necessary to ensure the cleanliness of the external genitalia and hands. It is ideal if a woman has the opportunity to wash herself after each visit to the bathroom, but washing her hands with soap after using the toilet, walking and interacting with animals is mandatory.

Air baths.

The suture after a cesarean section heals faster under the influence of ultraviolet radiation from direct sunlight and fresh air.
Sometimes ultraviolet irradiation of the suture is practiced in hospitals before the mother is discharged and continues on an outpatient basis in physiotherapy rooms. When taking an air bath at home, you should avoid physical stress during the session.

Home activities that speed up the resorption of sutures

You can begin to take steps to prevent the suture from getting rougher 1-2 months after surgery if there are no complications.

Methods:

• a solution of vitamin E (alfatocopherol acetate), applied to the scar itself;
• gel and ointments Contractubex, Derimatix and their analogues are recommended by manufacturers for use immediately after removal of stitches, but their effect on the health of a child during breastfeeding has not been clarified. Vaseline and moisturizing creams help to reduce the scar to some extent.

Physiotherapy

After the operation, lying on the stomach and breathing exercises with the stomach are recommended. 2 months after a cesarean section (when the suture softens and the ligature dissolves), you can contact a specialist in physical therapy to create an individual set of exercises that are designed to speed up the healing of the incision site and strengthen the abdominal muscles.

As a rule, these are exercises with a hoop, a Kegel complex, lightweight exercises for retracting the abdomen and body turns, lifting and rotating the arms and legs. Exercise therapy is designed to accelerate the scarring of the uterine and other internal sutures, so it should not be neglected, but if pain or complications occur, the start date for classes is postponed.

How long does it take to heal when sutures are removed: description by month

The course and duration of healing of sutures after a cesarean section depend on the type of incision used during the operation.

Monthly description of external sutures during normal healing:

When should an ultrasound scan of the suture be done?

Ultrasound examination of postoperative sutures can be planned or prescribed based on the patient’s complaints.

Features of the recovery period

The recovery period after a cesarean section is the healing time of the external suture, which is about 2 weeks (one of which is a hospital stay).

Pain and itching

Severe pain is observed in the first week after cesarean section. Normally, pain of varying degrees persists for up to 2 months after surgery, itching for up to 3-4 months. Some disturbing painful phenomena can be observed in the first 12 months, especially with changes in atmospheric pressure and changes in weather.

Inpatient methods of pain control include intravenous or intramuscular injections of non-narcotic analgesic drugs, taking into account the breastfeeding regimen, applying cold to the uterine area and breastfeeding to quickly contract the uterus, then warming up.

At the outpatient stage, the doctor informs you about safe medications for pain relief upon discharge; you can also contact the supervising gynecologist or pediatrician. Moderate physical activity also helps relieve pain.

The suture after a cesarean section may be itchy. This phenomenon indicates that regeneration is taking place and does not require intervention. Itching sensations can be relieved with soft stroking movements, but not by friction.

If a burning sensation appears, pain is accompanied by redness of the scar, swelling and temperature, or there are deep nagging pains in the lower abdomen, which are sometimes accompanied by vaginal discharge, then it is imperative to seek medical advice.

Serous discharge.

Serous discharge is the discharge of transparent lymph and ichor, which should end 1-2 weeks after the suture is applied. If they continue, intensify, or if blood appears in the discharge, you should consult a doctor.

During the normal course of the recovery period, the following should not be observed:

• severe bleeding from the external suture and vagina;
• opaque discharge with an odor;
• redness and swelling of the suture;
• increase in body temperature.

Early complications

Early complications are considered to be various adverse consequences of surgery that occur during the hospital stay. If one of the following phenomena occurs, you should immediately contact the hospital medical staff.

Bleeding

The cause of external (from the incision area) and internal postoperative bleeding, provided proper medical manipulations are performed, can be disturbances in the patient’s blood coagulation mechanisms, as well as concomitant diseases, such as diabetes or obesity.

Bleeding from the external suture can occur due to:

• excessive muscle tension;
• stretching of the skin on the abdomen;
• inaccurate medical manipulations during treatment and changing the dressing;
• improper connection of blood vessels during surgery.

Uterine bleeding (lochia) mixed with mucus is natural for 2 months after surgery, but its abundance should decrease within a week, and the color normally ceases to be bright red. The discharge should not be clear, watery with an unpleasant odor, or purulent; black discharge with an unpleasant odor is also a cause for concern.

If there is heavy or recurrent bleeding from the incision area or from the vagina, the woman’s recovery period in the hospital is extended, the suture is checked and treated, intravenous infusions, iron and vitamin supplements, and metroplasty may be prescribed.

Hematoma

Hematoma is a hemorrhage from blood vessels under the skin that were not sufficiently strengthened during surgery. Other causes of hematomas may be early or inaccurate removal of sutures.

Predisposing factors are diseases:

• kidney;
• of cardio-vascular system;
• blood (for example, anemia);
• phlebeurysm.

Internal hemorrhage is characterized by a feeling of heaviness in the perineal area. Depending on the location and extent of the hematoma, the doctor decides on conservative or surgical removal of the complication.

Suppuration

Inflammation and suppuration of the suture occurs when a bacterial infection develops on the dissected tissues when particularly viable strains of the pathogen enter the wound or when the patient’s immune system is disrupted.

A wound abscess begins with redness, pain in the suture area, accompanied by an increase in body temperature, chills, loss of strength and the discharge of a cloudy sticky exudate with an unpleasant odor from the wound.

Treatment includes a course of antibiotics and treatment of the scar with antiseptic agents.(Vishnevsky ointment, Levomekol, Syntomycin emulsion and others), in case of serious complications - drainage. To prevent suppuration, from the second day after surgery it is necessary to get up (gradually, without jerking) and follow the prescribed antiseptic treatments.

Seam divergence

The suture after a cesarean section may diverge due to several reasons. The opening of the wound edges occurs due to excessive physical activity of the woman in the first days after childbirth, active sports and heavy lifting in the future, as well as due to the infectious process in the wound tissues.

Sometimes the discrepancy is caused by excessively tight underwear or underwear made from coarse fabrics. Wound dehiscence is sometimes observed after stitches are removed and often in women whose child weighs more than 4 kg.

Late complications

Late complications of suture healing are considered to be events that occur after discharge from the hospital, usually within 12 months after surgery.

Seromas

Seroma is a bubble-shaped cavity at the suture filled with lymph. Seromas occur in the first weeks after the intervention due to the filling of the dead-end parts of the lymphatic vessels compressed as a result of the operation and are not a pathological phenomenon. But to differentiate seroma from fistula, medical consultation is necessary.

Ligature fistula

A ligature fistula is a breakthrough at the site of suppuration of the suture material, when a bacterial infection develops on the surgical threads (ligature). A fistula can also appear as a result of allergic rejection of the ligature.

First, any area on the suture becomes hot, turns red, thickens and swells, pain appears, then in one or more places the suture opens and pus flows out, the general temperature rises.

The site of the breakthrough is a through passage through which air can circulate noisily (hence the name of the complication). Self-opening of the suture allows some of the rejected material and purulent contents to come out, but indicates a dangerous inflammatory process that requires immediate medical attention.

The initial stage of inflammation is treated conservatively - by aseptic treatment or drainage and with the help of antibiotics. But sometimes the infected ligature must be removed surgically, while the wound is cleared of exudate, a new suture is applied using other materials, and a course of antibiotics is prescribed.

The doctor decides on the scale of the operation and the need to excise the fistula. External wound treatment using aseptic means at home is not sufficient.

If the fistula closes on its own after separation of the infected material, the inflammatory process continues and relapses may occur, intoxication of the body continues, dangerous with the risk of inflammation of the peritoneum and internal organs and other consequences.

Keloid suture

After a corporal cesarean section, keloid (colloid) coarsening of surgical sutures is most often observed as a result of a hereditary predisposition and represents the proliferation of dense connective tissue containing collagen. Scars protrude above the surface of the skin, change color, and can cause pain and discomfort.

Hypertrophic scars do not extend beyond the suture and are usually painless; keloid scars grow more extensively. Tissue changes can occur one month after surgery and persist for many years, although stabilization usually occurs within 24 months after the onset of changes.

Such a scar usually does not cause any particular concern, other than aesthetic, however, if the lump becomes patchy, or bumps or discharge appear, you should definitely consult a doctor. The specialist will refer you for an ultrasound examination and help rule out inflammation, ligature fistula and malignant degeneration of tissue in the scar area.

Hernia

The hernia occurs after excision of the abdominal tendons during corporal laparotomy as a result of overexertion when lifting heavy objects, frequent constipation or slow digestion and can be diagnosed many years after the operation. Small hernias require the use of a bandage, large hernias require surgical reduction.

The suture came apart after a caesarean section: symptoms and actions

The most obvious symptoms are the divergence of the external (skin) suture, which are observed more often in the first month after surgery. More dangerous is the failure of the suture on the uterus, the scarring of which lasts for 2 years.

Signs of divergence of the uterine suture:

• nagging pain in the lower abdomen;
• increased body temperature;
• bloody discharge from the vagina, especially renewed or intensified a week after surgery.

The only correct decision in this case should be to immediately consult a doctor.

Symptoms of external seam divergence:

The suture should be treated with Chlorhexidine, a sterile bandage should be applied, rest should be ensured and a doctor should be called. If the seam does not diverge much, then re-suturing is usually not required and treatment is limited to local tightening. If suppuration occurs, drainage will be required.

How to get rid of a scar: effective methods

The need to resort to scar correction arises both when a woman wants to improve the cosmetic appearance of the skin scar, and for medical reasons when there is a suspected failure of the uterine scar (“niche” in the area of ​​the suture on the uterus).

Metroplasty: effectiveness

Metroplasty after cesarean section is the application of a second suture on the uterus when the previous scar has failed. The operation is performed openly (laparotomy) or through laparoscopic openings.

The need for metroplasty usually occurs after:

• emergency caesarean section;
• inflammatory complications in the area of ​​the uterine suture;
• surgical termination of pregnancy up to 2 years after the previous intervention;
• pregnancy occurring early after section.

If home methods for dealing with rough external scars, discussed in the “Home Care” paragraph, are insufficiently effective, you can turn to plastic surgery and massage. The methods are applicable for fully formed scars (approximately 12 months after surgery).

Sanding: efficiency

In cosmetology, several methods for polishing skin sutures have been developed:

Massage: effectiveness

The effectiveness of massage is lower compared to grinding, but it can be successful on small seams or moderately soften rough defects. Massage is carried out after complete healing using pressing movements several times a day for 5 minutes.

The surface of the seam and the skin of the fingers are pre-cleaned; to enhance the effect, moisturizing creams or special products are used to soften the keratin. At the same time, the massage will help break down excess fat, strengthen the abdominal muscles and tighten the skin.

Other techniques

Less effective conservative methods include cryoprocedures (exposure to liquid nitrogen), external hormonal therapy, and ultrasonic resurfacing.

Plastic surgery

Surgical excision is performed on minor scars to remove excess connective tissue.

Tattoo

After the seam has completely healed, you can resort to the services of professional tattoo artists. Sometimes successful color and graphic solutions with the inclusion of a seam in the composition can completely disguise a scar.

In addition, keloid scars are treated with silicone and zinc bandages, compression devices, injections of corticosteroids, 5-fluorouracil, interferon, and electrophoresis. Irradiation of scars, which was practiced some time ago, is no longer performed due to the risk of malignancy.
When to plan a pregnancy after a cesarean section?

After the operation, it is highly recommended to refrain from conceiving another child for at least 2 years, so that the uterus has time to form a full-fledged scar, the tissue around the suture has acquired sufficient thickness and the bearing of a new fetus occurs without complications.

The optimal period for the next pregnancy is 3-10 years after cesarean section. Provided that a horizontal sparing incision and a synthetic (or semi-synthetic) ligature on the suture were used during the previous operation, a pregnancy following a cesarean section can be safely resolved naturally.

Article format: Vladimir the Great

Useful video about caesarean section

Pros and cons of KS: