KNOWLEDGE CENTRE
A Caesarean section is one of the most commonly performed operations in the UK. For most women, the discomfort of surgery improves steadily over the first few weeks as the body heals. However, for some women, pain continues long after the wound has healed. This can be physically exhausting and emotionally distressing, especially while caring for a newborn or young family. At Wye Sanctuary, we understand that persistent pain after Caesarean section is a recognised medical condition. Understanding why it happens is the first step towards finding the right treatment.
It is normal to experience pain during the first few weeks after surgery. When pain continues for more than three months after the operation, after normal healing has taken place, it is known as persistent post-surgical pain. Studies suggest that around 10–15% of women continue to experience pain several months after a Caesarean section, although for most the symptoms are mild. A smaller number develop pain that significantly affects their daily life.
Persistent pain after Caesarean section is rarely caused by one single problem. Instead, several factors often contribute together.
Nerve pain
During a Caesarean section, small skin nerves are inevitably divided as part of the incision. Most heal without difficulty, but occasionally a nerve remains irritated or becomes trapped within scar tissue. This may cause burning, shooting or electric shock-like pain, tingling, numbness, increased sensitivity around the scar or pain when clothing touches the scar.
Scar sensitivity
Although scars usually soften and become less sensitive over time, some remain tender for months or years. The scar may feel painful to touch, tight, itchy, overly sensitive or uncomfortable when clothing rubs against it. Scar massage and desensitisation techniques can often help.
Abdominal wall and pelvic floor
Pregnancy stretches the muscles and connective tissues of the abdominal wall. After surgery these tissues need time to recover. Weakness, altered muscle function and changes in posture may contribute to lower abdominal, pelvic or lower back pain. Pregnancy itself can also affect the pelvic floor, contributing to pelvic pain, bladder symptoms, pain during intercourse or difficulty exercising.
Nervous system and other conditions
For some women, particularly those who experienced significant pain during pregnancy or after surgery, the nervous system can become more sensitive. Although tissues have healed, the body’s pain alarm remains overprotective. Other conditions may also coexist, including endometriosis, adenomyosis, bladder pain syndrome, IBS, chronic pelvic pain or fibromyalgia.
Most persistent pain is not caused by a serious surgical complication. However, your healthcare professional will consider whether symptoms could be related to hernia, infection, scar endometriosis, adhesions, gynaecological conditions or other abdominal conditions. These problems are uncommon but important to identify.
Rarely, endometriosis can develop within a Caesarean scar. Symptoms often include a painful lump within or close to the scar, pain that becomes worse around your period, swelling of the scar, and occasionally bleeding from the scar. Although uncommon, scar endometriosis should always be considered if pain is cyclical or associated with a lump.
Assessment begins with listening carefully to your story. Depending on your symptoms, investigations may include physical examination, ultrasound, MRI scan, blood tests, or referral to a gynaecologist if appropriate. Often, the diagnosis comes from understanding the pattern of symptoms rather than relying on scans alone.
Treatment depends on the factors contributing to your pain. It may include education, scar rehabilitation, pelvic health physiotherapy, medication, injection treatments or nerve blocks for carefully selected patients, lifestyle medicine, and medical cannabis for selected patients with persistent pain that has not responded to conventional treatments.
Many women go on to have healthy pregnancies after experiencing persistent pain. Some notice their symptoms improve, while others experience temporary worsening as the abdominal wall stretches again. Your care should be individualised, and persistent pain alone does not usually prevent future pregnancy.
Seek prompt medical assessment if you develop fever, increasing redness around the scar, wound discharge, a rapidly enlarging lump, heavy vaginal bleeding, or severe abdominal pain that is new or rapidly worsening.
Persistent pain after a Caesarean section is often about much more than the scar itself. We take time to understand your symptoms in the context of pregnancy, childbirth, surgery, hormones, sleep, caring for a young family and your overall health. By considering the abdominal wall, pelvic floor, nerves, nervous system and any underlying pain conditions together, we can develop a personalised treatment plan that supports both recovery and long-term wellbeing. When appropriate, we work alongside your GP, obstetrician, gynaecologist and pelvic health physiotherapist to ensure your care is joined up.
“Many women tell me they feel guilty talking about their pain after having a healthy baby. They worry they should simply be grateful and get on with life. But persistent pain after a Caesarean section is a recognised condition, and you deserve to be listened to. Caring for a baby is demanding enough without living with ongoing pain. My role is to understand why that pain has continued and to help you find practical, evidence-based ways to move forward.”