Q: I’m 2 years postpartum, but I sometimes get cramps at my c-sec area. Should I be worried?

Answered by: Dr Lim Wan Teng, Obstetrics and Gynaecology (O&G), Pantai Hospital Cheras (PHC)

Caesarean section is one of the most common surgeries performed in women worldwide. Most women have some cramps over the Caesarean site after the surgeries. Abdominal cramps may persist for months and even years after the surgeries. There are some possible causes for the cramps.

“Abdominal cramps may persist for months and even years after the surgeries.”

Adhesion colic

Adhesion is very common as all surgeries produce adhesion. Up to one- quarter of patients have moderate to dense adhesion after Caesarean section. Adhesion band forms between the womb and other reproductive organs to the abdominal wall or bowel as part of the healing process after Caesarean section. The number of Caesarean sections, obesity, diabetes mellitus and infection are associated with more post- operative adhesion.

Adhesion colic often presents as intermittent abdominal pain that is not related to menses. Some may experience vomiting.

Pain due to adhesion colic is usually mild in nature and resolves by itself. Moderate pain may require painkillers and anti-spasmodic drugs. Uncommonly, severe unrelenting pain associated with bowel obstruction requires surgical release of the adhesion band.

Hypertrophic scar/ Keloid/ Granuloma

Hypertrophic scar, keloid or Granuloma are enlarged, thickened overgrowth tissues over the Caesarean scar. Hypertrophic scar is very common, occurs in 40-70 percent and keloid in about 15 percent of patients after Caesarean section.

You may have some pain and occasionally feel numbness over the scar.

Treatment options include injectable or topical steroids, painkillers, laser, cryotherapy and surgical excision of the keloid or granuloma.

Scar Endometriosis (SE)

Scar Endometriosis is very rare, occurring only in less than 1 percent. It is a very rare complication of Caesarean section. SE happens when the lining of the uterus (endometrium) grows into the Caesarean scar. SE may present as crampy abdominal pain during menses, thickened Caesarean scar, bleeding from the scar during menses, tightening of the muscles in the lower abdomen causing low back pain and occasionally limb weakness.

Due to its rarity, diagnosis is challenging, and they are often misdiagnosed as other conditions leading to late diagnosis. Ultrasound, Computed Tomography (CT scan) and Magnetic Resonance Imaging (MRI) may help to clinch the diagnosis. Mild to moderate pain may be treated with painkillers and hormonal therapy to regulate the menses. Surgical removal of the endometriosis is the ultimate treatment.

Cramps over Caesarean scar is not associated with serious conditions in most instances. Nevertheless, persistent cramping pain is not normal. Do seek medical attention and consult your Gynaecologist for further evaluation and reassurance if you experience these symptoms.

“Cramps over Caesarean scar is not associated with serious conditions in most instances.”