Seam after caesarean section: rules of care, treatment, possible complications. How long does the suture heal after cesarean Which suture after cesarean is better

A caesarean section is a type of surgical intervention in which an incision is made in the skin, subcutaneous and muscular layers, as well as the uterus in order to extract the baby. Be sure to apply a neat seam after the caesarean section.

Healing occurs individually in each case. But first of all, it depends on the type of incision, suture, the age of the woman in labor and her physique, as well as the correctness of following all the doctor's recommendations.

So, what do mothers need to do and know so that childbirth and the postpartum period pass quickly and unnoticed?

The most important thing after a caesarean section is to suture correctly, quickly and accurately. In total, there are three stages in the implementation of the surgical procedure.

1. Initially, a suture is placed on the uterus. In the operation, a cross-sectional incision is most often used, the total length of which reaches 11-12 centimeters. This is due to low blood loss and rapid healing.
2. At the second stage of the operation, sutures after caesarean section are superimposed on the abdominal cover and muscles of the anterior cavity, as well as tendons and subcutaneous fat. So that after surgery there are no traces left, surgeons use absorbable threads made of semi-synthetic material: vicryl, monocryl, and so on.
3. The third stage is the stitching of the upper layers of the skin. It is carried out only in the direction in which the incision was made.

Types of incisions for caesarean section

IN modern medicine, most often, the following types of incisions are used:

1. Excision of the anterior abdominal wall with a vertical incision. It is carried out in the direction from the navel to the pubis. It is used only in emergency situations that brook no delay.
2. Pfannenstiel section. It has the form of an arc that runs along the entire length of the suprapubic fold. After healing, it becomes almost invisible.
3. Excision according to Joel-Cohen. It is performed with a small incision between the pubis and the navel in horizontal position. Allows you to remove the baby as quickly and accurately as possible.

The Pfannenstiel and Joel-Kohen incisions are sutured with an internal suture, and the vertical one with absorbable sutures.

How to prevent complications after a caesarean section

Immediately after the operation, the woman in labor is transferred to the intensive care unit. Here she undergoes a thorough examination and control by medical personnel. In case of complications during caesarean section, short-term antibiotic therapy is used - it does not entail negative consequences for the health of the child. With a successful outcome of the operation, treatment with drugs is not required.

In order not to open the seam after a cesarean section, it is necessary to strictly follow the doctor's instructions, to avoid injury to the wound. Divergence can occur due to infection of the suture, improper wound closure technique.

In the first 24 hours, the woman in labor is replenished with blood lost during childbirth, and all life support systems are supported. Particular attention from the medical staff is paid to vaginal discharge - if the blood flows profusely, the risk of uterine blood loss is high. In addition, in the intensive care unit, the mother is put on drips for two hours with drugs such as oxytocin and methylergometrine - they quickly contract the uterus - and also put an ice pack on the lower abdomen.

“Immediately after the operation, the patient should learn to turn from side to side, and by the end of the same day, gradually get up: first sit up in bed, then lower her legs to the floor, and then walk around the bed and around the ward with the help of medical personnel.”

At the end of 6 days, ultrasound is performed to check the contractile function of the uterus.

During the entire postoperative period, the dressing is changed, examination and treatment of sutures with antiseptics. The sutures are removed after cesarean on the seventh day after the operation. Usually, immediately after this, the young mother and child are discharged home.

Suture removal and care in the hospital and at home

The treatment of sutures in the hospital is carried out by medical personnel using antiseptics. The duration of complete healing, at the same time, directly depends on the operation performed and the conscientiousness of the woman in labor to care for the scar at home.

The suture is removed in the hospital after a week as follows:

• From one edge, a knot is plucked off with a special tool, holding the threads together.
• The tweezers pick up the thread and gently pull it out.

Does it hurt to remove stitches after a caesarean? There is no single answer to this. It all depends on the sensitivity of the patient. Correctly performed suture removal procedure should not bring severe pain.

Before being discharged home, the patient receives a detailed consultation from a doctor about the rules of conduct during the healing period, as well as necessary measures to prevent complications.

So, mom, after a cesarean section at home, it is strictly forbidden to perform the following actions:

• Lift weights. These include all items that exceed the weight of the newborn.
• Be subject to physical stress. These include strength training or spring-cleaning Houses.
• Long stay in bed. With a small movement in a woman in labor, the scar hurts especially for a long time. This is due to stagnation of blood in the pelvis.
• Rub or squeeze the seam. With excessive discomfort, the scar can become inflamed and give complications.

“If the seam oozes after a cesarean - even a week after treatment - it is necessary to treat the wound. Zelenka or iodine is used for this, while the skin around the scar is lubricated.

What is allowed? The following actions:

1. Wearing a fixing belt on the stomach (bandage).
2. Taking a warm shower. The use of washcloths is not allowed.
3. Maintaining a diet for the entire healing period.
4. Blowing the abdomen with warm air for 30 minutes.

Possible difficulties with the healing of the seam

Quite often, mothers are interested in the question: how long does the seam heal after cesarean? The answer directly depends on the type of suture and possible difficulties with healing. So, there are primary and secondary complications. The first group includes:

Soreness

Immediately after the incision is made on the anterior abdominal wall, the patient experiences pain, which disappears only after a few weeks or months. To reduce its effect, painkillers are administered:

• on the first day: tramadol, morphine and other narcotic drugs.
• during the next week: analgin, ketanov or ketanol, diphenhydramine.

The suture after a cesarean section hurts differently for each patient - it all depends on the type of incision: vertical - up to 60 days, horizontal - up to one and a half months.

Seam sealing

Hardness within 60 days is a completely normal and natural phenomenon: during this period, complete healing takes place. The scar becomes soft only after a couple of years: the longitudinal one passes after a year and a half, and the transverse one after 12 months.

“It’s quite common for women to develop a slight crease above the stitches. It is not dangerous, but only in the absence of pus and pain. The fold contributes to the rapid healing of tissues. However, the presence of a bump should alert: it can be both a kind of scarring manifestation and a malignant formation.

Seam ichor

If the stitches are removed, but the scar becomes wet during the first 7 days, then there is nothing wrong with that: this is how healing occurs. However, if there is an unpleasant smell, color or blood, it is recommended to immediately consult a doctor.

Unpleasant sensations

Is the scar itchy? It's okay: any cosmetic suture after cesarean, healing and tightening, itches a lot. It is strictly forbidden to scratch or touch the seam! If the scar burns strongly, this is a reason to consult your doctor.

Secondary complications include those that appear six months or longer after a caesarean section. These include ligature fistula. This is a disease that occurs as a result of the rejection of threads by the body. It is characterized by a gradual deterioration:

• First, a small tumor forms.
• Then red spots appear.
• Soreness appears.
• Pus is formed.

At the same time, the edges of the wound can diverge, and then converge again - due to a small thread sticking out in it. In this case, you cannot process the seam yourself. You should consult a doctor in a timely manner, who will carefully pull the thread.

Getting back in shape after a caesarean

During the period of recovery and healing of the scar, it is not allowed to carry out a strong physical activity. However, light gymnastics is quite acceptable - even 6 hours after the operation. It is carried out as follows:

1. Light strokes on the abdomen with cross-shaped movements for 3 minutes.
2. Massaging in front and on the sides of the chest from the belt to the armpit.
3. Stroking the back with the wrists and palms from top to bottom and from left to right.
4. Deep breathing with the chest, and then with the stomach, holding the hands, alternately, in the area chest and seams.
5. Rotational movements of the feet, as well as alternate movement of the legs for bending and straightening.

- a type of surgical intervention that is quite common today, during which, as after any operation, the body remains small size the seam. And despite the fact that a pregnant woman knows in advance about the upcoming operation (at about 20-22 weeks, when all the tests were taken and the first ultrasound was done) and she, so to speak, has time to prepare (mostly mentally), there are a number of questions that continue to bother her

For example, how long does a cesarean section stitch heal, will it be noticeable, how to care for it, and what to do if the incision becomes inflamed or parted. An experienced doctor (obstetrician-gynecologist) should answer all these questions to the woman in labor immediately before (for better digestibility) and, of course, after the operation. In addition, do not be shy and contact the doctor at the site (the therapist or gynecologist) with questions of interest and problems that arise regarding the state of the suture after surgery, after returning home.

4. What to do if the seam after cesarean is inflamed
5. Small tricks for a quick recovery
5. How to remove the seam after a caesarean section

Types of seams

The condition of the suture after the operation depends, first of all, on how the caesarean section was performed: according to plan or urgently.

After all, if a woman knows in advance about the upcoming operation, she will be able to “tune in” to fast recovery After all, it is not in vain that they say that thoughts are suggestible.

And it’s a completely different matter when a pregnant woman who went to a natural birth, for quite understandable reasons, mainly of a medical nature, decide to be caesarean - hence the fear and panic about the current situation.

After the operation, the suture remains on uterus (internal) and skin (external).

As for the direction - the incision can be made vertically- from the navel to the pubis (most often during emergency surgery, if bleeding begins or there is a threat to the life of the baby or mother) and horizontally- transverse seam (similar to an arc). It is located on the skin fold near the pubis (they also joke - like a “smiley face” on the stomach). And if in the first case the seam is far from being so beautiful even after a certain period of time has elapsed, then a horizontal incision (in medicine this operation is called Pfannenstiel laparotomy) is more aesthetic and over time (of course, subject to certain rules) it becomes almost invisible. In rare cases, a transverse suture is made, located 3 cm below the middle of the distance from the navel to the womb (laparotomy according to Joel-Cohen).

Care, peace and no burdens

So how does the healing process go?

In order for the condition of the woman after the operation, whether she or emergency, to stabilize, 5-7 days must pass (from the moment of the surgical intervention to discharge from the maternity hospital). During this time, the woman in labor will receive the necessary course of antibiotics and other medicines that help reduce pain, compatible with breastfeeding.

In the first 2-3 days, painkillers are required, then they can be given as desired, depending on how much pain is felt in the abdomen and uterus.

Gradually, addiction to this kind of pain occurs, and besides, you need to understand (and especially accept!) That when the mother and baby return home, most of the pills that can relieve pain are contraindicated for her. But do not be afraid - the pain will gradually go away, especially if you follow a number of rules prescribed by doctors.

The only thing that you really have to endure is the first discomfort after the operation. 10-11 hours after surgery, the woman in labor is asked to get up and, moreover, to begin to move actively. And this is very important, because the more you move, the faster the pain goes away and the seam heals. It is even allowed to sit, but just do not lie on your back all day.

Firstly, bedsores can form, secondly, the seam can fester, and thirdly, less movement means more pain.

If a woman is full, a postoperative bandage will help to cope with painful omissions.

Do not confuse it with postpartum, it is advisable to purchase a postoperative one, as it will help at least somehow immobilize the wound when moving. Feel free to ask a nurse or roommate to "pack" you into this wonderful corset, the main thing is that as a result you can walk and carry the baby in your arms.

While the woman is in the hospital, the nurses carefully look after her suture - they treat it with brilliant green, and in case of suppuration, they open it and clean it.

It happens that the seam begins to get wet - due to insufficient motor activity, lack of air access (especially if a pocket is formed from an overhanging abdomen), the temperature rises or other complications arise. All these inconveniences are completely eliminated, the main thing is to notify the doctor in time (if he himself does not notice the problem during the daily examination) about the discomfort.

After 7 days there is an extract. If the seam is cosmetic, the threads are not removed from it, only knots are removed along the edges, and over time, the remaining particles disappear on their own. If the seam is made vertically, the seams will be removed from it only after 7 days (in general, it takes about 14 days to heal). To do this, a woman should come to the emergency department of the maternity hospital in which she gave birth and see the doctor on duty.

After discharge, the suture must also be carefully looked after. In no case do not rub it with a washcloth when taking a shower, since it is not recommended to take a bath until complete recovery (and this is 2 months). It is advisable to simply soap your hand with household (it dries better) or baby (ph-neutral) soap, but flavored cosmetics should be avoided, as they can cause allergic reaction, rinse the seam and rinse with water. Then dry thoroughly with a towel.

By the way, the occurrence of allergies at the site of the seam is not such a rare occurrence. This can happen for any reason - an overabundance of antibiotics in the blood, an "inappropriate" remedy for healing, and, finally, just a reaction to brilliant green.

What to do if the seam after cesarean is inflamed

If the seam after a caesarean section is inflamed, reddened, or even partially dispersed (as if the skin was neatly divided into two parts), you can try to treat yourself or consult a doctor. Of course, the second option is preferable, but, having assessed the situation, it is possible to cope on our own. And then again brilliant green will come to the rescue - it will dry, hydrogen peroxide - “kills” the infection (until the place of the seam stops hissing) and healing ointments and powders.

Medicines are very good in such cases - Baneocin powder and Levomekol ointment, but both have side effects, so read the instructions carefully and pay attention to the condition of the seam and abdomen after applying them. If it suddenly happens that the seam has opened after a cesarean, contact your doctor as soon as possible, as there is a risk of infection, and in rare cases, the inner seam may also open, and this is a repeated hospitalization and a possible mini-operation.

It happens that the seam after a caesarean section becomes hard– keloid, red in color and quite thick. This kind of scars occur only with a longitudinal incision. They can be smeared with ointments to reduce the effect, or you can seek help from plastic surgery professionals.

Little tricks for a quick recovery

To avoid discrepancy and contribute to the rapid healing of the suture after a cesarean section, following several rules will help:

• Do not lift weights - it is allowed to pick up only your baby;
• Feeding - only in the supine position, at least in the first months;
• Wearing a bandage - it does not allow the internal organs to move strongly, causing pain;
• Compliance with the rules of hygiene and diet so that the intestines and stomach return to normal faster;
• Carrying out daily therapeutic exercises.

And one more little trick - every time you have to get out of bed, use one hand as a kind of weighting device, for example, if you are trying to get up through your right side - put your right hand on your stomach and lightly press it in the navel area, as if holding it on one place, and left (over right hand) grab the side of the bed or something else and pull yourself up. And vice versa - right to left, if through the left side. At first, this will help you quickly cope with the difficulties that arise when getting out of bed.

Doctors also advise getting up on tiptoe after surgery and walking around for a few minutes a day. As for the exercises, their action is aimed at relieving pain in the spine (especially the calf), legs and abdomen.

It is very important to lie on your stomach as often as possible. In this position, the healing process is accelerated, the uterus begins to contract more often, which leads to an improvement in the general well-being of the woman.

Very efficient heating

It can also be like warming up. For example, in some maternity hospitals today there are magnetic devices, the action of which is aimed at the rapid healing of wounds received during the operation.

Sometimes it happens that there are painful and pulling sensations along the edges of the seam - you should not be scared, unless of course there are a number of other conditions. Perhaps, during the operation, they took a little extra skin - everything goes away with time. The same applies to slight twitches, as if the nerve in the tooth is pulling. If you move a lot, all pain will disappear. And definitely - breast-feeding, it is best to help cope with any manifestations of pain.

How to remove a stitch after a caesarean section

Many women are also interested in the question: how to remove the seam after a cesarean section. The solution to the problem is possible, but only after complete healing and ultrasound. By the way, after a cesarean, the diagnosis of the state of the seam is done 2 months after the operation, then every six months. According to the data obtained during the study, it will be possible to see what condition the internal suture is in, whether there are adhesions or fistulas, how the external suture has healed.

The best option for seam correction is laser resurfacing, which removes damaged tissue from the incision. However, this process is very painful and requires a course of medications that exclude the occurrence of any kind of infection at the site of the scar.

The most expensive procedure is suture excision, when coarse collagen particles and vessels that have grown at the incision site are removed under local anesthesia along with excess skin and a new abdominal contour is formed.

It is also possible to carry out a chemical peel, grinding the seam with aluminum oxide (microdermabrasion), get a tattoo or simply apply a special tool that helps to make the postoperative seam invisible. The components that make up this kind of ointment help prevent the appearance of scar tissue, as well as increase collagen production and help reduce the size of the scar.

A caesarean section is a surgical delivery procedure. Its essence lies in the fact that the doctor cuts the skin and muscle tissue, the uterus and removes the child. The healing period and the aesthetic appearance of the scar in the future largely depend on how and how well the sutures are then applied to the cut tissues.

Types of stitches after caesarean section

The appearance of the future scar depends on many factors - how the incision was made, how the stitches were applied and what kind, how the recovery period went. Every woman is different and the healing process is different for everyone. Fortunately, with the high-quality work of the surgeon, full care and the absence of complications, the suture heals within a few weeks, and six months later, only an inconspicuous postpartum scar reminds of the operation, which is almost impossible to completely get rid of.
With a horizontal incision, there is no opening of the abdominal cavity, and the scar from a caesarean section will subsequently become almost invisible

Depending on the type of incision, the following types of seams are distinguished:

1. Horizontal seam. The optimal variant of the cut today is horizontal. It is done during a planned operation, when the date and time of birth are set by the doctor. This type of operation is called a Pfannenstiel laparotomy. A transverse incision is made along the natural skin fold under the abdomen, directly above the pubis, while the abdominal cavity is not affected. After removing the baby from the uterine cavity, cosmetic sutures are applied, which are not noticeable after healing.
2. Inner seam. Superimposed on the incision of the tissues of the uterus. The main task in this case is to optimize the healing process, make the seam strong and reduce blood loss, and speed up the healing process. The success of bearing subsequent children largely depends on this. Both hardware suturing techniques and manual ones are used, at the discretion of the surgeon.
3. vertical seam. It is practiced during an emergency operation, when seconds count, and delay is dangerous for the life of a baby or a woman in labor, for example, with acute fetal hypoxia or heavy bleeding in a woman during natural childbirth. In this case, the incision is made vertically from the navel to the pubis. This method is called a corporal caesarean section. Such a seam heals for a long time, has a pronounced character, and over time can become thicker and thicker. At the same time, the suture on the uterus is longitudinal, it is sutured with strong synthetic self-absorbable threads. The abdominal cavity is also sutured with stitches. Muscle tissue during corporal caesarean section needs a strong screed, cosmetic sutures are inappropriate here. After healing, such a seam does not differ in aesthetics, the scar has a nodular character.

Incision healing

The period of suture healing is inevitably accompanied by painful sensations, because a deep incision is made on the abdomen. Its timing is individual. In general, experts say that discomfort can last from 2-3 weeks to six months.

Factors affecting the healing time:

• type of sutures. If the operation was planned, without complications, a horizontal incision was made, cosmetic self-absorbable sutures were applied, the tissues will heal faster than with a corporal incision with strong sutures or staples;
• scar condition. With the formation of an inelastic scar, the seam for 3–6 months causes pain when the tissues are stretched during movements of the abdominal muscles;
• adhesion formation. Damage to the muscles of the peritoneum and internal tissues can lead to the formation of adhesions - dense blood clots that cause discomfort for 1.5–2 months after childbirth;
• body features. Each organism is individual, the sensitivity of nerve cells and pain threshold each woman is also different. This is especially evident in the first days after childbirth, when a “hardy” woman in labor almost does not feel serious discomfort, and the other cannot get up because of pain;
• problems with the gastrointestinal tract. Unpleasant sensations in the seam area can also cause digestive problems, when pressure is exerted on damaged tissues due to the accumulation of gases;
• timing of uterine contractions. Intensive contraction of the uterus occurs in the first days after childbirth, when a woman feels a throbbing sharp pain. The tissues of the uterine wall are damaged during caesarean section and require additional time to heal.

If a month after the cesarean section, the pain does not go away, it is recommended to consult a gynecologist, as well as to do an ultrasound scan and undergo an examination. This will eliminate or detect possible complications after childbirth.

Photo gallery: wound healing by months

Stitch care at home and in the hospital

The rate of healing of external tissues and the aesthetics of the scar in the future largely depend on how high-quality and complete the care of the suture will be. While the woman in labor is in the hospital, care is provided by the medical staff, and upon discharge, she is given instructions on how and how to process stitches at home.

in the maternity hospital

In a hospital setting, the medical staff performs the processing of the seam:

• after a caesarean section, the woman is transferred to the intensive care unit, where she stays for about a day or more, if necessary;
• the seam is treated with green paint or other antiseptic solutions by doctor's prescription;
• the bandage is changed daily;
• After 5-7 days, the sutures are removed (except for self-absorbable ones). This is usually done before discharge from the hospital. First, the doctor cuts off the knots at the edges, then pulls out the entire thread. Pain at the same time, they are individual, but in most cases insignificant. Anesthesia is not required for this;
• before discharge, an ultrasound scan is done, the degree of healing and contraction of the uterus, the condition of the sutures are examined.

After discharge

Discharge from the hospital does not mean that the body has recovered. The woman still needs special care, including stitches after surgery. The following rules must be observed:

• cannot be overstressed physically. Doctors advise not to lift anything heavier than a newborn baby. It is not recommended to play sports for the first 2 months after childbirth. But walking will benefit - you need to walk at a moderate pace;
• seam processing should be done daily. Most often used green, iodine. Antiseptics are applied with a cotton swab with gentle movements around the scar. The wound does not need to be covered with a band-aid, air access is necessary for speedy healing. Treatment time depends on the condition of the wound. If it does not get wet, dried crusts of blood have self-removed approximately 1-2 weeks after discharge, then the treatment can be completed;
• underwear should be made from natural materials. Pants - high, so that the elastic does not rub the seam;
• to promote scar healing and fix the stomach, you can wear a postpartum bandage while awake;
• you can wet the seam, the shower should be daily, but you can’t rub the scar with a washcloth;
• nutrition after cesarean section should be dietary in order to normalize bowel activity.

If you find any problems with the seam, you should seek the advice of a doctor.

I was also treated only in the hospital. In the shower they said not to stick anything, only after a shower for 2 weeks, anoint with green paint and that's it!

Maria

http://eka-mama.ru/forum/part23/topic141717/

I have a horizontal one, the muscles were not cut, they were moved apart. But, the numbness did not go away completely, 3 years after the birth. It itches all the time, I smear with a moisturizer, it helps.

the guest

http://www.woman.ru/health/woman-health/thread/4054321/

Possible Complications

A caesarean section is a serious operation during which the integrity of the skin, muscle, abdominal tissues, and uterine wall is violated. Problems with the suture can occur both in the first weeks after childbirth, during healing, and several years later. Depending on the period of their occurrence, early and late complications are distinguished.

Early complications:

• hematoma or bruising. Most likely, during the operation, damaged blood vessels were sewn up poorly. The reasons may be a careless change of dressing, and improper treatment, and premature removal of sutures when a fresh wound is again mechanically touched;
• seam split. Occurs quite rarely, usually within 1-2 weeks after surgery. The seam may crack, disperse at the edge or completely along the entire length. Perhaps an infection has entered the tissue and prevents fusion. Another option - a woman in labor lifted weights, actively engaged in physical labor;
• redness and inflammation of the seam. May occur due to inadequate care or infection of the wound.

Especially dangerous are the conditions when the seam fester, diverge, bleed, swell. This may increase body temperature, which indicates infection. You need to see a doctor urgently. As a rule, anti-inflammatory drugs, antibiotics in the form of ointments and tablets are prescribed. If the case is advanced, additional surgical intervention may be required, which will negatively affect the aesthetics of the scar.

after the second caesarean, on the 4th day, they removed the patch and allowed me to go to the shower, it was still in the RD ... after the shower I pulled it on, sorry for the shorts, I completely forgot that I need to distribute them below the seam ... in general, the fabric safely stuck to the seam, and I I jerked with all my foolishness when I went to the toilet as a result, in a couple of places the seam turned out to be turned out, nothing, they processed it, they discharged me from the cop on the 7th day. At home, the seam was a little wet, I smeared it well with brilliant green, went to bed - I didn’t specifically cover it with anything so that it was blown with air, it healed in 5-7 days

Olga Mladenova

https://deti.mail.ru/forum/v_ozhidanii_chuda/rody/gnoitsja_shov_posle_kesarevo/?page=2

... I went to the surgeon, they pulled out a thread of cm 4, after a week of dressings with levomekol and potassium permanganate, everything dragged on!

Julia

https://www.baby.ru/blogs/post/37006209–14907231/

Late complications:

• ligature fistulas. This phenomenon manifests itself months after the operation. The tissue becomes inflamed in the area of ​​​​the threads with which the blood vessels are sewn together. There is swelling, nodular compaction, redness, then suppuration. The body rejects the suture material. Treatment with drugs is ineffective, surgical removal of the fistula is required;
• hernia. It is formed quite rarely, with a vertical seam or the presence of several seams from different operations. A protrusion appears in the seam area, accompanied by painful sensations. Remove the hernia by dissection surgically;
• keloid scar. This complication is only aesthetic in nature and is not harmful to health. The tissue damaged during the operation can grow unevenly, as a result, the seam becomes wide, rough. You can try to eliminate this complication by conservative methods: using ointments, creams, laser exposure, ultrasound, liquid nitrogen. Surgical excision of the scar is considered the most effective.

Recovery period problems

During recovery, a woman may encounter certain problems, some of which require a visit to a doctor:

• pain sensations. The pain is most acute immediately after the operation. In a maternity hospital, a woman must be prescribed painkillers, analgesics, which are administered intramuscularly. After discharge, she can use painkillers in the form of tablets. It is important to consider that these drugs are compatible with lactation if breastfeeding is practiced. It is necessary to consult a doctor who will help you choose the best painkillers. The seam can hurt for several months, and discomfort in the incision area can persist for up to a year;
• scar thickening. The seam can become hard and hurt - this is how tissue heals. The vertical scar retains its hardness up to 1.5 years. The horizontal seam softens during the year. The fold directly near the seam can also be compacted. If there are no signs of inflammation, then this phenomenon is not dangerous. If the seal is in the form of a bump, you need to apply for medical care. Perhaps this is a symptom of a hernia, fistula or other complications;
• seam discharge. The ichor (clear liquid) released from the suture in the first weeks after the operation should not cause concern. However, if the discharge is purulent or bloody, you will need to see a doctor;
• itching. The fact that the suture itches is a confirmation of tissue healing. However, the scar cannot be combed. The reason for anxiety can be itching, accompanied by burning and pain.

Video: doula talks about caesarean section

Doctors recommend planning a subsequent pregnancy after a caesarean section no earlier than 2 years after the operation. However, if an unexpected conception occurred earlier, gestation may be possible. At the same time, the condition of the suture is carefully observed by means of ultrasound - whether it has managed to heal completely, is there a risk that it will disperse due to an increase in the uterus. Subsequent births can be natural if there are no contraindications to this, but only the doctor makes the decision.

The cosmetic suture after the operation allows you to mask the trace of the surgical intervention as much as possible. But why sometimes a rough scar in the form of a fish skeleton or just a sloppy uneven line remains on the operated area? The fact is that a cosmetic suture can not always be applied due to the characteristics of the operation performed (the site of the incision, the severity of the wound). Therefore, sometimes it is necessary to mask surgical sutures with the help of additional cosmetic procedures.

Suture materials for cosmetic suture

The requirements for surgical sutures were formed during the entire process of development of the surgical business. Initially, they had to be simply strong in order to eliminate the risk of wound divergence and infection. Then they began to attach importance to appearance, especially in visible areas of the body (face, neck). Gradually, not only various types of surgical sutures began to appear, but also suture materials, as well as needles, on which the visibility of the future scar also depends.

By the way! A cosmetic suture differs from a conventional surgical suture precisely in its appearance. It is almost invisible and is the thinnest line that follows natural outlines (sometimes it resembles a wrinkle or crease, for example, on the neck or in the lower abdomen).

Self-absorbable threads that do not require removal have gained particular popularity today. They are of an organic nature, therefore, over time, after suturing, they simply disappear under the influence of biological fluids (blood, lymph) and enzymes, in particular, proteins. Such threads are often used in dentistry so that the doctor, when removing the stitches, does not once again disturb the delicate tissues of the gums.

Cosmetic self-absorbable sutures are often placed using a suture material called MedPGA. The last three letters mean that the threads are made on the basis of polyhydroxyacetic acid.

Initially, this thread is very strong and allows you to firmly sew the edges of the skin. On the 20th day, approximately 50% of its strength remains, but this is enough to hold an already healed wound. Completely MedPGA resolves in 60-90 days.

There are also three more types of self-absorbable surgical sutures used for cosmetic sutures.

1. Catgut. The resorption time is from 1 to 4 months, depending on the diameter of the thread and the operated area.
2. Lavsan. Dissolves faster than catgut: from 12 to 50 days.
3. Vicryl. An analogue of catgut. Vicryl suture resolves, on average, in 70-80 days.

Types of sutures in surgery

Of all the surgical sutures, only a few are cosmetic. And not always the doctor has the opportunity to impose them. After all, the elasticity of the skin and its surface tension depends on the operated area and the depth of the wound.

When evaluating a wound, the surgeon first tries to determine if a cosmetic suture will fit. Moreover, it does not matter on which part of the body the operation is performed, and what gender the patient is. And the saying “scars adorn men” is inappropriate here, because the doctor always tries to minimize the visibility of the scar.

Therefore, conventional surgical sutures are used only in extreme cases, when it is impractical to risk aesthetics due to a complex or deep wound. Also, depending on the situation, the surgeon chooses which suture materials to use, i. whether these will be self-absorbable sutures, or after some time they will have to be removed.

If there was no scar left on the abdomen after cesarean, then, probably, more women would prefer this method of delivery. After all, many are not afraid of the fact itself abdominal surgery(and in fact this is it), namely the presence of an ugly scar on the stomach. In addition, very young girls who do not want to lose their attractiveness due to a huge scar often become mothers.

A cosmetic suture after a caesarean section will not be particularly noticeable if a planned operation was performed with a transverse incision in the pubic area. Due to the anatomical features, the sutures will be applied continuously and they will heal quickly. The remaining thin scar will pass along the lower fold of the abdomen, i.e. along the line of underwear.

By the way! If the incision site after a caesarean section hurts, you should consult a doctor. You must first find out the exact cause of the pain (infection, spasm, hernia provoked by surgery), and not take painkillers without a prescription, as mothers often do.

For an emergency caesarean section, doctors sometimes have to make a vertical incision from the navel to the pubis. The scar will be noticeable for two reasons. Firstly, because of the location, and secondly, because of the peculiarities of the stitching technology. The resulting nodules will subsequently thicken, and the scar will not only be wide, but also convex. To eliminate such a defect will help plastic suture after cesarean section.

Can I remove stitches myself?

Doctors usually forbid any kind of influence on the seam, but patients still sometimes pull out protruding threads. If they remain after the removal of the suture by the doctor, then, as a rule, nothing terrible happens. But if these are self-absorbable threads, then it is better not to do anything, but to wait until they dissolve naturally.

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 of labor. The imposition of internal and external seams for a woman in labor has already become a habit and is not surprising. But if we can see the external seams and observe the process of their healing, then the situation is completely different with the internal ones.

Classification of internal postpartum sutures and their characteristics

The internal genital female organs, which are directly involved in the birth of the baby, are subjected to mechanical stress, which leads to ruptures and cracks in the soft tissues. Internal damage cannot be seen with the naked eye. The gynecologist discovers them as a result of a thorough examination with a surgical mirror, and then sutures them.

Internal seams, depending on the place of application, 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

Ruptures of the soft tissues of the cervix and vaginal walls are formed as a result of incorrect actions of the woman in labor, as well as the physiological characteristics of the fetus and the woman's genitals. In the process of labor activity, large gaps and small cracks occur that require surgical intervention and suturing.

The most common causes of damage to the internal genital organs:

• wall inelasticity;
• large size of the fetus;
• 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 nulliparous women. With the second and subsequent births, this takes less time. With rapid childbirth, as well as false contractions, when the woman in labor begins to push, and the cervix has not yet fully opened, the soft tissues of the genital organs are torn under the pressure of the baby's head. If the gynecologist is present at the birth from the very beginning of the contractions, then he will prompt and at the right time stop the woman in labor from premature attempts.

Features of the imposition of internal sutures on the cervix and vaginal walls after childbirth

The first two or three hours the cervix is ​​devoid of sensitivity, so the stitches are applied without anesthesia. But when it comes to stitches on the walls of the vagina, which are strewn with nerve endings, then they resort to local anesthesia novocaine or lidocaine.

In order not to expose 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 thread vicryl. Resolves within 50-85 days;
• semi-synthetic thread kaproag. Dissolved within 180-210 days.

The stitches on the cervix do not cause discomfort and do not disturb the woman in labor, while the stitches on the walls of the vagina ache and hurt for a few more days.

Internal sutures for caesarean section

A caesarean section involves the dissection of the anterior abdominal wall, fatty tissue and the anterior wall of the uterus.

Types of incisions on the uterus for 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 the fastest healing of the wound;
• classic transverse in the upper part of the uterus, which is characterized by large blood loss, as it passes in the place of accumulation of blood vessels;
• vertical, from the navel to the pubis, is done with the wrong location of the fetus.

According to medical indications, the seam is:

• 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 caesarean 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 a mother of a three-year-old girl, I also have a “smile” from a cesarean 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.
Uterine suture is performed with self-absorbable sutures

The incision on the uterus, as a rule, is sutured with a single-row or double-row suture without interruption with special absorbable threads:

• dexon;
• vicryl;
• monocryl;
• kaproag and others.

While the longitudinal seam and the classic “decorate” the body of a woman 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 superimposed under the fat fold.
It is impossible to get rid of the longitudinal seam even with a laser

Stitches after a caesarean 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 hospital, as an anesthetic, given that the woman is breastfeeding, you can take:

• Paracetamol and Panadol;
• Nurofen, Ibuprofen, Ibufen;
• No-shpu. One-time non-systematic reception medicinal product will not harm the baby.

If the pain constantly bothers a woman, then it is better to seek the advice of a gynecologist.

It is possible that the transverse suture in the lower segment of the uterus decreases or not, depending on the complexity of the delivery and the skill of the surgeon. Exactly three years have passed since the appearance of the seam, but a kind of thread-like unevenness still betrays the secret of my daughter's birth.

Seam care

Internal seams do not demand special leaving. The optimal treatment is the complete absence of external interference in the woman's body, peace and keeping the genitals clean.

If a woman's genitals are severely damaged during childbirth and large gaps are observed, then a course of antibiotic therapy is often prescribed to prevent suppuration and infection. The duration of the course of antibacterial therapy with injections 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 the body. breast milk and do not harm the baby, so there is no need to stop lactation.

The group of safe antibiotics allowed during lactation include:

• 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 broad-spectrum, refers to synthetic antibiotics of the penicillin group Cefazolin is poorly absorbed from the gastrointestinal tract and therefore is used in the form of injections

Rules for the behavior of a woman after childbirth

After childbirth, a woman must follow 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, postpartum pads should be used, then hygienic ones, which are changed every 2-3 hours, since the woman will have postpartum discharge - lochia for another two months;
• take a shower at least twice a day;
• do not sit down 2-3 days after birth. The main position is lying or standing, you can sit down only on one buttock;
• heavy lifting, including the child, should be avoided;
• it is worth normalizing the diet by including more liquids and soups in the diet. In this case, bread and other fixing foods that cause constipation should be excluded;
• it is not recommended to wear tight underwear that constrains the perineum and vaginal walls in order to avoid rupture of the seams;
• you should refrain from sexual activity for two months until the stitches heal and the elasticity of the vaginal walls is restored.

When to see a doctor: the first alarming symptoms

Every healthy woman needs to visit a gynecologist at least twice a year. New mothers who have given birth with sutures need to undergo an examination once a month to identify pathologies and monitor the correct healing of sutures.

Incorrectly fused sutures and scars formed 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 the period of bearing a child, and the scar may prevent its closure.

How to speed up the healing of internal seams and make this process less painful

For the speedy healing of tears, 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:

1. Tighten the muscles of the vagina, perineum and anus.
2. Hold your breath for 3-4 seconds.
3. To relax.
4. Repeat for ten minutes.

In addition to a number of painkillers prescribed by the attending physician, women take a cool shower to relieve pain or apply ice to the abdominal cavity at the site of internal sutures.
Ibuprofen can be used to relieve pain during breastfeeding

Perhaps, earlier, girls with stitches after childbirth were looked at as sick, and bed rest was prescribed, but now everything has changed radically. After 10 hours in the intensive care unit after a caesarean section, I was lifted up and asked to go to the personal hygiene room on my own. Yes, it was not easy, and most importantly, scary. But I did not feel any pain at that moment, except for the feeling of discomfort from the urinary catheter. Six hours later, as they were 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 get there. Either so lucky, or from constant movement and the desire to get to my feet as soon as possible and see the baby, but I did not feel pain either for the first three days, while the painkillers were pricked, or the next, when they canceled.

The first signs of complications after the application of internal sutures

If a woman feels changes in the body and discomfort, this is the first sign that a gynecologist's consultation is necessary.

Complications after surgery:

• the seam came apart. As a rule, this happens within three days after the operation as a result of lifting weights over four kilograms, exerting effort when emptying the intestines, or when the suture is not properly applied;
• the seam became inflamed, festered. More often this happens if the woman in labor has infectious diseases left untreated before pregnancy or due to non-compliance with the rules of personal hygiene.

Postoperative symptoms of complications include:

• a sharp increase in body temperature up to 38-40 ° C. Temperatures up to 37.5 ° C are considered normal until the moment the seam heals;
• vaginal discharge with an admixture of pus and an unpleasant odor;
• heaviness and pulling pains 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 plentiful, but gradually their number decreases. The discharge acquires a smearing character and becomes a grayish-yellow color. The sudden onset of bleeding, which is accompanied by weakness, dizziness, pallor of the skin, rapid breathing and pulse, constant chills, should alert the woman.

All these signs are a signal of suppuration or divergence of the seam and infection of the body. At the first symptoms of complications, a woman should urgently contact a gynecologist.