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Last Updated on November 18, 2023 by theosteomum
A C-section “pouch”, sometimes also called a “pooch” or “shelf”, is the bit of softness or roundness that appears above a C-section scar.
It appears because the scar appears to divide your lower belly in half, and the skin and tissue above can hang down a little (or a lot) causing an interruption to what might previously have been a smooth surface.
Many mothers simply weren’t expecting this to occur, and are surprised to find they now have something else to add to their postpartum to-do list.
Related: Postpartum Headaches Everyday- 5 ways to help
But don’t give up just yet- there’s definitely ways to manage it, and it doesn’t have to stay that way forever.
Table of contents:
- What causes a “c-section shelf”?
- Will my C-section shelf go away?
- Will my C-section pooch go away if I lose weight?
- Does everyone get a C-section shelf?
- Why is my C-section shelf so big?
- What is the difference between Diastasis Recti and a C-section pouch?
- Do you need crunches to “fix” your c-section shelf?
- Can you prevent a C-section pouch?
- What are “adhesions”?
- How do adhesions impact both function and appearance?
- What actually helps with the “c-section shelf” appearance?
- How to treat a C-section pouch
- Why is my C-section shelf numb?
What causes a “C-section shelf”?
An obvious statement is that a C-section is a surgery, with a fairly large incision, that your body needs to heal from.
A normal part of healing from such a large wound is scar formation.
And in a normal scar, wound contraction is an important part of healing (1).
This means that it’s normal for the tissue around the scar to “shrink” a little. It looks and often feels “tighter” than it did before.
Shrinking causes the skin around the scar to be pulled inwards, whilst the skin of the rest of your belly remains normal.
The result?
A tight band of tissue in your lower abdomen, which causes the tissue above it to stick out more. Commonly called a C-section shelf.
Will my C-section shelf go away?
Depending on how long ago you delivered your baby, the shelf may decrease in size.
However, without specific treatment, it’s unlikely to completely go away.
With the right management, though, it is possible to decrease how obvious it is.
A combination of lifestyle and genetic factors will determine exactly how much change you can make.
Will my C-section pooch go away if I lose weight?
The honest answer here is- maybe, kinda or sort of.
The shelf is caused by scarring and adhesions that go right down to the level of the uterus. So while people with a larger amount of abdominal (tummy) fat may have more tissue to bulge over the scar, the issue can be quite deep.
When you lose weight, there is likely to be less abdominal fat to protrude over the scar. This may make your shelf less visible. However, untreated scarring will persist. For some women, this will mean that their “shelf” will hang around even after they lose their “baby weight”.
Does everyone get a C-section shelf?
Unfortunately, this is another of those times where life just isn’t quite fair.
Depending on a number of genetic and lifestyle factors, not every person who’s had a C-section will develop a “shelf” afterwards.
Factors that may influence shelf development include:
Age:
Younger skin tends to heal more smoothly than more mature skin.
Genetics and ethnicity:
Skin type is inherited from your parents, and is categorised into 6 “Fitzpatrick” types from lightest to darkest tones (2).
| Fitzpatrick Skin Type | Characteristics |
| 1 and 2 | Lighter coloured skin tones that burn easily in the sun |
| 5 and 6 | Brown to dark brown skin and either rarely burn or do not burn in the sun. |
The risk of scarring increases as you move from Type 3 to 6.
So those with darker skin are more likely to have more significant scarring, and therefore possibly a more prominent “shelf”, than those with lighter skin tones.
Abdominal body fat and muscle tone:
People with more body fat in their belly are more likely to have more tissue to overhang their scar. This can make a shelf appear more prominent than it does in a person with a flat belly.
Similarly, the stronger your abdominal muscles, the more likely it is that everything will be “held together”.
However, it should be noted that the scar will run through all the layers of tissue down to your uterus. So even women with rock-hard abs may have some “shelf” or noticeable scarring, as all of the other layers of muscle, connective tissue and skin are also affected.
As with many things in life though, there’s always exceptions to the rule and a bit of luck that comes into play.
Just because you’re a more mature mother, or have a darker skin tone, doesn’t necessarily mean you’ll develop a C-section shelf.
Similarly, younger mothers or those with lighter skin tones aren’t immune from developing them.
Why is my C-section shelf so big?
According to the Journal of Obstetrics and Gynaecology, the typical C-section scar length is 13-22cm (around 5-9 inches).
This difference of almost 10cms (or around 4 inches) means that some scars will be significantly bigger than others.
The larger the scar, the greater the possibility of a person developing a larger C-section shelf.
This is especially true if you also possess some of the factors listed above which predispose you to a more prominent shelf, such a relatively older age, darker skin tone or larger percentage of abdominal fat.
What is the difference between Diastasis Recti and a C-section pouch?
Whilst diastasis recti and a C-section pouch are often both caused due to pregnancy, that’s about where their similarities end.
Diastasis recti is where the tissue that holds the two halves of your “six pack” muscles together is stretched or weakened.
This can vary greatly in significance, and may contribute to many signs and symptoms, such as:
- A visible line that runs vertically down the middle of your tummy (i.e. up and down from the top of your belly towards your pelvis)
- Lower back pain
- Pelvic floor weakness
- Pelvic organ prolapse
Related: Will I still have pelvic pain after birth?
A small degree of abdominal muscle separation is totally normal in the early months post birth. However, if you feel that your diastasis is on the larger side, or that it is persisting beyond a few months, or if you’re suffering from lower back pain, ongoing pelvic floor symptoms or pelvic organ prolapse, you should consult a pelvic floor PT/Physiotherapist for specialised advice.
In contrast, the scarring caused by a C-section runs horizontally, and so will look quite different to the appearance of a diastasis. It will run across your belly, from one side of your belly to the other.
This means that it’s possible to have both a diastasis recti and a C-section shelf, which may mean that your tummy looks divided into a few parts, or may no longer be as smooth as it used to be.
Do you need crunches to “fix” your c-section shelf?
Because the C-section shelf involves many layers of tissue and not just muscle, it is unlikely that simply doing crunches will “fix” it.
It is possible that losing weight overall and toning up your abdominal muscles may improve the appearance of a C-section shelf, but even women with muscular, 6-pack style abs may still have some noticeable effects of a shelf. This is because adhesions from the scar can have an effect on many other tissues.
Can you prevent a C-section pouch?
Because a C-section shelf often arises as part of the healing process, it’s pretty difficult to avoid developing one.
Some tips to help minimise (but not totally prevent) the formation of a C-section shelf are:
| Follow your Doctor’s advice after surgery | Don’t try to push yourself or lift things you’re not supposed to be. Let yourself rest where possible, and allow your body to heal to it’s fullest capacity. |
| Silicone Scar Strips | Using silicone scar strips or sheets such as these over the wound has been shown to produce up to 86% reduction in the texture of scars. Speak to your health care provider about when it may be appropriate for you to use these strips. |
| Weight gain | Try to keep weight gain within recommended limits during pregnancy. This will help minimise the excess tissue that remains around your scar after delivery. |
| SRC Recovery Shorts | Wear a postpartum support garment such as these SRC Recovery Shorts. Many of the pregnant and postpartum women I see in my clinic swear by these shorts. They’ve also been tested to continue to provide support for over 100 washes- so you’ll love to just wash and wear them for as long as you need them. |
| Breastfeed if possible | On average, exclusively breastfeeding mothers lose more weight in the first year after birth than those who either mix feed or formula feed. This can help minimise abdominal fat, and therefore the appearance of the C-section shelf. Of course, breastfeeding is not always possible for a variety of reasons. In this case, trialling some or all of the above three options may help. |
What are “adhesions”?
An adhesion is a band of scar tissue that joins two (or more) surfaces of the body that are usually separate.
Adhesions are a common occurrence following surgery: up to 93% of people who have abdominal surgery will go on to develop them (5).
How do adhesions impact both function and appearance?
Unfortunately for some people, the impacts of the C-section shelf are more than just cosmetic.
The scar involves multiple layers of tissue, which can form adhesions as they heal. This means that different layers, which normally move freely and slide over each other, become “stuck”.
Depending on the severity of these adhesions, this can lead to a range of symptoms, such as:
- Pain
- Fertility complications/infertility
- Dysparenunia (painful sex)
- Bowel and bladder problems
What actually helps with the “c-section shelf” appearance?
There are a few at-home strategies you can employ. Some, such as the silicone strips discussed above, can be used from relatively early on after your C section.
Other techniques, such as those discussed below, will need the scar to be more mature, and can be started months to even years afterwards. Read on in the “How to treat a C section pouch” for more information.
How to treat a C-section pouch:
There are a few ways you can minimise the appearance of a C-section pouch.
Depending on the size and extent of your “shelf”, you may need to consider some or all of these strategies.
How to fix a C-section shelf without surgery:
There are 3 well-known ways to improve the appearance of a C Section shelf without surgery.
I’ve listed them in order of least invasive to most invasive.
Always get clearance from your C-section provider before attempting these strategies
Scar tissue mobilisation:
The C section shelf predominantly occurs because tissues are restricted by scar tissue that simply isn’t moving well. Mobilising these tissues can have a dramatic impact on the appearance of the scar.
The great news is, it’s really simple to do and best of all- it’s free! No special tools required.
To start, lay on your back on a comfortable surface. Try to have warm hands and wear loose clothing that will give you direct access to your scar.
Feel your way along your scar.
Some things you might feel include:
- Raised or lumpy sections
- Deeper sections that feel like little “holes” in the scar
- Tender or sensitive sections that don’t really like to be touched
- Numb or less sensitive sections
When we start to do this work in my clinic, many women tell me they’ve never really felt their scar. They have looked at it, and often been quite unhappy with its appearance, but that’s about it.
Depending on the details of your C-section, there may be some strong emotions around this area. If working on your scar feels confronting for you, start slowly and give yourself all the time you need. For some women, simply allowing yourself to explore the contours of your scar will be all they can manage for some time. And that’s totally fine!
Once you’re ready, begin to feel how the scar moves. This will differ in varying parts of the scar.
How do you massage a C-section shelf?
Lay on your back with your knees bent.
Starting at one end of the scar, gently keep your hands on the surface, but slowly move them up, down, left and right. This will create a small amount of drag in the skin and tissues underneath it. Use the same type of pressure you’d use if you were massaging your baby.
When you find a point that doesn’t want to move in a certain direction, gently stretch it that way. For example, if one point doesn’t want to move downwards, use a very small amount of force (remember- baby massage!) to move the tissues downwards. You can either hold it down for 10-30 seconds, or gently move it back and forth. After a short time, you’ll probably notice that it can either move a little further, or more freely than it did before.
I usually perform this without any creams or oils. I just keep my hands on the skin surface and move the tissues around, rather than moving my hands over the skin. If you prefer, however, you can use a small amount of lotion and gently move your hands over your skin in a similar manner.
Move your way along the entire length of the scar, freeing up each point in whichever direction it needs.
How long and often should you perform scar massage?
The length of time you need for this will vary, depending on how long your scar is, how much adhesion you have, etc. But as a rough guide, it may take somewhere between 5-10 minutes for you to work your way along.
C-section scar mobilisation isn’t something you do once and then you’re done though. You’ll definitely get better results if you repeat this multiple times over a period of weeks or months.
Leave a few days to a week or so in between mobilisation sessions to allow your body time to adapt.
Cupping:
C section shelf cupping works in a similar way to basic mobilisation, with the difference being you’ll use a cup such as this rather than just your hands.
You’ll also need some massage oil or lotion.
Most women will find they need to start a short distance away from the scar, as cupping is quite a powerful tool that may feel too intense if you just jump straight into using it directly on the scar.
Before beginning this technique, there are two things you should be aware of.
Firstly, this technique can cause some visible redness or bruising on the skin. IThis is nothing to be alarmed about, and is all a normal part of how this technique works.
Secondly, if you leave the suction cup in one place for too long, you’ll possibly end up with circle-shaped bruises or marks on your skin.
Both types of bruises or marks usually fade within a few days to a week, and leave no permanent scarring. However, you need to be aware that they’re a possibility if you have an occasion coming up where you’d rather not have marks on your belly, such as a trip to the beach, photo shoot etc.
Cupping- how to:
Lay on your back with your knees bent.
Apply a decent amount of your chosen cream or oil to the skin of your lower abdomen, from the belly button downwards. You’ll need to put more on than you would if you were simply moisturising your belly, as this will help the cup to glide. As a guide, about as much as an Australian or American 50 cent coin is usually needed.
Squeeze the two sides of the cup together in one hand, then place it down on your skin somewhere just either beside or below your belly button. The stronger you squeeze the sides together, the more suction and more forceful this technique will be.
Due to the design of the cup, as well as the suction created by the cream on your skin, it should “stick”.
Gently move the cup around in small motions- up, down, left and right. Even though you’ve started quite a distance away, many women will feel this as a deep pulling type sensation around their scar.
If this feels too intense for you, you can either start above your belly button, or release the cup by squeezing the sides together again and reapplying it without as much suction.
As with the mobilisation technique, work your way around the abdomen, gently freeing up the tissues in the directions they don’t want to move. As it becomes more comfortable, work your way towards your scar.
Again, the exact time needed for this will vary, but aim for somewhere between around 2-5 minutes. Repeating this every few days to once a week over a period of weeks to months usually gives the best results.
Each time you work through this area, you might find that you can tolerate slightly stronger suction, or working closer to the scar.
Laser:
Some scars will be suitable for treatment with special types of lasers, which have been shown to improve their texture and appearance.
The goal is to help stimulate collagen and elastin production, which can help with scar remodelling.
Evidence suggests that the earlier you start, the better. I.e. newer scars will respond better than older ones, but this is not always the case.
The same evidence also suggests that the ideal treatment plan is for 2-4 treatments around 2-3 weeks apart.
Different types of lasers are used for different types of scars.
This treatment is usually performed by a Dermatologist, who will be able to advise on the right type of laser based on your skin type and the appearance of your scar.
You’re not suitable for laser scar treatment if any of the following apply to you
- The use of oral retinoids within the past year,
- Current pregnancy or breastfeeding,
- Immunosuppression,
- Connective tissue disorders, and
- The presence of any concomitant skin disease at the site of treatment. (3)
Side effects and potential complications of laser treatment include:
- Redness
- Skin irritation such as blistering, crusting lasting up to three months
- Mild to moderate pain during the treatment
For more information, speak to your health care professional.
Surgery:
Scar formation is an inevitable part of any surgery. However, depending on many factors such as the technique of the surgeon, wound infection and your body’s unique healing abilities, some scars’ appearances are simply less than ideal.
If you have tried the above techniques, and are still concerned about the appearance or functionality of your scar, surgery may be an option worth considering.
Surgery cannot erase a scar, but can often help to make it less obvious.
Before undergoing surgery, you’d need to consider and discuss the following points with the surgeon who may attempt to improve your scar’s appearance:
| Expectations | Are your expectations realistic? Does the surgeon truly believe that they will be able to meet your expectations in terms of appearance and function? |
| Surgery/surgeries | How many follow up surgeries would be involved? Are you well placed to be able to fund, recover and rehabilitate following surgery? |
| Timing | Timing is important. It takes around 12-18 months for a scar to mature. Attempting revisions prior to this often gives unsatisfactory results. |
| Overall Health | Your overall health- Ensuring you’re consuming adequate vitamins, minerals and nutrients will provide the ideal healing environment for your scar. Also, pre-existing illnesses such as diabetes mellitus may complicate healing. |
| Tobacco Use/ Smoking | Tobacco use: smoking interferes with blood flow and healing. It is recommended that surgery candidates don’t smoke from 4 weeks before to 4 weeks after surgery (4). |
Why is my C-section shelf numb?
It is impossible to make a surgical incision into the abdomen without causing a disruption to the nerve supply to that area.
These nerves give us the ability to feel touch, pain and pressure. When they are disturbed, they can either stop working for a while, or give out confusing signals.
Because of this, some women will feel numbness or tingling in this area in the weeks, months or years after their C section.
Unfortunately, there is not much that can be done to help this improve any quicker. Some women do find that using the scar mobilisation and massage techniques discussed above actually helps improve their local sensation.
Many women find that over time, normal sensation gradually returns. In a small percentage of women, however, the area will remain permanently numb.
C section shelf- wrapping up:
A C section shelf is a common occurrence following this type of delivery.
Certain features such as age, ethnicity and skin tone will have an impact as to how obvious this shelf is.
There are a number of things you can try at home to decrease the appearance of a C section shelf. If these don’t give you the improvements you’re hoping for, there are other more invasive strategies you could try.
I use the scar massage and mobilisation techniques daily in my practice, and have seen first hand just how beneficial they can be.
If you’ve tried any of these strategies, I’d love to hear from you about the impact they’ve had on your C-section shelf.
