Dear Doctor,

It’s been two years since I gave birth. My C-section scar recently started swelling and itching. I was advised by relative to look for creams from pharmacies as they will help. However, I do not want to find myself in deeper problems. Should I be worried? Will the swelling and itching go down?

Jackie

Dear Jackie,

You have not stated whether it is the first time you are experiencing this swelling and itching after a Caesarean section or it has occurred before as well? Do you have a keloid (hardened itchy skin) over the site of C-section?

A C-section incision usually takes eight weeks to heal completely. It may get infected during the time of healing or immediately after that. This can be due to some contamination at that place and is manifested by itching, swelling which is painful to touch, fever, nausea, vomiting, and etcetera. But after treatment, one is mostly symptom free. Till the time of healing, one may experience some pain and itching over the scar. However two years is a long time.

At times, after healing, instead of a normal skin, thickened, hyperkeratotic skin may form over the site of surgery, which is called a keloid. This keloid is mostly dry and itchy. It may get infected due to contaminated hands, or due to irritation caused by some soap or chemicals present in some body product used. This manifests as painful swelling and increase in itching. Infection in either case is diagnosed by clinical features and a full blood count. Treatment is by suitable antibiotic and anti-inflammatory drugs. It is completely curable.

Swelling can also occur, a long time over the surgical site after a Caesarean section due to incisional hernia. Due to some weakness in the abdominal wall, as can happen after lifting or pushing heavy weights, strain on abdominal muscles as due to severe coughing or constipation, the bowels protrude through an opening created in the scar. This forms a soft swelling, at that site, which is very superficial and increases on coughing or straining. Mild cases can be controlled by manually reducing the hernia and keeping it reduced by a belt. Taking precautions to avoid the risk factors causing it, treating identified underlying risk factors can prevent its exacerbation. However, severe cases need surgery.

A uterine tumour or fibroid can also cause swelling over the lower abdomen. However, there would be other associated features present like pain, menstrual irregularities, and etcetera.

Itching over the scar can simply be due to dryness of the skin. It can be corrected by applying a suitable moisturising lotion or cream. It can be due to fungal infection or eczematous dermatitis, both of which are treatable. Allergy to any new body product used or nylon lace of an undergarment can also cause itching over that site. Extensive itching can cause mild swelling as sequel.

Dr. Rachna Pande is a specialist in internal medicine.