Abdominal pain after a caesarean section

Introduction

Despite modern medicine, pain after giving birth is usually unavoidable – a birth by cesarean section is no exception. Abdominal pain after a caesarean section occurs in almost every woman and is harmless in most cases. Occasionally, however, they are the first sign of a complication requiring treatment or a new illness.

Very severe or increasing pain in particular should therefore always be clarified by a doctor. Typically, the abdominal pain will become significantly weaker within a few days or weeks and disappear completely when the surgical wound has healed. Until this time, they can usually be well controlled with effective painkillers.

Causes

The causes of abdominal pain after a Caesarean section are many and varied. By far the most common cause, however, is the operation itself. Regardless of the surgical procedure, the abdominal wall and uterus are fully opened during a Caesarean section.

The wounds that result are much smaller than in the past, but take at least a few weeks to heal completely and no longer cause pain. Because of these surgical wounds, movement, abdominal tension and insufficient protection increase the pain in the first weeks after the Caesarean section. A further, occasionally occurring trigger for pain after the operation is the inflammation of the surgical wound.

This is usually caused by bacteria and, depending on its extent, can be hardly noticeable or lead to very severe pain. In addition to pain, inflammation also indicates reddening, swelling and overheating of the wound as well as overproduction of wound secretion. Due to the conspicuous symptoms, it is usually quickly recognised and treated.

Furthermore, after a Caesarean section – as after all operations in the abdominal cavity – the intestine can be sluggish for a few days. This can lead to severe flatulence and constipation and thus to abdominal pain. Other, much rarer causes of abdominal pain after a Caesarean section are infection of the uterus or peritoneum, a wound healing disorder or post-operative bleeding at the uterus, diseases of the gastrointestinal tract such as a gastrointestinal infection, and bladder voiding disorders.

Diagnosis

All patients are recommended to stay in the clinic for about 1 week after a caesarean section and to be monitored. During this week, regular check-ups are normally carried out to assess whether complications occur. During these examinations, it is also checked whether abdominal pain is normal or a sign of an illness or complication requiring treatment. This includes, for example, an abdominal examination, a check of urine and stool, a check of the uterus and, in unclear cases, an abdominal ultrasound.

Which abdominal pain after a Caesarean section is (still) normal?

Mild to moderate abdominal pain is normal after each Caesarean section. The main pain is usually located in the lower abdomen and at the surgical wound. It usually becomes stronger during movement and when the abdominal muscles are tensed.

While the abdominal pain lasts for only 2-3 weeks in some women, in others it is still noticeable after months. If it lasts for more than 3 months, it is called “chronic”. Chronic pain does not necessarily mean that a dangerous illness is the cause, but it is not normal and should be clarified by a doctor.

It is important to note that regardless of the speed of healing, abdominal pain should be minimal when pain medication is given and physical rest is taken. In the course of time, a tendency to improve must be noticeable. It is not normal if the pain becomes noticeably stronger after a few days.

This should be reported to the treating physician at an early stage so that possible complications can be quickly identified. It is also unusual if painkillers are not (no longer) effective. On the one hand, this could be due to the fact that the chosen medication is too weak, on the other hand, complications such as a wound infection can also manifest themselves in this way.