I had a caesarean section about a year ago, but my scar still sometimes hurts, itches and even smells. What is going on?

If you have had a caesarean section, you may have expected your wound to be healed and relatively pain-free after a few months. But an estimated 7 to 18 per cent of people develop chronic scar pain after such a procedure, and symptoms like numbness, itching and odour can be common too – sometimes for months or even years after the surgery.

About 30 per cent of births are via a caesarean section, said Ms Katie Kelly, a pelvic floor physical therapist in New Brunswick, Canada. That’s “a lot of women who could potentially have issues”, she said.

Here is what may cause scar-related symptoms and what to do about them.

Soon after surgery

During the six to eight weeks after a caesarean section, it is common to experience pain, soreness and itching around the incision site, said Dr Ashley Rawlins, a physical therapist in Dallas who specialises in pelvic and obstetric health.

Itching can arise, too, because the body produces itch-inducing chemicals called histamines, she said, which increase blood flow to the wound and facilitate healing.

Some people can also have allergic reactions to the disinfectants or adhesives used during surgery, said Dr Angela Lamb, a dermatologist at Mount Sinai Dermatology in New York City, so if the itching is intense or your skin is red and blistery, consult your doctor.

If your incision smells bad during the first six to eight weeks after surgery, it is possible that you have an infection, Dr Lamb said. This could either be a bacterial infection of the wound itself or a yeast infection of the tissue surrounding it, she added.

Call your doctor to make sure everything is healing properly, she recommended.

To reduce the chance of an infection, keep the area around the incision clean and dry, Dr Rawlins suggested. A few times a day, dab the area with a clean, dry cloth to remove any moisture.

Longer-term symptoms

Even beyond the first six to eight weeks, though, certain symptoms can persist.

“Once the wound has healed, I think that some people are very surprised that they can continue to have pain,” Ms Kelly said.

Sometimes, the scar tissue is so tight that it pulls on the surrounding skin or muscle, leading to discomfort, she added. Some women might have trouble bending backwards or extending their legs behind them, or “they’ll feel a pulling sensation on their scar”.

If this happens, a physical therapist can help you relax and stretch the tissue, Dr Rawlins said. You can also try massaging the scar yourself, she added, by gently pressing on it, massaging the area in a circular motion or gently pinching and rolling the scar between your fingers.

A brush from your underwear or pressure from your pants seam can also be a “significant source of pain and itch”, Dr Rawlins said.

She recommended that people with sensitive scars wear softer fabrics, seamless underwear or high-waisted clothing that will not be in direct contact with the tissue.

It is also possible for the muscles near your midsection, like the abdominal or inner thigh muscles, to feel sore for a while, Ms Kelly said. People tend to lean forward during recovery so as not to pull on the incision, but over time, this can cause tight, sore muscles around the hip flexors, stomach and even the chest.

Once your incision has healed, try sitting with a straighter posture, said Dr Rawlins, and do gentle abdominal and thigh stretches such as the cat-cow yoga stretch or a kneeling hip flexor stretch.

Certain nerves can also get severed during surgery, leading first to numbness, and then to aches and pains when the nerves start to regenerate, Dr Rawlins said.

Sometimes, scar tissue can entrap nerves as it forms, causing a burning sensation in the lower abdomen and groin, Ms Kelly added. Nerve pain usually subsides over time, but if it persists, see a physician.

Scars can also keep growing beyond the original incision site and turn into keloid scars, which are thick and raised. These can cause pain and itching too, Dr Lamb said, and may be treated with steroid injections or silicone creams or tapes.

Infections are also possible, even months or years after the scar has healed.

One common infection is called intertrigo, which develops when skin rubs together and moisture builds in the crease around the scar, allowing yeast or other microbes to proliferate.

“It can feel very itchy, it can be painful and it can produce an odour,” Ms Kelly said.

Intertrigo is typically treated with topical or oral antifungal medications or antibiotics.

If you are having a tough recovery, call your doctor, experts say.

Women may feel hesitant seeking help, but “it’s not something that someone has to suffer in silence with”, Dr Rawlins said. NYTIMES