Lump above caesarean section scar: causes and what to do next

Noticing a lump above your caesarean section scar can be worrying. But understanding what might be causing the lump will help you make informed decisions about your health.

Clare Bowden, nurse in the 24/7 health support team, for members, explores what the possible causes might be, from a haematoma or scar tissue, an incisional hernia to endometriosis, and suggests what steps to take next.

C-sections (caesareans)

Around 1 in 4 women will have a caesarean birth¹ which is either planned or unplanned. During the operation a 10 to 20cm cut is made in the tummy and womb which will usually be a horizontal cut just below your bikini line.

The womb is then closed with dissolvable stitches, and the cut across the tummy is closed with either dissolvable stitches, or stitches or staples that need to be removed after a few days.²

You should be advised by a midwife how to look after the wound and keep it clean. After any stitches are removed or dissolved then a scar will eventually form. There are, however, occasions where lumps can form over a c-section scar.

We explore what the possible causes might be.

Causes of a lump above caesarean section scar

Infection

Surgical site infection can occur at or near a surgical incision. Bacteria can enter the body through the incision, leading to swelling or a hardness/thickening. Other signs of infection can be redness, heat, tenderness, and discharge from the wound.

Sometimes wound infections can cause the scar to open up. In this case specialist dressings will be required, and the wound re-dressed by a health care professional.

Women who are overweight, smoke, have diabetes or a poor diet have an increased risk of wound infection.³

You can help prevent wound infection by:

• Always washing your hands before and after touching your wound or dressing.
• Wear loose clothing and underwear to prevent friction.
• Avoid rubbing soap, shower gel or talcum powder onto the healing wound.
• Pat the wound dry with a clean towel or clean kitchen roll.

If you notice any signs of wound infection, it is important to seek medical attention. Antibiotics are likely to be required.

Haematoma

A haematoma is a common reason for a lump near a caesarean section scar. It occurs when blood collects in the tissues surrounding the wound. Initially, the lump may appear along with discolouration, similar to a bruise. It can also be inflamed or feel tender or swollen.

Over time, the skin may release old blood as the haematoma resolves. A hematoma under the nail or skin may be painful, but it will not usually cause complications. If it is especially painful, it is best to seek medical attention.⁴ Similarly, if you notice any signs of the wound reopening or not healing, it's important to speak with your doctor promptly.

Scar tissue

Scar tissue forms when the body's tissues are damaged during a caesarean section. As part of the healing process, the body produces collagen, a protein that aids in healing and strengthening the wound.

Over a period of three months or longer, collagen builds up at the wound site, resulting in a raised, lumpy, and red scar. Eventually, some collagen breaks down, blood supply decreases, and the scar gradually becomes smoother, softer, and paler.

Although scars are permanent, they may fade over time, typically within two years.

>Read more about understanding scars and effective care

Incisional hernia

Having undergone a caesarean section, it can weaken the muscles in the abdominal wall, potentially causing tissue to bulge through a weakened area in your pelvic region. If you have an incisional hernia, you may experience tenderness and pain when moving, coughing, or lifting.

Treatment for an incisional hernia can vary depending on each individual case and can also depend on whether an incisional hernia has affected any previous abdominal surgery. A surgeon may need to repair the original surgery before treating the hernia.

If a hernia is small, not causing problems, and not likely to cause any complications, people might not need surgery. They may have to wear an abdominal binder around the abdomen to support the abdominal wall. If an incisional hernia develops a few weeks after the c-section, then a doctor may wait to allow the abdominal wall time to heal and recover.⁵

Endometriosis

Although rare, endometriosis can develop when the lining of the uterus (endometrium) sheds and attaches to scars and other abdominal organs instead of being released normally during menstruation.

As the endometrium thickens and grows each month, lumps can form. Some women may notice tenderness, especially during menstruation.

A study specifically looking at caesarean scar endometriosis (CSE), reported that CSE is the most commonly reported type of abdominal wall endometriosis. It suggested that a caesarean section greatly increased the risk of developing abdominal wall endometriosis due to the direct implantation of endometrial tissue in the caesarean incision. With an appropriate supply of nutrients and hormonal stimuli, these endometrial cells survive and multiply, which finally leads to CSE.⁶

>Read more about endometriosis and the symptoms

If you suspect endometriosis, it is essential to consult your doctor for advice.

What steps to take next…

If you discover a lump above your caesarean section scar, it is recommended to schedule an appointment with your GP or midwife as soon as possible. Your GP will assess the lump, determine its cause, and provide guidance on any necessary treatment.

Seeking prompt medical attention will ensure you receive the appropriate care and peace of mind.

Coming across a lump above your caesarean section scar can be concerning, but understanding the potential causes can help you take appropriate action. Whether it's a haematoma, scar tissue, incisional hernia, or endometriosis, consulting your doctor is crucial for accurate diagnosis and treatment.

Remember to prioritise your health and seek medical advice if you notice any changes or abnormalities near your scar.

Information provided and reviewed by the AXA Health 24/7 health support line team, for members.

References

1. C-sections (caesareans) - everything you need to know – Tommy’s
2. Caesarean section, What happens – NHS
3. Surgical site infections in caesarean wounds – British Journal of Nursing
4. Hematoma: Everything you need to know – Medical News Today
5. What is an incisional hernia? – Medical News Today
6. Cesarean scar endometriosis – BMC Women's Health