I had a cesarean section and my incision is now itchy; is this normal and how should I manage it while monitoring for infection?

Itching in Cesarean Section Incision After Delivery

Itching at your cesarean incision is a normal part of wound healing and does not require treatment unless accompanied by signs of infection such as fever >38.5°C, spreading redness >5 cm from the incision, purulent drainage, or severe pain.

Understanding Normal Post-Cesarean Itching

Itching is a common and expected symptom during the healing process after cesarean delivery. This occurs as part of the normal inflammatory response and tissue repair mechanisms. The sensation typically develops as the wound progresses through the proliferation and maturation phases of healing, when collagen is being deposited and nerve endings are regenerating 1.

When Itching is Normal vs. When to Worry

Normal Healing (No Action Needed)

• Mild to moderate itching without other symptoms is expected and benign 1
• The incision may feel itchy as subcuticular sutures dissolve (typically 4-0 Vicryl or Monocryl, which are absorbed over weeks) 2
• Some mild redness immediately around the incision line is normal inflammatory response 3

Warning Signs Requiring Medical Evaluation

You need to contact your healthcare provider immediately if you develop any of the following:

• Temperature ≥38.5°C (101.3°F) or heart rate >110 beats/minute 3, 4
• Erythema (redness) extending >5 cm from the wound edge 3
• Purulent (pus-like) drainage from the incision 3
• Severe pain, tenderness, swelling, or warmth at the incision site 5
• Wound separation or opening 3
• Signs of systemic illness such as hypotension, decreased alertness, or organ dysfunction 3

Management of Normal Itching

Safe Symptomatic Relief

• Keep the incision clean and dry with gentle washing 5
• Avoid scratching the incision directly, as this can introduce bacteria or disrupt healing 3
• For mild itching of intact skin around (not directly on) the incision, topical hydrocortisone cream may be applied to surrounding skin not more than 3-4 times daily 6
• Wear loose-fitting clothing to minimize irritation from fabric rubbing against the healing incision

What NOT to Do

• Do not apply topical medications directly into the incision line itself 6
• Do not use antibiotic ointments unless specifically prescribed, as they are not indicated for normal healing 3
• Do not remove or manipulate any visible suture material, as migration can occur 7

Timeline Considerations

The timing of symptoms matters significantly:

• Within first 48-72 hours: Fever and mild symptoms are typically non-infectious inflammatory responses from surgery itself 4
• After 96 hours (day 4): New or worsening symptoms are more likely to represent infection and warrant closer evaluation 4
• Surgical site infections rarely occur in the first 48 hours after cesarean delivery, with rare exceptions being aggressive bacterial infections 5, 4

When Antibiotics Are NOT Needed

Most itching does NOT require antibiotics. Antibiotics are only indicated when there is evidence of actual infection with systemic signs 3. Specifically, antibiotics should NOT be given for:

• Isolated itching without other symptoms 3
• Mild redness <5 cm from incision edge 3
• Temperature <38.5°C without tachycardia 3
• Normal postoperative inflammatory response 4

When to Seek Immediate Care

Go to the emergency department or call your obstetrician immediately if you develop:

• High fever (≥38.5°C) with rapid heart rate 3
• Spreading redness with induration (hardness) or any tissue necrosis 3
• Any purulent drainage, even if minimal 3
• Severe systemic symptoms like hypotension, confusion, or difficulty breathing 3

These signs may indicate surgical site infection requiring prompt incision opening and drainage, with antibiotics added only if systemic inflammatory response syndrome (SIRS) criteria are met 3.

Common Pitfalls to Avoid

• Do not assume all itching means infection - itching is a normal part of healing 1
• Do not start antibiotics empirically for isolated itching - this promotes resistance and is not indicated 3, 4
• Do not ignore warning signs - delaying treatment of true infection can lead to progression to deeper tissues 3
• Do not culture the wound unless signs of infection are present - this wastes resources and may lead to unnecessary treatment 4