Let's be honest; childbirth is no cakewalk. We women and our bodies are abundantly strong and resilient, which is why the scars we carry after delivery, should be seen as nothing less than a badge of honor. We've given life, and with that comes some changes to the body, but not to fear, you can support your recovery.
We connected with Jordan Mrosewske, PT, DPT, to tell us more about the cause of postpartum scars, and the technique to relieve pain and discomfort - scar tissue massage.
Scar Tissue Massage for Perineal Lacerations and Vaginal Tears
Perineal lacerations and tearing of the birth canal are common consequences of childbirth. It can occur naturally or be induced by the doctor through a technique known as an episiotomy. With vaginal tears, the doctor will use dissolvable stitches to repair the torn area, and during the healing process, some may have little to no discomfort. In contrast, others may have discomfort until their first postpartum checkup or even beyond. This discomfort is caused by scar tissue adhesions, areas where different tissues heal stuck together, which can lead to pain with daily activities, difficulty with urination and/or bowel movements, and painful intercourse.
How to take care of vaginal tears.
To decrease the potential for discomfort, you should massage your scar daily, starting anytime after the incision has healed, usually 4-6 weeks following delivery. Around this time, you will notice reduced redness, heat, and swelling in the area. Prepare to perform the scar tissue massage by washing your hands, ensuring your fingernails are short and having a hypoallergenic, water-based lubricant available. Start externally around the tear and then work your way toward the torn site and even internally.
If you are experiencing the discomfort and symptoms outlined above, try this common scar tissue massage technique.
- Apply lubricant to the opening and your thumb
- Insert the tip of your thumb (to the first knuckle) into the birth canal
- Gently press downward towards your tailbone
- Hold for 30-60 seconds with gentle pressure
- Then move a little to the left. Again, apply gentle downward pressure for 30-60 seconds
- Repeat to the right
- Apply a gentle sweeping motion, from left to right 15 times
C-Section Scar Tissue Massage
Another site of childbirth that can be impacted by delivery are the abdominals following a cesarean (c-section). As the abdomen heals, scar tissue adhesions may occur and feel as if the area is stuck or sensitive, which can lead to pain along the scar (especially with tight clothing) and/or low back and issues with your bladder.
How to take care of c-section scars.
As noted above, scar tissue massage should be performed daily after the incision has healed, typically 4-6 weeks following delivery. Always start by washing your hands and ensuring your fingernails are short. Initially, you may want to focus on the area above and below the incision line. Don’t use lotion or lubrication in this area, you want to be able to gently move the skin and have full control without the potential of increased sliding.
If you are feeling discomfort at the incision site or notice other indications of scar adhesions such as puckering, try this common c-section scar tissue massage technique:
- Lying down comfortably, place one hand on your lower ribs and/or above your incision.
- Gently move your hand from side to side, then up and down. If you notice any restrictions, gently hold your hand there for 15-30 seconds. You may feel a gentle release, or it may take a few sessions before you start to feel any movement.
- Perform the same process below your incision site.
- Following massage above and below the incision site, perform direct scar tissue massage.
- Start at one end of the incision. Place the tips of your fingers lightly on your skin. See if you can move the skin up and down, right and left, clockwise, counterclockwise. Work your way down the length of the scar. If you have noticed your scar is sensitive to clothing, you may want to utilize a damp cloth in conjunction with your hands to desensitize the area.
- Another technique you can try is skin rolling. Gently ‘pinch’ the incision between your fingers and thumb and lightly roll it back and forth.
With either massage technique, you may notice that for the first few weeks, the scar will appear red/pink, raised, itchy, with a minor burning sensation, tenderness and/or numbness. As the scar heals, you will notice the scar flatten and appear thinner, at which point, you will be able to apply more pressure and stretching to the area. Keep in mind, this isn’t a no pain, no gain mindset. We are retraining our system and you want to be kind to yourself!
If you are still experiencing discomfort or sensitivity along your tear, voiding problems (leakage, frequency, and urgency), obstructed or painful defecation, pain with intercourse and/or chronic pain, the pain may not be isolated to just the pelvic floor muscles, but also the lower abdomen, perineum, anus, tailbone or low back. In this case, please consult your healthcare provider- OB, midwife, and ask for a referral to a pelvic floor physical therapist. It is never too late to get started- whether you are a new parent or your children have their own children! However, the sooner you see someone, the more quickly you don’t have to make pain, “your normal”.
Other techniques your pelvic floor physical therapist may discuss with you include: utilizing a dilator or wand, dry needling, diet for proper healing, reconnecting with your partner for decreased pain with intercourse, and retraining the brain to decrease the hypersensitivity of your nerves throughout your body to decrease pain. These are all tools for you to free yourself of chronic pain and manage your pain and body!
Jordan Mrosewske, PT, DPT, is a pelvic physical therapist at Advocate Aurora Health (AAH), in Milwaukee, WI. She is passionate about empowering and educating her patients to be in control of their well-being; physically, emotionally, mentally and/or spiritually. She is also part of the Pregnancy committee within AAH and specialized in Pelvic Health for the Tgncnb Community.