Hi friends! You’ve made it through pregnancy, labor and delivery, and now you’re loving life with your bundle of joy—except that pesky scar is causing issues! Maybe your scar is painful or it may be extra sensitive to touch. Sound familiar? Many individuals report this to their provider postpartum but are given little to no help, but there are things we can do.
There are a few different reasons you may have a scar after delivery; maybe you had a cesarean section, an episiotomy, or maybe you had some perineal tearing that required stitches. (To learn more about perineal tearing, check out our blog post here). In many of these cases, you can be left with a scar that hurts when you touch it or it may cause pain when you’re trying to perform your day-to-day activities. These scars can even make it painful to be intimate with your partner.
*If you’re having pain while returning to sex postpartum, check out our self-paced course Sex After Baby. You get access to the course for 12 months and can complete it from the convenience and comfort of your own home. You can also read Sex After Baby: How to Resume Intimacy with Confidence and Ease.
While having a painful scar can be daunting, we have some good news: scar massage and other manual therapy techniques that can be done by a physical therapist have been shown to be effective at improving this pain and decrease scar adhesions (Wasserman, 2018).
It’s important for scars to move to prevent the skin and tissues from getting “stuck.” There are many layers of tissue and they are designed to glide and move with each other, but when we have scars they can form adhesions which essentially make the different layers of tissue stick together. This is extremely important because your muscles sit underneath these tissues. Your abdominal muscles are underneath a cesarean scar and pelvic floor muscles are underneath an episiotomy or perineal scar.
Imagine a tablecloth on your dining room table. Without anything on it, you should be able to easily move the tablecloth along the table with little effort. However, if you put items like plates on the table it makes the tablecloth adhere to the table, but only in the spots with a plate. The plates are like adhesions in the scar tissue. At these spots, it is difficult for the tablecloth to move on top of the table. The more plates you have, the more restricted the tissue movement will be. Scar massage techniques can help to get rid of your plates so that the table cloth can move freely again!
If these tissues are not moving freely, this can lead to pelvic pain, back pain, incontinence, and many other issues.
HOW TO PERFORM SCAR MASSAGE
It’s important to mention that your scar needs to be healed and you need to get clearance from your provider before doing any massage techniques. Most individuals are okay for gentle massage around 6 weeks after delivery. The skin around the area you are going to massage should not have any scabs, rashes, or other signs of irritation (like redness).
When you’re ready, find a comfortable, private place to perform the massage. A warm bath can be a great place, but any place where you can lie back works great. Find a position where your legs can be supported to help turn off your hip and pelvic floor muscles. You can use items like pillows or blankets to help support you. Soothing music or candles can help you to relax even more.
Now that you’re comfortable and relaxed, start by lightly touching your scar. If it causes pain or you tense up, practice deep breathing until the pain eases and the tension releases and then try again.
Once you are able to tolerate lightly touching your scar, you can begin to draw small circles along the scar—draw these circles both clockwise and counterclockwise.
You can pull and stretch the skin in all directions (up and down, side-to-side), starting with short, smooth strokes. Pay attention to any directions that move less under your finger and give these areas a little more time and attention. Hold a stretch on these areas for 15-60 seconds to allow it to release and soften. When you are stretching the skin, you want your finger to have a firm grip on the skin so that you are pulling the skin and not just gliding your finger along it.
Once you are able to apply deep pressure without pain you can do a shallow vaginal massage—place the tip of your finger into the vaginal canal and begin to place gentle pressure. Lubrication can be extremely helpful in decreasing friction and making this more comfortable. There are many different types of lubricants to choose from; coconut oil or Good Clean Love are great options.
While performing any of these techniques, it’s important to listen to your body. While these techniques may be uncomfortable at first, they pain should not linger after you are done with the massage and you should not have any bleeding. If you do, this may be a sign that you did too much or were a little too aggressive with your techniques. It can be helpful to use a mirror to look at where you are touching and to help you become self-aware of your anatomy.
Try to perform this massage two to three times per day for 5 to 10 minutes at a time.
If you are having pain or bleeding with the massage, or if you are not seeing improvements, it may be beneficial to see a pelvic floor physical therapist. They can help you to address many different issues related to pregnancy and postpartum. Often times, they can help to dramatically improve symptoms in just a few sessions!
For more postpartum help, check out these great resources:
Ask your healthcare provider for a referral to a pelvic therapist.
Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.
Watch our interview with Dr. Amanda Fisher PT, DPT on Cesarean Section Rehab Tips
Watch Our Postpartum and Your Pelvic Floor playlist on YouTube
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
Sign up for our email newsletter!
Visit our Instagram page for more on pelvic health.
Visit our Amazon Store for pelvic health products
For Healthcare providers, check out all our continuing education courses here to help you better serve your pregnant and postpartum clients. You can purchase courses individually or join our Ambassador Program and most of our courses are included with your membership!
Early Cesarean Rehabilitation with Dr. Ann Croghan PT, DPT, CLC
Impact of Delivery on the Pelvic Floor with Dr. Lauren Trosch PT, DPT, OCD
Written by Emily Reul, PT, DPT
References
1. Wasserman JB et al. Soft tissue mobilization techniques are effective in treating chronic pain following cesarean section: a multicenter randomized control trial. J Womens Health Phys Therap. 2018;42(3):111-119.