Perineal Scar Tissue Restriction
Perineal Scar Tissue Restriction
The perineum is a thick band of muscle tissues that lies between the vaginal and anal opening. During a vaginal delivery, you may have a tear of these muscles or an episiotomy (when a doctor cuts part of these muscles) to make space for your baby to exit. Whether you have a grade 1 tear or grade 4 tear, these muscles have to heal and recover in the postpartum period.
Fortunately, a large amount of perineal tears can heal on their own with stitching; however, there are times where there can be an excess in tissue growth called granulation tissue or there can be continued scar tissue restriction that limits intimacy and returning to increased physical activity.
What Are The Grades Of Perineal Tearing?
Grade 1: injury to perineal skin
Grade 2 and episiotomy: injury to perineal skin and perineal muscles
Grade 3: injury to all of the above plus the anal sphincter
Grade 4: injury to all of the above plus the rectal tissue
At 6 weeks, you will likely see your OB or midwife to have the scar assessed to ensure appropriate healing. At this time they will let you know if you're “cleared” to engage in intercourse and exercise or need to wait longer for further healing to occur. If you have been “cleared” this does not necessarily mean you or your muscles are ready to engage in vaginal penetration so make sure you listen to what you want.
If you are breastfeeding, your estrogen levels are decreased which can dry and thin the vaginal and perineal tissues which lengthens healing time and increases tissue sensitivity which unfortunately does not magically go away at 6 weeks. So if your tissues are not healing appropriately by 6 weeks, you may require vaginal moisturizer or potentially a prescribed localized estrogen to ensure proper recovery.
In addition, when scars lay down, they do so in an unorganized bundle of collagen that does not move or act like the rest of our muscles, so this can occasionally form a thick adhesive wad that can cause discomfort during vaginal penetration and increased activity levels. Manual work may need to be performed to improve this scar restriction and tissue sensitivity.
Perineal scar tissue can limit how well the pelvic floor muscles move through their full range of motion. Meaning you may have a weakened pelvic floor during exercise and activity and reduced ability to lengthen the pelvic floor during defecation. By improving the scar restriction, you can improve pelvic floor muscle function.
So What Should I Do If I Tear?
We recommend nothing being inserted into the vaginal canal until 6 weeks postpartum to ensure tissue healing. Until this time, you can begin with gentle mobility exercises and diaphragmatic breathing. For instance, some stretches you can begin with at week 2-3 postpartum are cat cow, gentle single knee to chest stretch, hip 90/90 in sitting, lower trunk rotation, and gentle figure 4 stretch.
At 6 weeks postpartum, we recommend seeing a pelvic health physical therapist to reassess pelvic floor muscle function including muscle tone, tenderness, strength, endurance, and coordination. At this time, we can also assess the scar and healing and teach you when/if it is appropriate to begin gentle perineal massage techniques to reduce scar tissue restriction and sensitivity. If coming to an in person appointment is not possible this early postpartum, schedule online and we can walk through how to perform these techniques to prevent worsening and return to prior level of function.