The third category of common postpartum ailments I see in my clinic pertains to scar management.
When patients are postpartum, their scar tissue should be able to move freely, without pain, discomfort, or itchiness. Scar management varies on type of scar, of course, so I’ll describe more in detail below.
With cesarean scars, restrictions can lead to impairments in scar mobility, posture, fertility, pressure tolerance, pelvic pain, low back pain, and leakage.
Patients can manage their cesarean scars by using silicon sheets to improve scar color, flatten their scar, and improve mobility. Patients should only begin using silicone sheets when their incision is healed and they no longer have any stitches or scabs.
Patients can use soft to harsher materials to rub across the incision to desensitize the surgical area in an effort to get the area used to having something touch it. Start on the outside of the skin, around the incision area – as opposed to directly on top of the scar – as early as 2-4 weeks postpartum.
After the incision has fully healed – with no redness or red spots anywhere – patients can move the scar in all different directions without pain.
Cesarean: In time, patients should be able to lift the scar and move it up and down, side-to-side, and twist the scar skin.
Restrictions associated with perineal scars can lead to painful sex, urinary or fecal incontinence, prolapse, and postnatal depression. As many as 25% of perineal scars will get infected, unfortunately.
A majority of perineal scars are in the grade 1 or 2 category, with only a small number of people having grades 3 or 4. Patients can perform self-scar massages by using clean hands and gently sweeping their thumb across their scar. It may be uncomfortable initially, but it shouldn’t be painful.
Ice pack: Patients can also apply ice packs to their perineal area to help minimize swelling and decrease pain. Ice is most often used for the immediate acute pain, though some patients also use heat.
Sitz bath: Patients can use a sitz bath 2-3 times a day when they are newly postpartum to help soften tissues, but typically this option is not available to most postpartum parents due to newborn constraints.
Local anesthetic: Using a local anesthetic such as Epifoam or lidocaine gels or creams can help decrease the pain temporarily.
Use a cushion when sitting: Sitting on a cushion can help decrease the pressure to the perineum when it feels particularly raw and tender postpartum.
When to see a pelvic floor physical therapist
So often parents with newborns feel like their own health challenges become secondary, and they assume that their experiences postpartum, like urinary leakage, constipation, or painful perineal or Cesarean scars, are “normal” because they know so many postpartum parents who have the same.
I started Optimize Pelvic Health in part because I want the world to know that just because something is “common” does not mean that it is “normal.” Many pelvic floor dysfunctions are rectifiable by pelvic floor physical therapy; you don’t have to live in pain or discomfort.
Consider seeing a pelvic floor physical therapist if you’ve experienced any urinary or fecal leakage, organ prolapse, or pelvic/back/hip pain that has lasted longer than six weeks. If you’re having difficulties or pain managing your cesarean or perineal scar, you may also be a good candidate for pelvic floor physical therapy.
Pelvic floor dysfunction can feel like an “invisible” injury and oftentimes is uncomfortable and stigmatized to talk about, making it hard for patients to get the care they need. I would love to partner with you and help restore your health so that you can fully and comfortably enjoy life with your family.
Written by Dr. Janet Yiu, PT, DPT, OCS, FAFS