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Massage for perineal, episiotomy and caesarean scars

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Massage can reduce scar tissue and ease any discomfort, pain or sensitivity if you have had an episiotomy, perineal tear or caesarean birth. These tips and techniques should help you to massage your postnatal scar safely and effectively.

When should I start massaging?

Wait until you have had your postnatal check, which is usually at six weeks. Make sure your stitches or scar have fully healed before beginning. You should not start massage if you have any vaginal infection as this could make it worse. 

Perineal massage

If you have had an episiotomy or a perineal tear, the scar tissue around the area can become tight and may become attached to layers below. This may cause discomfort during intercourse and during activity. By massaging the perineal area, you can reduce your scar tissue. 

Glossary of terms

Episiotomy: a straight incision from the lowest edge of the vaginal opening, toward the anus

Perineum: the area between the vagina and the anus 

External anal sphincter: The outside layer of your anal muscles

Internal anal sphincter: The inside layer of your anal muscles 

 

Perineal area describing tears and episiotomy

Degrees of tearing

2nd degree: involving perineum area

3rd degree: 3a Less than 50% EAS 

3rd degree: 3b More than 50% EAS

3rd degree: 3c Both EAS and IAS 

4th degree: EAS and IAS and anorectal mucosa

How to prepare

  1. It helps to have had a warm bath or use a warm compress before starting. This helps to relax the muscles and increase blood flow to the area. 
  2. Make yourself comfortable: lying or semi-sitting, use pillows. 
  3. Use oil or lubrication for comfort – for example, almond, coconut or olive oil (as long as you are not allergic to it) 
  4. You should massage the scar tissue in three directions for 5-10 minutes each day. 

Technique

Start externally. With you thumb or fingers as below, apply pressure and firmly massage into the scar along, the line of the scar, across the scar and in circles over the scar. Work over all parts of the external scar towards the anus.

Perineal caesarean massage technique

Internal stitches: Get into a comfortable position with your legs gently open. Insert your thumb into the entrance of your vagina so the pad of your thumb is facing down towards the anus. Place your index finger over your perineum. You should be able to feel the scar under your finger.

Perineal massage internal stitches

Apply a firm pressure on the back of the vaginal opening with your thumb and make firm ‘U’ shapes (imagine a clock and go from 4 to 8) over the scar area. This might feel a little bit tender to start with. 

Caesarean scar massage 

It takes about six weeks for your scar to heal fully. It may feel tender, itchy and numb in the first few weeks and can heal to be pink or red, and slightly raised. Once healed, it should not be excessively painful or sensitive, or prevent you from doing any of your everyday activities. It can take two years for your scar to fade to a smooth white line.

As your scar heals, the scar tissue can attach to the skin and muscles around it which can make the scar sensitive, painful or raised. Scar massage can help reduce these adhesions. Wait until your scar is fully healed before starting scar massage – there must be no open areas or scabs. Check with your GP or consultant before you begin if you have concerns. 

How to prepare

  1. It helps to have had a warm bath or use a warm compress before starting. This helps to relax the muscles and increase blood flow to the area 
  2. Make yourself comfortable: lying or semi-sitting, use pillows. 
  3. Use oil or lubrication for comfort – for example, almond, coconut or olive oil (as long as you are not allergic to it) 
  4. Aim to do this for ten minutes each day. 

Technique

Gently massage around the scar, focusing on tissues immediately above and below it. As it becomes less sensitive, place the pads of your fingertips just above the scar line. Move the skin gently up and down, side to side and in circles along the length of the scar. Work more into areas of resistance where the skin feels tighter. You should feel stretching in the tissue but it should not be painful.

Perineal caesarean massage technique

As this becomes easier, push your fingers firmly down into the tummy muscles and repeat the up and down, side to side and circular movements. You can massage the entire lower tummy area. You must be firm, but not aggressive, as you massage: let pain be your guide. A slight tingling sensation as you stretch tissues is normal. Keep massaging into deeper areas as pain allows.

 

c-section scar

 

When you are comfortable with the first two stages, roll the scar between your thumb and finger. It may take some days or weeks before you can do this.

caesarean scar massage

Continuing problems - when to seek advice

If you have any of the problems below, seek advice from your GP, who can then refer you to a women’s health physiotherapist. 

  • excessive weakness around the abdominal area 
  • heaviness/bulging sensation in your perineal area 
  • any problems with loss of bladder or bowel control – such as wetting, soiling or having to rush to the toilet. 
  • difficulties or pain with sexual intercourse.

Useful sources of information

If you have any questions regarding perineal or caesarean scar massage, please contact your midwife, GP or physiotherapist. 

NCT

A charity for parents providing antenatal support, information and networking.

www.nct.org.uk

Pelvic, Obstetric and Gynaecological Physiotherapy

The POGP produces information booklets written by qualified women and men’s health physiotherapists with reference to evidence and research where available.

pogp.csp.org.uk 

 

 

Ref number: 5075/VER1

Date published: Sep 2020 | Review date: Sep 2023 

© 2020 Guy’s and St Thomas’ NHS Foundation Trust

A list of sources is available on request

 


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