April 28, 2021

By Emeline Mugisha, MSN, MPH, RN

A scar is new tissue that develops on and below the skin as part of your body’s natural healing process after an injury or surgery. Scar management is a significant part of recovery for many postpartum moms, including all women who had a perineal tear, episiotomy, or a cesarean birth (c-section). While every woman, delivery, and scar is different, there are a few things to know to help postpartum scars heal, including how to massage a scar safely and effectively.

The benefits of scar tissue massage

Most postpartum scars do not cause long-term problems, but some do. For example, studies show that 6 to 18% of women who had a c-section experience chronic scar pain. This pain can lead to difficulties with everyday activities, painful sex, and pain with bowel movements. Similarly, some women recovering from a perineal tear or episiotomy also notice pain during sexual activity and discomfort with bowel movements. These women may also experience soreness between the vagina and rectum and difficulty inserting a diaphragm or tampon.

Related: What to do about painful sex after childbirth

Whether you do it or someone else does it (such as your partner or a physical therapist), massage is an effective way to increase healing and manage the development of physical scars after childbirth. The earlier and more regularly massaging occurs, the faster you will heal (inside and out) and the less likely you are to experience physical restrictions from your scar.

Overall, scar tissue massage can help:

• Relieve pain, discomfort, or sensitivity
• Reduce scar tissue build-up
• Reduce discoloration and itching
• Soften and flatten scars
• Increase flexibility and mobility of scars
• Improve or restore everyday activities

When to start massaging and how to prepare

When to start:

Unless a health care provider advises you to start sooner, wait for your wound to fully heal before beginning massage. Allowing your skin to recover fully can help prevent infection or injury. A fully healed scar will not have open areas or scabs, should not cause severe pain or sensitivity, and should not prevent you from completing your everyday activities. It usually takes about six weeks for a scar to fully heal, depending on the type of scar and your skin's condition.

How to prepare:

1. To decrease pain, relax your muscles, and increase the effectiveness of massage, it helps to take a warm bath or apply a warm compress before your treatment time.
2. Self-massage can be done in many lying, sitting, standing, or kneeling positions. Make yourself comfortable by using a position that works best for you and pillows if needed.
3. Apply an oil or cream to your scar for comfort (as long as you are not allergic to it).
4. Though treatment time will vary depending on your pain tolerance, aim to massage your scar for at least 5-10 minutes a day and gradually work up to twenty minutes.

How to massage perineal scars

If you had a perineal tear or episiotomy during vaginal delivery, you will have scar tissue that needs to heal in the area between your vagina and anus. This area is also known as the perineum. The resulting wound—whether natural or surgical—is called a perineal scar.

Technique:

• Using two thumbs or index fingers, gently massage the scar in all three directions—along the scar line, across the scar line, and in circular movements over the scar. You should feel stretching and light tingling, but it should not be too painful.
• Massage all parts of the scar towards the anus.
• Apply as much pressure as possible without it hurting, starting with light pressure to the superficial scar tissue and moving to deeper areas with firmer pressure.

How to massage c-section scars

If you had a c-section, you will have deep-tissue scars that need to heal. Unless there are physical complications such as infection, the scar on your skin’s surface will heal automatically. Deeper physical scarring, however, will require more work and patience for a full recovery.

Technique:

• Gently massage around the scar, concentrating on tissues just above and below it.
• As the scar becomes less delicate, 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. You should feel stretching and light tingling, but it should not be too painful.
• As this process becomes more manageable, press your fingers firmly down into the tummy muscles and repeat the massage in all three directions (up and down, side-to-side, and circles). Be firm but not aggressive, and let pain be your guide as you massage. Continue to massage into deeper areas as pain allows.
• When you become comfortable with the above steps, roll the scar between your thumb and index finger. It may take several days or weeks before you can do this.

When to consult a health care provider

If you have any questions or concerns about scar massage before you begin, speak to a health care provider. Also, consult a medical provider if you develop any of the problems below:

• Extreme weakness around the abdominal area
• Heaviness or a bulging sensation in your perineal area
• Bladder or bowel control problems, such as wetting, soiling, or rushing to the toilet
• Difficulties with sex or painful sex

Sources:

Kukuchka, K. (2001). Potential dysfunctions occurring in the postpartum years. Physical Therapy Scholarly Projects. https://commons.und.edu/pt-grad/270

National Health Service (UK). (2020, September). Postnatal scar tissue management.
https://www.stgeorges.nhs.uk/wp-content/uploads/2018/11/THE_STM_01.pdf

Wasserman, J.B., Abraham, K.S., Massery, M., Chu, J., Farrow, A., & Marcoux, B. (2018). Soft tissue mobilization techniques are effective in treating chronic pain following cesarean section: A multicenter randomized clinical trial. Journal of Women's Health Physical Therapy, 42(3), 111-119. doi: 10.1097/JWH.0000000000000103

Emeline Mugisha, MSN, MPH, RN - Emeline Mugisha is an award-winning, master's-prepared nurse with over a decade of experience in community/public health and clinical health services at the field and management levels. She has co-authored two professional manuscripts in Women's Health Issues and the Journal of Midwifery and Women's Health. She has an M.S. in Public Health Nursing and an M.P.H. from Johns Hopkins University.