Battle Wounds: Postpartum Scar Management (C-Section and Perineal Healing)

No one tells you that the pain of childbirth does not always end with that final push. It also does not matter whether you had a vaginal birth or a cesarean birth. If you are among the roughly 10% of people who delivered without tearing, we salute you and your fairy child.* For the rest of us, here are practical, evidence-informed strategies for postpartum scar care.

For many new parents, scars from delivery heal without intervention. However, in our clinic, we often see hypersensitive or restricted perineal and cesarean scars. These scars can affect nearby structures and contribute to decreased core coordination, pain with sex, and urinary or fecal incontinence.

What is happening in a scar?

Scars are the body’s natural repair system, built from a complex network of proteins. Scar tissue reaches about 70% of the strength of the original tissue. This is usually enough for normal function.

The healing process is similar whether you cut your finger or have a cesarean incision or perineal tear. Immediately after injury, inflammation helps clot the area and build an initial framework. In the first few days, collagen fibers begin pulling the wound together in a disorganized way. This is protective and necessary. Over the next several weeks, those fibers reorganize based on how the tissue is used. This phase often gives scars a pink or reddish color. Around this time, you may notice if something feels off. A healing scar should not remain painful. We do not fully understand why some scars become problematic. Contributing factors may include genetics, tissue tension, hormonal influences, and blood supply (Aarabi et al., 2007; Agha et al., 2011). By 7 to 12 weeks postpartum, a scar should be relatively pain-free, mobile, and integrated with surrounding tissue. It should not tug or restrict movement elsewhere in the body.

Early Postpartum Care: Movement and Ice

In the early days, the goal is to support circulation while managing pain.

For perineal scars:

• Begin gentle pelvic floor contractions at about 25% effort

• Change positions regularly to prevent pressure and stagnation

For cesarean scars:

• Practice deep breathing to create gentle movement through the abdomen

• Avoid large, forceful movements early on, while recognizing that daily life still requires movement

Pain control matters. When pain is well managed, muscles can function more normally. Tools such as frozen pads, supportive garments, and prescribed medications can be helpful.

Scar Massage After Birth

At your six-week postpartum visit, ask your provider to assess scar mobility. If the scar feels painful or restricted, ask whether it is safe to begin gentle scar work. The goals of scar massage are to:

• Decrease sensitivity

• Improve tissue mobility

• Help collagen fibers reorganize in a more functional way

Start with desensitization

If touching or moving the scar causes more than 2 to 3 out of 10 pain, begin with simple desensitization:

• Light tapping

• Gentle rubbing with a towel

• 3 to 5 minutes per day

Perineal scar techniques

Pain should remain at or below 2 to 3 out of 10. Over several weeks, mobility should improve. Using a clean finger:

1. Gently slacken the tissue by pressing slightly toward the body

2. Move the scar in all directions to assess mobility

3. Identify the most restricted direction

4. Hold gentle pressure in that direction for about 30 seconds

5. Repeat 3 to 5 times

Cesarean scar techniques

Again, discomfort should stay within a tolerable range. Many people find it easiest to incorporate this work into quiet moments, such as during a shower.

For scars under 3 months:

• Gently lift the tissue around the scar

• Move it up and down, then side to side

• Spend extra time on areas of restriction, repeating 10 to 30 movements

For scars older than 3 months:

• Progress to direct pressure and skin rolling

• Work in multiple directions including circular patterns

Silicone for Scar Healing

Silicone is considered the gold standard for managing hypertrophic scars and keloids (Meaume et al., 2014; Son and Harijan, 2014).

For cesarean scars:

• Silicone sheets or gels can be worn 12 to 24 hours per day

• Use consistently for 2 to 4 months

• Benefits include softening, flattening, and reducing sensitivity

Silicone is not recommended for perineal scars due to proximity to sensitive tissues.

When to Seek Pelvic Health Physical Therapy

If your scar remains painful, restricted, or seems connected to symptoms elsewhere in your body, pelvic health physical therapy can help. Research shows that even older scars can improve in mobility, thickness, and pain with targeted manual therapy in as few as 4 to 8 sessions (Comesaña et al., 2017; Wasserman et al., 2018).

Why Postpartum Scar Care Matters

Scar management is standard in orthopedic, plastic, and dermatologic care. It should also be a routine part of postpartum recovery. Addressing scar mobility early can improve comfort, restore movement, and support long-term pelvic health.

Reducing risk of perineal tearing

If you want to reduce the likelihood of perineal tearing:

• Work with your birth team to allow a slow, controlled delivery of the baby’s head

• Use warm compresses during pushing

• Stay mobile during labor

• Consider side-lying or upright birth positions

• Try perineal massage in late pregnancy

References

• Aarabi S, Bhatt KA, Shi Y, et al. Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis. The FASEB Journal. 2007;21(12):3250-61.

• Agha R, Ogawa R, Pietramaggiori G, Orgill DP. A review of the role of mechanical forces in cutaneous wound healing. Journal of Surgical Research. 2011;171(2):700-8.

• Comesaña AC, Vicente MD, Ferreira TD, et al. Effect of myofascial induction therapy on post-c-section scars more than one and a half years old. Journal of Bodywork and Movement Therapies. 2017;21(1):197-204.

• Huang C, Murphy GF, Akaishi S, Ogawa R. Keloids and hypertrophic scars. Plastic and Reconstructive Surgery Global Open. 2013;1(4).

• Lewit K, Olsanska S. Clinical importance of active scars. Journal of Manipulative and Physiological Therapeutics. 2004;27(6):399-402.

• Marshall CD, Hu MS, Leavitt T, et al. Cutaneous scarring. Advances in Wound Care. 2018;7(2):29-45.

• Meaume S, Le Pillouer-Prost A, Richert B, et al. Management of scars and use of silicones. European Journal of Dermatology. 2014;24(4):435-43.

• Seow KM, Huang LW, Lin YH, et al. Cesarean scar pregnancy. Ultrasound in Obstetrics and Gynecology. 2004;23(3):247-53.

• Son D, Harijan A. Surgical scar prevention and management. Journal of Korean Medical Science. 2014;29(6):751-7.

• Wasserman JB, Abraham K, Massery M, et al. Soft tissue mobilization for chronic pain following cesarean section. Journal of Women’s Health Physical Therapy. 2018;42(3):111-119.

• Wurn LJ, Wurn BF, Roscow AS, et al. Manual therapy for dyspareunia and orgasm function. Medscape General Medicine. 2004;6(4).

Looking for Pelvic Floor Physical Therapy in Philadelphia?

If you are experiencing pelvic girdle pain during pregnancy or postpartum pelvic pain, individualized care can make a meaningful difference.  At Hazel Physical Therapy, we provide pelvic floor physical therapy, prenatal physical therapy, and postpartum care in Philadelphia to help you move with less pain and more confidence. Schedule an evaluation to get started.

This post has been adapted from the original post written by Joanna Hess and published on the Beyond Basics Blog.