Scar Tissue: A Potential Source for Pelvic Pain

Pelvic pain is something that affects many people and is a hard thing to quantify. Some studies say this affects as much as 5% to 23-25% of the population.

An often not thought about source of pelvic pain is scar tissue. Read on to learn how scars form, how they can cause pain, and what you can do about it. 

Scar tissue is a normal part of healing from an injury or from surgery.  Scar tissue does heal naturally, but there are things that we can do to help scars heal in a good way and to make sure that scars can move freely.  

Scars that most commonly contribute to pelvic pain include:

• C-section scars
• Abdominal surgery scars
• Hysterectomy scars
• Episiotomies
• Vaginal delivery tearing

We frequently see women at our clinic who are dealing with chronic pelvic pain. When asked, most patients state that no one has ever evaluated their scars to see how they are moving. Non-mobile scar tissue can be a big source of pain. 

There are things you can do early in the healing process to make sure scars are moving freely and are healing well for you. We will teach you a few things about how to manage scar tissue. Unfortunately most patients report they’ve never been told to do anything about their scars by any other medical practitioners. Some women are very nervous to do anything to their scar. I am here to tell you, it is okay to touch your scar! We want you to be comfortable with all parts of your body, including your scars.

In an early phase of healing (first 2 weeks), you need to leave the scar alone  and protect it to make sure it closes well. In those first few weeks, we want to make sure the incision stays clean and dry as your scar develops.  Once the scar has closed, you can start on scar desensitization.

Scar Desensitization
Sometimes, scars can be really sensitive to touch. It can be uncomfortable even when clothing is touching the scar, so desensitization is important. We recommend using different materials to desensitize including cotton balls, tissues, paper towels, jeans, or soft velcro. In the early stages, don’t go directly over the scar, but move the material over the tissue near the scar. Different textures can create different sensations. If your scar is very sensitive, start with really soft material, like a cotton ball or facial tissue. Gently tap or touch the area to help you get used to the feeling. Try to slowly work your way up to the more highly textured fabrics. You can do this for 5-10 minutes, a couple of times per day to desensitize the nerves in that area. This is great to do 1-2 weeks after surgery to help the abdominal scarring become less sensitive and help your nerves relearn how to react. 

Scar Mobilization
Once the scar heals completely, usually around 4-6 weeks, you can start to work on scar tissue mobility. We want scars to be able to respond to the stresses that are put on them, so we need to make sure the tissue can move as freely as possible. 

As an example, say you have an abdominal hysterectomy or c-section scar. Start by making sure you have clean, dry hands and no lotion on your skin. Use a couple of fingers to tap on the scar, and then try to move the scar up and down. Once you have done that on all parts of your scar, take your fingers and hold down the scar, moving your fingers in a circle. You can also move the scar side-to-side on all portions of the scar while holding down the scar. 

There are many ways to help a scar get more mobile. You want to get the scar moving as well as the surrounding tissue. You can even try lightly plucking or lifting the scar away from your body to get the tissue underneath moving more freely. You may feel some burning with this technique, but shouldn’t have intense pain (Stop if you do). You may have some redness over the area as well which is normal. Do not place a lot of pressure over the scar and be sure that the scar isn’t opening up while doing these techniques. That is an indication to stop and that your technique may be too aggressive and the tissue needs more time to heal properly. 

It is important to get scars moving early on to prevent issues down the road.  Stuck scar tissue is something that can be a source of pain for long into the future. Scar tissue can cause adherence of pelvic organs, affecting how the organ functions including changes in bowel or bladder habits, pelvic pain, and potentially fertility issues. 

Scar desensitization and mobilization works the best and quickest when done early on while the scar is still healing, but don't despair if your scars are years old. Scar tissue mobilization can be effective on old scars as well. We’ve met patients who had a hysterectomy years ago who have benefited from scar tissue release and mobilization to address their pain and get the tissue moving. 

Hopefully we have given you some ideas to help you assess and get your own scars moving better. However, if we have left you with more questions than answers, we are happy to be of assistance. Click here to talk with a pelvic PT on the phone if you would like to learn more about how pelvic PT can help you with your scar symptoms.