3 Reasons Why Some Perineal Tears and Episiotomies Don’t Heal
Show Notes:
Your client’s perineal tear should be healed by now – but why is it still painful, tender, or resistant to treatment? In this episode, Lynn Schulte, PT, shares 3 factors you need to include in postpartum treatments if scar tissue is not healing. This episode will teach you a different way to address postpartum scar tissue to heal perineal tears and episiotomies that remain stubbornly symptomatic long after birth.
Clinical Takeaways from this Episode
- Assess for an Open Birthing Pattern when perineal healing is delayed.
- Approximate the ischial bones during scar tissue treatment.
- Evaluate the tissues surrounding the scar – not just the scar itself.
- Consider whether tenderness reflects more than tissue restriction.
- Prioritize blood flow and tissue mobility.
- Never force tissue release.
Timestamps from this Episode
[00:24] Introduction
- Why some perineal tears and episiotomies struggle to heal
- Looking beyond traditional scar tissue treatment
[1:20] The Impact of an Open Birthing Pattern
- How ischial splay affects pelvic floor tension
- Understanding the mechanical stress placed on healing tissues
[3:15] Connecting Birth Position to Scar Symptoms
- Correlating tear location with pelvic bone positioning
- Identifying asymmetrical tension patterns
[4:35] Using Ischial Approximation During Treatment
- Why pelvic bones should be addressed alongside soft tissues
[6:10] Working with Surrounding Tissue Restrictions
- Looking beyond the scar itself
- Additional structures that may contribute to scar restriction and discomfort
[7:15] When Scar Tissue Remains Extremely Tender
- Understanding trauma responses within the tissues
- Why some scars stay painful despite treatment
[8:04] Clinical Case Study: Releasing Trauma Before Tissue Work
- A client whose tissues would not respond until trauma support was addressed
- The importance of interdisciplinary referrals
[9:00] Clinical Case Study: A Non-Healing Perineal Wound
- Working with surrounding tissues rather than the wound itself
- Improving tissue mobility and circulation
[9:34] Blood Flow and Tissue Healing
- Why wounds need circulation to heal
[10:45] Applying These Concepts to C-Section Scars
- Similar principles for surrounding tissue release and trauma resolution
[11:05] Clinical Insights and Closing Thoughts
Educational Resources
- Holistic Treatment of the Postpartum Body Course: This hands-on and clinically focused course provides more than 40 techniques that can be immediately applied in practice. Unlike other programs that emphasize theory, this course takes a holistic, full-body, clinic-based approach, making treatments more efficient and effective. It will boost your confidence and improve your results, no matter how long you’ve been practicing.
- Advanced Postpartum Techniques Course: Gain the confidence, clinical reasoning, and hands-on skills needed to treat complex postpartum cases with greater effectiveness. You will learn how the nervous system, body connections, and advanced manual therapy techniques work together to create deeper and long-lasting results with clients. (Holistic Treatment of the Postpartum Body is a prerequisite for this course).
Clinical Concepts Discussed
Open Birthing Pattern
A pattern in which one or both ischial bones remain more splayed following birth, potentially increasing tension through the pelvic floor muscles and perineal tissues.
Ischial Approximation
Bringing the ischial bones toward the midline to reduce tension through the pelvic floor and create a more supportive environment for tissue healing.
Surrounding Tissue Restrictions
Restrictions adjacent to a scar may contribute to decreased mobility, altered circulation, and ongoing tension at the wound site.
Trauma Held Within Tissues
Persistent tenderness or hypersensitivity may sometimes reflect unresolved trauma responses that require a trauma-informed treatment approach.
Frequently Asked Questions
Why do some perineal tears or episiotomies fail to heal completely?
According to Lynn Schulte, delayed healing may be influenced by ongoing pelvic floor tension, surrounding tissue restrictions, decreased blood flow, and trauma responses being held within the tissues.
How can an Open Birthing Pattern affect scar healing?
When an ischial bone remains splayed outward after birth, increased tension may be placed on the pelvic floor muscles and perineal tissues, potentially creating stress at the healing site.
Should pelvic health therapists treat only the scar tissue?
No. This episode emphasizes assessing and treating the surrounding tissues, pelvic bone positioning, and other structures that may be influencing the scar.
Why are some scars extremely tender to touch?
Persistent tenderness may indicate more than tissue restriction alone. In some cases, trauma responses associated with the birth experience may contribute to ongoing sensitivity.
How can pelvic health therapists improve blood flow to a healing wound?
Reducing tension in surrounding tissues and improving tissue mobility may help increase circulation, supporting the body’s natural healing processes.
About The Speaker
Lynn Schulte, PT is a pelvic health physical therapist with more than 30 years of experience helping practitioners understand the biomechanical, myofascial, and nervous system influences affecting pregnancy, birth, and postpartum recovery. Through the Institute for Birth Healing, she teaches evidence-informed continuing education courses focused on practical techniques that help clinicians achieve meaningful outcomes for their clients.
Connect With Lynn
Have a comment or question about today’s episode? Message Lynn on Instagram or Facebook, or Email Lynn.
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To learn more visit: InstituteforBirthHealing.com
Love Dr. Rachael! She is such a gem in the Metro Detroit area. She was my pelvic floor PT during my first pregnancy and postpartum and inspired me to pursue pelvic health certification (coming from an Ortho PT clinic). I’m now working through Holistic Treatment of the Pregnant and Postpartum Body.
Thank you so much for this presentation…I am an osteopath and also trained in SER (love love Upledger!)…the piece about ‘freeze’ related to transgenerational trauma was very informative and a reminder to look further…I have had a client who lost a baby and when I treated her she felt she needed to give birth to this child…and then went back several lives and saw that she had also lost a baby many lives prior! This relieved her of some stress…so every piece of the puzzle counts…keep the nuggets coming, so appreciative! Best, Judith
Great interview, Lynn and Susanne, for pushing us beyond “hands on, hands in”, confirming our need as therapists, for wide, grounded personal presence for our clients to feel safe and then willing to bring forth those physical/emotional/transgenerational, traumas/beliefs that lead to more complete healing and return to function. Appreciate the shout out, and listened delightfully to two of my favorite teachers and mentors. All of this was gold!