Why Some Perineal Tears and Episiotomies Don't Heal: 3 Hidden Factors For Healing

Why is your client's perineal tear or episiotomy still painful months after birth? Today, Lynn Schulte, PT, explores three commonly overlooked contributors to delayed healing: pelvic bone positioning, surrounding tissue restrictions, and unresolved trauma responses held within the tissues.

Clinical Takeaways From This Episode
• Assess for an Open Birthing Pattern when healing is delayed.
• Approximate the ischial bones during scar treatment.
• Evaluate tissues surrounding the scar, not just the scar itself.
• Consider unresolved trauma when tenderness persists.
• Prioritize circulation and tissue mobility to support healing.
• Never force tissue release.

Why do some perineal tears or episiotomies fail to heal completely?

Lynn explains how an Open Birthing Pattern can create ongoing tension through the pelvic floor and perineum, placing stress on healing tissues. She shares practical assessment and treatment strategies, including approximating the ischial bones during scar work and addressing restrictions in the tissues surrounding the scar rather than focusing solely on the scar itself.

The episode also explores why some scars remain extremely tender despite treatment. In certain cases, persistent sensitivity may reflect unresolved trauma responses that require a trauma-informed approach and interdisciplinary support.

How can pelvic health therapists help create a full recovery?

Through clinical case studies, Lynn demonstrates how improving tissue mobility, reducing tension, and restoring blood flow can help facilitate healing when traditional approaches fall short.

Whether working with perineal tears, episiotomies, or C-section scars, pelvic health therapists can uncover the root of why some tissues fail to heal and what they can do to work with the tissue in a different way to promote full healing.

What educational resources for pelvic health therapists can help you learn these skills?
Holistic Treatment of the Postpartum Body: https://instituteforbirthhealing.com/postpartum-body/

Advanced Postpartum Techniques: https://instituteforbirthhealing.com/advanced-postpartum-techniques

Learn More and Connect With Lynn Schulte

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Email Me: support@instituteforbirthhealing.com

Learn More: InstituteforBirthHealing.com

Visit Institute for Birth Healing to learn more about how to care for the pregnant and postpartum body: CLICK HERE

Transcript

@0:24 - Lynn Schulte, PT (lynnschultept@gmail.com)

Welcome to this episode, everyone. I am excited to share with you talking today about tears and episiotomy. And what has shown up in my clinic recently is how is tears that are not healing, episiotomies that are not healing well.

And I want us to think about the consequences of what happens during birth when we're tearing, when we have a episiotomy.

And that tissue is trying to heal after birth. And it can't. And there are a couple of things that I want you to be thinking about as you're working with your clients to help facilitate greater healing of the tissues.

And the first thing is I want you to think about the impact of an open birthing pattern in the pelvis and what that is actually doing to the perennial tissues.

And when the ischial bones are more splayed apart, or maybe one side is more splayed apart, if the episiotomy or tear is on that side, there's way more tension on the pelvic floor muscles on that side because the muscles are trying to hold that pelvis together, trying to encourage that ischium to come more immediately.

So there's always more tension on that, on those muscles on the side where the ischium is more splayed. So if you can put two and two together, knowing what position they were in during their birth, and then recognizing that, oh, the tear is on that side that did get more splayed out to the side, approximating those ischiums together towards the midline will help decrease some of the tension that is on those muscles, which will allow the tissues to heal better.

So please keep that in mind. Whenever I'm working on scar tissue, whether it's healed or not, the, what helps to facilitate the release of that scar tissue is approximation of that ischium on the side that we're working on the scar tissue.

Remember, we should always be working on the pelvic bones while we're working with the pelvic floor muscles and tissue, vaginal tissues together at the same time and using the approximation of those bones.

While we're doing the work with the tissues to really help allow healing to happen. So with that, there's a couple of things that can make things more restricted, less likely for the tissues to be able to heal.

And that's also the surrounding tissue. So the open birthing pattern could be put in tension on it, but also just the general tissue around the scar and the episiotomy.

Needs to be have good freedom. So think about, you know, if we have episiotomy scar, we can work with the issue of rectal fossa, more inferior to where that episiotomy scar is and make sure that that has less tension in it so that there's the there's not even greater pull on that open wound.

So that's one thing. But. We want to release the sphincter muscle whenever we have scar tissue in there as well, especially if it's not healing.

And one thing that I just want you to remember is that scar tissue, if it is super tender, if it's super painful for your clients, that's usually an indication that there's a trauma response in those tissues or possibly an emotion that's being stuck, something that happened during that birth may be being held in that tissue.

And once that trauma is addressed or released, the tenderness goes away instantly. And that is, it's so important that if you are not able to address the trauma in the tissues, please have people that you can refer your clients to so that they can work with those clients too.

Work with the therapist, the trauma therapist, to release the trauma and the effects of the trauma, and then you'll have easier access into the tissues and helping the tissues to release.

I actually have one client that I worked with years ago before I got really good at working with trauma, and like all the skills that I had up to that point, I wasn't able to make any changes in her tissue, and I referred her off to a trauma therapist.

I said, you'll know when you're ready to come back, and she did. She returned several months later, and then I was able to get into the tissues and get the tissues to respond appropriately without having to use excess force, without having to make something happen in there, and so please really honor the tissues, honor what's being held in them, and never, ever, ever force a release.

I had one client that came to see me that had. The most interesting, it was almost like a cyst, and it was a cyst that actually, was it a fissure, I'm trying to remember, was years ago, but she had been dealing with trying to heal this cyst-like formation on the side of her labia near her perennial body, and she was doing ointments left and right, and it would heal a little bit and then open back up again.

And it may have, it did, it tunneled back in, that's what was going on, and so they had to pack it and help it to heal, but it just, it wasn't healing, and the surrounding tissues around this wound that was in her labia was extremely hard, and I was able to work with the surrounding tissues without actually putting pressure on the open wound itself.

And that really Really, like the entire area just softened, and then, you know, that is going to be able to bring greater blood flow into the area to allow to assist in the healing of those tissues.

So keep that in mind that the surrounding tissues is super important for getting increased blood flow into the wound to allow it to heal.

Um, and so the open birthing pattern, trauma being held in the tissues and the surrounding tissues needing to be released are all things that need to be addressed if we have a wound that is resistant to healing.

And the same thing could be said for C-section scars as well. We can do surrounding tissue mobilization for that if there's restriction in there.

Um, we can work with the trauma in the tissues if you know how to address that. 3 cut that down.

down. And then, um, just, like, Okay. And then that can allow the tissues to increase its ability to heal because we're increasing blood flow to that area and hopefully making it less tender by releasing the trauma in there so that we can work easier around the open wound.

So wounds need blood flow to get rid of the junk and bring in the goods. So what can we do to help facilitate that?

And if it's an episiotomy or perennial tear, working on closing the bones, bringing the bones back together, and releasing the surrounding tissues and releasing any trauma that might be being held in that area, all three of those are imperative to really help tissues to be able to heal in a more expedient fashion, okay?

So please keep that in mind and see if you can correlate the episiotomies on the left side. have a left.

If ischium splay because they may be birthed and right side lying, or they had that left leg up in a squat, but a standing squat or a kneeling squat, that left leg was up, that left ischium is going to be more splayed out, abducted, that's going to put more tension on the transverse perennial body, all the pelvic floor muscles on that left side.

If we have a tear on that side, we want to help approximate that bone and relax those muscles, so that the tissues can heal better.

Okay, so please keep this in mind and look for it in your clients and also know the importance of learning how to work with releasing the trauma in the tissues because it's, that is also a huge component to allow the tissues to heal.

All right. Thanks so much for listening in everybody. And we will see you all on the next episode, share this.

I you episode with any colleague that you feel needs to hear this information, all right? Thanks, everybody. Take care.

Bye-bye.