What causes episiotomy scar and is the scar tissue normally painful or itchy? If this question rings bells in your mind, then this article is for you. We’ll not only give you a comprehensive rundown of episiotomy scarring, but also include several pictures to inspire your imagination on what to expect after the surgery.
Scar Tissue After Episiotomy – What Is an Episiotomy Scar?
Episiotomy is a simple surgical procedure in which a small cut is made to increase the vaginal opening. This helps to speed up birth or allow the use of instruments such as ventouse suction or forceps.
Episiotomy may be recommended if the baby has developed a condition referred to as fetal distress which is associated with a significant increase or decrease in the baby’s heart rate. Women with heart conditions may also be candidates for episiotomy.
Since the operation involves injury to the skin (the cut), it is normal and is indeed expected that the patient will form scar tissue after episiotomy.
According to Dana R. Gossett, MD, assistant professor and chief of the Division of General Obstetrics and Gynecology at Northwestern University, Chicago, episiotomy scar tissue is often to blame for long-term painful sexual intercourse, especially after menopause when declining estrogen often leads to reduced vaginal lubrication.
This, she says, is usually attributed to the lack of flexibility typically associated with scar tissues. This can also make the perineum (the area between the vagina and anus) so tight that episiotomy becomes necessary during the next delivery.
As with any scar, episiotomy scar is the result of accumulation of collagen as part of the body’s natural response to injury. Collagen helps to strengthen the wound as it heals. The straight formation of the collagen that builds up in scars is different from the basket weave-like formation of the collagen found in normal tissues.
This gives the scar tissues the distinct appearance that distinguishes them from the surrounding skin. The low quality associated with this type of collagen also explains why scars don’t grow hair.
The build up of collagen in the episiotomy scar decreases after a while and the scar starts to fade gradually. In a few women however, this doesn’t happen, resulting in an excessive, raised scar tissue. Such a scar tissue can benefit from surgical or non-surgical treatments which are discussed in a subsequent section of this article.
Episiotomy Scar Lump
Some patients reporting having a hard lump near the episiotomy scar. Depending on the location of the lump, it could be the result of formation of a keloid scar (a scar that extends beyond the original borders of the wound) or a swollen gland. It is best to seek the input of your doctor or a dermatologist. Keloid scars may benefit from steroid injection.
Episiotomy Scar Pictures
And here comes our favorite segment where we post pictures showing the discussion at hand. As per our topic today, here are a couple episiotomy scar pictures to give you an idea as to what episiotomy scarring looks like:
Episiotomy 1, 2
Episiotomy Scar Tissue Treatment
Unsightly episiotomy scar tissue, or a long-time scar that ha suddenly started making your sexual intercourse painful can leave you wondering what episiotomy scar tissue treatment options are available. Among the most common approaches to treating scars sustained from episiotomy are:
Surgical revision: A small operation can be done at the site of scarring to improve the appearance and the associated effects of the scar tissue. One commonly used technique is punch excision whereby the scar is neatly cut out and the edges of the wound then stitched together using fine sutures.
Surgical revision seems to be the most preferred option for treatment of episiotomy scars.
Kegel exercises: It is normal to feel pain for several weeks after episiotomy but if you start experiencing painful sexual intercourse years down the line, especially after menopause, then you may want to consider trying kegel exercise in addition to using vaginal moisturizers such as Replens to make sex more enjoyable as Dr. Gossett advises.
This doesn’t really treat the scar tissue but can help to minimize the pain associated with sex.
Episiotomy Scar Tissue Pain – Painful Episiotomy Scar
Episiotomy scar tissue either signifies the formation of adhesions or secondary infection of the scar tissue.
Adhesions are bands of scar tissue that attach themselves to the surrounding tissues, often attaching two organs or tissue that are naturally not attached together. When this happens, nerves often get trapped in the process, creating a pressure point that culminates in a feeling of pain.
Scar tissue release therapies such as Myofascial Release, Active Release Technique, and Graston Technique may help to reduce pain associated with scar tissues.
Sore Episiotomy Scar and Itchy Episiotomy Scar
An episiotomy scar can become itchy or sore as a result of secondary infection of the scar tissue following primary bacterial infection in the surrounding tissues. The scar may also look reddened, inflamed and feel warm. You should seek the attention of your doctor if these symptoms are observed.
A round of antibiotics may be required. Depending on your case, the doctor may also include some medication to relieve the inflammation and/or antihistamines to control the itching.
Healed Episiotomy Scar
After 4 to 6 weeks, the episiotomy scar will have healed considerably such that the redness and inflammation that characterized it at first is gone. Most scars will however take between 6 and 12 months to fully heal and fade away as to blend with the skin surrounding them.
Of course some scars might take longer to mature (some as long as 2 to 3 years) depending on factors such as how the initial wound healed – which has a lot to do with how post-op guidelines were followed – genetics, age of the patient.