![]() ![]() If you suspect that granulation tissue is the cause of your pain, see your OB/GYN prior to PT. Myofascial release techniques to the surrounding external tissues, and internal trigger point release to your pelvic floor muscles can be very helpful. If you are experiencing symptoms that you feel might be due to normal perineal scar tissue, physical therapy can be very beneficial. Potentially palpable piece of stitch along the area of inflammation.Spotting or bleeding with wiping for hygiene, intercourse, or pelvic exam.A “raw,” “tearing,” or “burning” pain with intercourse or pelvic exam.A “raw” sensation with palpation to the involved area.A bright red area of tissue at or very near the healing perineal tear.Potential difficulty with kegel contraction and pelvic floor relaxation.A “stretching” or “pulling” pain with intercourse or pelvic exam.Tissue resistance to palpation along the area of the healing tear.If you are having a hard time determining if your pain is from normal scar tissue or granulation tissue, below are some things to look for. ![]() This can lead to tissue restriction, limited blood flow, and pain (especially with intercourse or a pelvic exam). Oftentimes, scar tissue will form just along the vaginal opening where the tear was. It is important to note that a perineal tear that has healed normally can also be painful. ![]() A quick exam can help determine if this is the case, and advise you on the appropriate treatment. If you are experiencing pain or spotting postpartum, or if you feel your perineum is slow to heal, mention it to your OB/GYN or pelvic PT. You may also require topical estrogen or silver nitrate for healing. This will require a visit to your OB/GYN to remove the remaining stitch. Oftentimes, the stitch will even begin to protrude from the tissue and the patient may be able to feel the stitch. The remaining piece of the stitch will then cause an irritation of the tissue and stimulate an excessive healing response in the tissue. StitchesĪlthough the stitches used to close a perineal tear are dissolvable, sometimes the end of the stitch does not completely dissolve. Sometimes this can occur as part of the natural healing process, or as the result of an undissolved stitch. There has been some evidence of increased incidence of granulation tissue with this estrogen treatment. Topical estrogen is often prescribed to help promote local estrogen to the tissues and healing to the laceration. It can lead to tissue dryness and frailty which can slow tissue healing. This decrease in estrogen can be more significant for those nursing or pumping. This is believed to be beneficial as in the early postpartum phases there is a drop in estrogen. This treatment is usually recommended for women who have slow wound healing or wound dehiscence (a reopening of the wound). Some experts have found an increased incidence of granulation tissue in women who are treated with local, topical estrogen creams following a perineal tear or episiotomy. There is no exact known cause for the formation of granulation tissue. In very rare cases, surgical removal of the granulation tissue may be required. Silver nitrate is a chemical compound used to debride and cauterize the granulation tissue to allow for normal healing, and reduce pain. In these cases, the tissue is treated with silver nitrate. In some instances this tissue heals and resorbs on its own, but occasionally it may require treatment from an OB/GYN. If you are concerned that you might have some granulation tissue present, don’t be alarmed. However, if the tissue continues to feel raw, appear red and inflamed, and there is prolonged bleeding it is likely granulation tissue is present. Perineal tissue is commonly very tender during the initial postpartum recovery phase. In the very initial phases of healing (prior to the common 6 week check up), this can be difficult to diagnose. The presence of granulation tissue can also lead to pain and bleeding with intercourse, pelvic exam, or the use of tampons. Unlike healthy vaginal tissue, granulation tissue is often fibrotic and can cause local pain, inflammation, and bleeding. While most perineal tearing heals on its own with stitching, there are times when the body can over heal and develop an excess of tissue at the wound site. Perineal tearing during a vaginal delivery can have varying levels of severity, and each woman’s tissue heals differently. ![]()
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