As a pelvic health physiotherapist, I often see women experiencing discomfort or confusion surrounding their postpartum recovery, particularly when it comes to healing after vaginal births, including tears or episiotomies. One of the lesser-known issues that can arise during this healing process is vaginal or perineal granulation tissue. Let’s explore what it is, how it forms, and what you can do about it.
Granulation tissue is a type of tissue that forms during the healing process after an injury, surgery, or childbirth. It’s part of the body’s natural wound repair mechanism, and it often appears as pink or red tissue with a bumpy surface. When it forms in the vaginal or perineal area after childbirth, it’s usually a sign that the body is trying to repair a tear or episiotomy.
However, when this tissue continues to form or doesn’t heal properly, it can become problematic. Women may experience symptoms like:
Ongoing discomfort or soreness at the site of stitches.
Bleeding or spotting, especially after sex.
A feeling of irritation or sensitivity in the area.
A noticeable small lump or raw area.
Why Does Granulation Tissue Form?
Granulation tissue forms when there’s been an injury to the skin or mucosa, such as with a tear or episiotomy during childbirth. It’s the body’s attempt to create new tissue to cover the wound and facilitate healing. However, in some cases, the tissue becomes overactive, creating an excess of granulation that doesn't resolve on its own.
Factors that may contribute to excessive granulation tissue formation include:
Poor healing of stitches from tears or episiotomies.
Infection or irritation at the site of the wound.
Low oestrogen levels, especially in breastfeeding women, can slow down tissue repair, making granulation tissue more likely.
What Can Be Done About Granulation Tissue?
The good news is that vaginal and perineal granulation tissue is treatable. Depending on the severity and the symptoms, there are several options for managing it:
Topical Treatments: Oestrogen creams like Ovestin can sometimes help the tissue heal by promoting mucosal health. This is especially useful for breastfeeding women with low oestrogen levels.
Silver Nitrate: In cases where the tissue becomes problematic, a healthcare provider may apply silver nitrate to "burn off" the excess granulation tissue, which helps the healing process.
Surgical Removal: In more persistent cases, the granulation tissue may need to be surgically removed.
Seeking Help for Vaginal and Perineal Granulation Tissue
It’s important to remember that if you are experiencing ongoing discomfort, bleeding, or any unusual symptoms postpartum, you should seek help. Ignoring the issue or assuming it will go away on its own can lead to prolonged discomfort.
If you suspect granulation tissue may be affecting your recovery, I encourage you to speak to a pelvic health physiotherapist. You may also need a referral to a gynaecologist for further management, especially if non-invasive treatments haven’t worked.