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Episotomy Care

WHAT IS AN EPISIOTOMY?

An episiotomy is a cut made through the perineum (area between vagina and anus). It is a procedure done during childbirth to make the area larger for the baby to pass through.

SIGNS OF INFECTION

Like any wound it needs to be cared for to prevent infection. If however you feel or see any of the following signs seek medical help:

  •  red, swollen skin or small pustules developing in or around the stitches
  •  increased pain in the stitches
  •  smelly discharge
  •  you develop a fever

RECOVERY & PAIN RELIEF

The episiotomy will likely bleed quite a lot initially but this should be stopped by the stitches and some pressure.  If you suddenly begin to bleed more or feel you may have burst the stitches seek medical treatment.  While a sudden increase in pain is not usual it is common to feel some pain and discomfort for the first 2-3 weeks. There are a few over the counter painkillers that are safe to be taken even while breastfeeding. Ask  your doctor or pharmacist about which would be best for you.

Ice 

Another very effective pain relief tool during the early stages of recovery is ice. There are different options for its application. The one many women prefer is the frozen sanitary towel. As seen in our video this is where you take clean water, soak a large sanitary towel in it and freeze it. It should not be used for longer than about 15 minutes as the ice will melt and it will become a warm & moist area which could increase chance of infection.  Ideally we advise using the sanitary towel for about 15 minutes or until it is melted and no longer giving relief. Then gently dry the area by gently patting with a towel, then lying on the towel with no underwear for about 10 minutes.  This is a gravity offloaded position as well as allowing the area to dry out which is also an important healing component.

TOILETTING 

One of the most common concerns after giving birth is how will I pass urine and a bowel movement?

Urination

After giving birth if you are in a medical setting they will likely want to measure your first urine output. Urination may sting initially after giving birth as the urine passes over the wound. However this generally reduces quite quickly. Pouring clean warm water with a squirt bottle as you urinate may reduce this stinging sensation.

Positioning 

Some women find hovering over the toilet seat as opposed to sitting down can reduce the stinging sensation when urinating. While long term we do not recommend this position but rather a knees above hip position via the use of a stool/ potty squatty; for the first few days it can help.

Cleaning

After urination using a squirt bottle with clean water or a sitz bath (after 24 hours) is recommended. Toilet tissue can come apart and get stuck in the wound or stitches, and is usually quite uncomfortable to use. After cleaning if you chose you can either air dry or use a clean towel to pat dry the area rather than wiping.

Bowel Movements

That first post birth poo is generally one of the things most women dread especially if you have had a tear or episiotomy.

Constipation

Preventing constipation is very important for a healing pelvic floor especially during those first few weeks. Ensure a sufficient fluid & fibre intake. Take care if you are using a fibre supplement as if not taken with sufficient fluid it can increase constipation. Some women will be given or may need a laxative or stool softener, discuss this with your healthcare provider.

Positioning

When passing a bowel movement in the first couple of weeks you can use a clean pad gently pressed over the wound for a bit of counter pressure. The ideal position for passing a bowel movement should have your knees above your hips as this allows the a muscle in the pelvic floor (puborectalis) to relax which unkinks your bowel making it easier to pass out the stool. Simply placing a step or stool below your feet or using a device such as the potty squatty can help create this position. This is not just for the postpartum period but for everyone at all life stages.

Cleaning

It is important to ensure the perineum is kept clean. After passing a bowel movement using clean water via a squirt bottle or a sitz bath (only after the first 24 hours) can help. And always ensure to wipe front to back to avoid getting any faecal matter in the wound.

LONGER TERM CARE

Dissolvable stitches are most commonly used and generally break down in the first 2-4 weeks.  Depending on where you have given birth you may have a 6 week follow up where your healthcare provider will check that the stitches have dissolved and that the scar is healing well. Ideally you will see a pelvic floor physiotherapist at around 6-8 weeks after birth who will also check your perineum and your scar as part of the assessment. They will advise you on what you need to do to continue care if needed as well as any other postpartum issues you may be facing.

 LONGER TERM COMPLICATIONS

Occasionally some women may develop scar hypertrophy (excessive scar tissue formation); scar sensitivity (where the scar becomes overly sensitised to any touching) or the tissue around the scar becomes a bit tight which may cause discomfort or pain on penetration. All of these can be helped with different programs of desensitisation exercises as well as perineal massage and stretching if required and the correct kind of pelvic floor exercises. Even if you have given birth many years ago if you are facing any of these issue a pelvic floor physiotherapist can help, do no struggle and suffer alone.

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