Episiotomy repair

Overview

An episiotomy repair is a procedure to stitch the cut made in the perineum (the area between the vagina and anus) during childbirth. This cut, called an episiotomy, is sometimes done to make more room for the baby to come out safely. The repair helps the wound heal properly.

Episiotomy is less common now than in the past, but it is still performed in about 1 in 10 vaginal births in the UK. The repair is a standard part of postpartum care.

It affects women who have given birth vaginally, especially if an episiotomy was needed. Most repairs heal well with proper care.

Symptoms

Common symptoms

• Pain or soreness in the perineal area for the first few days to weeks
• Swelling and bruising around the stitches
• Mild discomfort when sitting or walking

Causes

Main causes

• An episiotomy is performed to enlarge the vaginal opening during a difficult birth, such as when the baby is in an awkward position or the mother needs a forceps or vacuum delivery.
• It may also be done to speed up delivery if the baby's heart rate shows signs of distress.

Risk factors

• First-time vaginal birth
• Large baby (over 4 kg or 8.8 pounds)
• Prolonged pushing stage of labour
• Use of forceps or vacuum during delivery
• Breech birth or shoulder dystocia

When to see a doctor

See a doctor urgently if:

• If you have heavy bleeding or severe pain (call emergency services immediately)
• If you have signs of infection like fever, redness, or discharge that worries you

Book a routine appointment if:

• At your 6-week postnatal check-up, your doctor or midwife will examine the repair site.
• If stitches become loose or fall out early, or if you are unsure if the wound is healing well.

Diagnosis

The repair is usually done right after the birth. The doctor or midwife will look at the cut to see how deep it is. They will check that the wound is clean and then stitch it together. Later, at your postnatal check, the repair is assessed for healing.

Tests that may be done

• A physical examination of the perineum to check the stitches and look for signs of infection or poor healing.

What to expect at your appointment

The examination is quick. You will be asked to lie down with your knees bent. The healthcare provider will gently look at the area. It may be slightly uncomfortable but should not be painful. If you are worried, you can ask for a chaperone or to have the exam done at your own pace.

Treatment

Episiotomy repair is the treatment itself. It involves cleaning the cut and stitching it in layers. The stitches dissolve on their own over a few weeks. You will be given advice on how to care for the wound at home to help healing and prevent infection.

Self-care at home

• Keep the area clean and dry. Gently bathe the perineum with warm water after using the toilet.
• Change sanitary pads regularly (every 4-6 hours) to keep the area dry.
• Sit on a soft cushion or a doughnut-shaped ring to reduce pressure on the stitches.
• Apply a cold pack (wrapped in a cloth) to the perineum for 10-20 minutes several times a day to reduce swelling during the first 48 hours.
• Take paracetamol or ibuprofen as directed by your pharmacist or doctor to manage pain.

Medical treatments

If the wound gets infected, your doctor may prescribe antibiotics. For severe tears that extend into the anal muscle, a specialist may be needed to repair the muscle and ensure it heals properly. Pain relief and local anaesthetic creams may be offered to ease discomfort.

When is surgery considered?

In rare cases, if the episiotomy repair does not heal well or there is a large scar that causes pain, a minor procedure called perineal revision may be done. This is usually not needed.

Living with this condition

For the first few weeks after an episiotomy repair, you may need to take it easy. Avoid heavy lifting, vigorous exercise, and sexual intercourse until your healthcare provider says it's safe (usually after 6 weeks or when the wound is fully healed). You can walk gently and do pelvic floor exercises to strengthen the area.

Lifestyle tips

• Use a peri bottle with warm water to rinse the area after using the toilet.
• Pat the area dry with a soft towel – do not rub.
• Wear loose, cotton underwear and avoid tight trousers or pantyhose.
• Do not sit for long periods without getting up and moving around.

Diet and exercise

Eat a high-fibre diet (fruits, vegetables, whole grains) and drink plenty of water to prevent constipation. Straining during bowel movements can put pressure on the stitches. Gentle walking is fine, but avoid heavy lifting and strenuous exercise for at least 6 weeks.

Mental health and emotional wellbeing

It is normal to feel worried or anxious about the wound, especially if it is painful or takes time to heal. Some women may feel embarrassed or stressed. Talk to your partner, a friend, or a healthcare professional about your feelings. Your midwife or health visitor can offer support.

Prevention

Some episiotomies are unavoidable, but you can reduce your risk by discussing birth plans with your midwife, keeping your pelvic floor muscles strong before and during pregnancy, and considering natural birth positions that reduce pressure on the perineum. Perineal massage in the last weeks of pregnancy may also help.

Complications

If left untreated

• Infection at the stitch site, which can cause pain, redness, and discharge.
• Poor healing leading to a scar that is painful or uncomfortable.
• Rarely, a tear that extends into the anal sphincter muscle, which can cause bowel control problems.

Long-term outlook

The vast majority of episiotomy repairs heal well within a few weeks. With proper care, most women have no long-term problems. If complications arise, they can usually be treated effectively. It is important to attend your postnatal check-ups to make sure healing is on track.

Find support

Local organisations

• Your maternity unit or postnatal ward · UK
• Health visitor or GP · UK

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