If you had an episiotomy that healed poorly and is causing discomfort or pain, a revision episiotomy can be done even years later to repair the issue.
A revision episiotomy can remove excess tissue (granulation tissue) and knots that may have developed from the previous episiotomy. The procedure can especially help women who experience pain during sex.
What is episiotomy and why is it done?
Episiotomy is a procedure that involves making an incision in the area between the vaginal opening and the anus, and it is done to enlarge the vaginal opening for childbirth.
In the past, the practice was done routinely for all types of childbirth to avoid extensive vaginal tears and to hasten healing of the surgical tear. However, now the procedure his only done when necessary, such as in cases of:
- Shoulder dystocia (baby's shoulder gets stuck behind the pelvic bone during labor)
- Arrhythmia in the baby
- Forceps or vacuum delivery
- Fetal distress (baby is not receiving enough oxygen through the placenta)
- Breech presentation (baby is positioned bottom or feet first)
- Prolonged second stage of labor
- Large baby
- Preterm baby
How is an episiotomy performed?
Generally, the following steps are involved in an episiotomy:
- Local anesthesia will be administered to numb the area around the perineum.
- Your doctor will then decide which type of incision to make:
- Midline (median) incision, which is done vertically
- Mediolateral incision, which is done at an angle
- During the second stage of labor when you are pushing, your baby's head stretches your vaginal opening. At this time, your doctor will use surgical scissors or a scalpel to make the incision.
- After delivery of the baby and placenta, the incision will be stitched up.
What are the potential complications of an episiotomy?
An episiotomy can cause complications such as:
- Fecal incontinence (if there is a grade 4 tear extending to the rectal tissues and anal sphincter muscle, which control the passing of stool)
- Hematoma (collection of blood in the perineal tissues)
- Injury to the urethra
- Injury to the bladder
- Chronic infections
- Pelvic organ prolapses (dropping down of a pelvic organs, such as the uterus)
Risk of complications vary depending on your condition and whether you are on any medications. Remember to discuss your concerns with your doctor before delivery.
How long does it take for an episiotomy to heal?
Episiotomy wounds heal within 2-3 weeks after delivery. To relieve pain and swelling during recovery, here are a few things that may help:
- Prescription medications or over-the-counter pain relievers
- Stool softeners (if bowel movements are painful)
- Cold packs applied over the incision for 15-20 minutes about 4-5 times a day
- Warm baths (sitz baths) to help ease soreness and speed up healing
- Medicated creams or local numbing sprays
- Keeping the incision area clean and dry
Avoid douching, using tampons, or having sex until your doctor allows you to do so. You may also be advised to avoid certain physical activities, such as heavy lifting, and sitting still for too long. Follow up with your doctor and make sure you keep your appointments.
When to contact a doctor
Call your doctor if develop you develop the following:
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Gün I, Dogan B, Özdamar Ö. Long- and short-term complications of episiotomy. Turk J Obstet Gynecol. 2016;13(3):144-148. doi:10.4274/tjod.00087
Lappen JR. Episiotomy and Repair Technique. Medscape. https://emedicine.medscape.com/article/2047173-technique#showall
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