How to care for an episiotomy or tear after delivering vaginally

For many women who deliver vaginally, a tear or laceration can occur at the time of giving birth. Some women may also have an episiotomy, though doing these routinely is becoming less common in the United States. So how should you care for this after you deliver, and what should you know about healing and recovery?

Keeping clean

The basic truth is that lots of bacteria live in and around the vagina, and while most of these are good bacteria that keep your vagina healthy, sometimes an infection can set in despite your best efforts. To try and avoid this, you can do a few basic things:

• After urinating, squirt warm water from a special bottle called a peribottle (you’ll be given this in the hospital and should take it home with you, or you can buy one from any pharmacy) to help to cleanse away the urine.
• If you need to directly touch the area, always wash your hands before and after.
• Change your pads frequently to reduce exposure to bacteria and to keep the area dry.

Staying comfortable

Some women who have a minor laceration notice minimal pain postpartum, while others with deeper lacerations or in certain locations notice a lot of discomfort.

• Keeping fresh ice packs or pads filled with ice on your bottom can provide immense relief in the first 24 hours after delivery, and doing this can also help decrease swelling in the area.
• Taking pain medication as needed (which is usually just ibuprofen or acetaminophen, but may need to be something stronger if you have a more extensive tear) is important, as failing to do so can make your pain intolerable, make it difficult to empty your bladder, and may keep you from doing the things you need to do to heal, like getting out of bed and walking around. Don’t worry, you won’t be prescribed anything that is not OK for breastfeeding if you are nursing!
• Soaking in a sitz bath can bring relief and help keep the area clean. To do this, fill the tub with a few inches of water (nothing else!), and soak your vagina and bottom for up to 20 minutes. You can do this a few times a day, and some women find this very comforting.
• If sitting on the couch or in a chair bothers you, you can place pillows or blankets so that you aren’t sitting directly on your stitches. Pharmacies also sell special “donut” shaped pillows that can help with hemorrhoids. These can also be great for postpartum moms, so be sure to get one if you think it might help!
• Avoid sex until you get the OK. Doing so too early can lead to abnormal healing and possibly increased pain or infection.

Avoiding constipation

Constipation can definitely make your pain worse and can also lead to stitches coming apart. To avoid this, be sure to:

• Take stool softeners as needed. These are not addictive, so do not be afraid to use them! If they are not working, let your doctor or midwife know so that something stronger can be used temporarily.
• Drink plenty of water.
• Eat foods high in fiber.
• Get moving! Exercise (even if it is just walking) can definitely help keep your bowels regular.

Regain strength

After your doctor or midwife gives you the all clear, you can start doing Kegel exercises to help your pelvic floor muscles regain their former strength. This may also help if you are noticing any urine leakage, which can happen in the weeks after giving birth.

Warning signs to look out for

While most lacerations and episiotomies heal without any problems, sometimes a complication can occur. If you notice any of the following, be sure to let your doctor or midwife know:

• An increase in vaginal bleeding or swelling.
• Worsening or new pain.
• The inability to urinate or have a bowel movement.
• New redness around your vagina or discharge that has a foul odor.

Reviewed by Dr. Jen Lincoln, April 2020