I Had an Episiotomy: Now What?

December 9, 2022

Did you know that in some countries, a referral to a pelvic floor physical therapist is standard care for postpartum women? I don’t know about you, but I would LOVE to see this standard of care adopted into American culture! Here’s why:

Women’s bodies are capable, strong, and resilient—but for many postpartum moms, true physical recovery requires more than just the passing of time. In fact, unaddressed pregnancy-related changes in the alignment and function of tissues in the pelvis can lead to chronic issues like back pain, painful sex, and urinary incontinence, which can impair a woman’s quality of life long after she’s “healed” from labor and delivery.

The need for increased postpartum care may be especially true for women who receive a medical procedure during labor and delivery known as an episiotomy. If you’ve ever received an episiotomy, here’s what I’d like you to know.

What is an Episiotomy?

An episiotomy is defined by Mayo Clinic as “a cut (incision) made in the tissue between the vaginal opening and the anus during childbirth.” Originally the purpose of an episiotomy was thought  to help with delivery and potentially prevent tearing in the perineal area.

But you should know that episiotomies are no longer recommended as a “routine” procedure for people giving birth. According to Mayo Clinic, an episiotomy is generally only recommended in certain situations, such as when:

• The baby’s shoulder is stuck behind the mother’s pelvic bones
• The baby is in distress during labor and delivery (e.g., has an unusual heart rate)
• The medical team needs to use forceps or vacuum extraction during a vaginal delivery

Episiotomies are stitched after birth, and these stitches usually dissolve gradually over time as the incision heals. As you might imagine, episiotomies can be uncomfortable! If you choose to take any prescription or over-the-counter pain relievers to help ease the discomfort, be sure to do so as instructed. If your pain gets worse over time instead of better, or if you notice signs and symptoms of an infection (like redness, swelling, or pus), call your doctor right away.

Why See a Pelvic Health Physical Therapist After Getting An Episiotomy

If you’re recently postpartum and received an episiotomy during labor and delivery, let your doctor know that you’d like to consult with a pelvic health PT. A pelvic health physical therapist can help you during your recovery in several ways.

Here’s what our women’s health PTs can do to help:

• Assess and improve your body mechanics, posture, and breathing style during exercise and daily activity to minimize excess pressure on the pelvic floor and perineal area
• Provide gentle and appropriately progressed manual therapy to assist with scar tissue development, circulation, and pain
• Educate you on how to safely mobilize your own scar tissue to decrease tenderness and improve the elasticity of the scar
• Teach personalized exercises and stretching techniques to improve overall pelvic floor function
• Augment your overall healing process with guided breathwork, yoga for the pelvic floor, and additional mind-body strategies

By the way—seeing a pelvic health physical therapist before labor and delivery may even reduce your risk of tearing or requiring an episiotomy once the big day comes! Research has found that performing pelvic floor exercises in addition to daily perineal massage may reduce the risk of requiring an episiotomy by over 30%.

Are You Healing from an Episiotomy?

Contact ITR Physical Therapy at 301-770-7060 to schedule an appointment with a Bethesda or McLean women’s health PT today!