Recovering after the episiotomy

MANY women who deliver by way of vaginal birth, especially in the case of first-time mothers, will experience vaginal tears or lacerations of a certain degree. This, obstetrician gynaecologist at ICON Medical Centre Dr Keisha Buchanan said, usually occurs naturally; however, sometimes the doctors may find it necessary to perform a surgical procedure — an episiotomy — which is basically a minor incision of the perineum (the skin and muscle between your vagina and anus) to make a wider opening which will make the baby’s entrance into the world much easier.

“The incidence of vaginal tears (or lacerations) is 80-90 per cent. Some factors that increase the risk of tears include if this is the first vaginal delivery; the larger the baby, the greater the chance of tears; the more forceful the expulsion of the infant increases the risk of tears, or if the baby’s head circumference is larger,” Dr Buchanan outlined.

She pointed out that while in most cases vaginal tears are superficial, involving the more superficial (surface) tissues, some are more severe involving deeper muscle layers. She said the most severe tears extend to the rectum, but fortunately, these are rare.

Regardless of the severity of the vaginal tear, they often come with much discomfort and pain, and as such it is important that moms — as well as those who will assist in their care as they recover from childbirth — have a very good understanding of how to treat and manage these tears.

Below, Dr Buchanan shares how to do this.

Keep the area clean

This is rule number one. Always keep the area clean, and it is very easy to achieve.

“Simply keep the area clean by bathing twice per day and wiping the area from front to back after passing stool. You should also use a dilute antiseptic to cleanse the area if faecal soiling is detected,” Dr Buchanan instructed.

The sitz bath

“The commonest method of caring for vaginal tears is by the use of the sitz baths. This involves soaking the area in warm, salt water, usually twice daily.”

She explained that this will this will keep the area clean, prevent swelling, and improve blood flow to the area which promotes healing.

Take some antibiotics

Oral and topical antibiotics are often given, especially if the area around the tears (laceration) was contaminated with faeces, which can often happen at delivery.

“Even though enema is given in early labour to remove as much stool as possible prior to delivery, it’s not uncommon that while pushing the baby out during delivery, stool can escape and may contaminate a laceration. As such, antibiotics are often prescribed to help prevent infection of the laceration,” Dr Buchanan advised.

She underscored that if there is an infection at the laceration site, this can cause it to reopen after being sutured (closed up by the doctor with stitches).

Try to prevent constipation

One of the most common complaints that women have after childbirth is constipation. However, this can sometimes be a challenge, and as such Dr Buchanan recommends using stool softeners, consuming a high-fibre diet, and keeping well hydrated. She said that constipation and the subsequent straining to pass stool can result in a strain and tear of the sutures.

Ice packs offer great relief

As with many other cuts and tears that you will experience, applying ice can work wonders. This simple method will help in preventing swelling in the area where the laceration is located and sometimes even contribute to pain reduction.

Use a wound care solution

Use of sprays such as Microdacyn, which is an antimicrobial liquid spray, can prevent infection at the perineum.

Avoid sex

It is always recommended to give yourself a little time to heal after delivery before you start having sex.

“If you have a vaginal tear, then avoiding sex for five to six weeks after delivery will prevent trauma to the wound and infection and will prevent infections from ascending into the womb,” Dr Buchanan advised.

Avoid strenuous activities

Whether it is that you can’t leave the household chores alone or you are anxious to get back to exercising, you need to hold off for just a little bit longer.

“Avoiding strenuous activity such heavy lifting, exercises such as squats, and weight lifting will prevent trauma and rupture of the laceration,” Dr Buchanan explained.

Infrared light/laser therapy

Infrared light therapy to the perineum is effective in promoting wound healing and easing pain and swelling at the laceration site. On the other hand, laser therapy has been studied to assist with the healing of vaginal tears; however, the studies on this are inconclusive so far.

Painkillers

“Use of oral painkillers can help to decrease pain, inflammation and swelling at the site of the vaginal tears,” Dr Buchanan advised. However, she said that these should be prescribed by your doctor to ensure that they are safe during breastfeeding.

While some amount of discomfort is expected with vaginal tears, Dr Buchanan said that with the right combination of care methods as well as constant care and cleaning of the area, you should have a speedy recovery.