How Do I Manage Episiotomy Pain?

An episiotomy is a medical procedure in which the perineum, the skin between the anus and the vagina, is cut, typically to enlarge the vaginal opening during childbirth so that the baby can be more easily delivered. Most episiotomy pain significantly diminishes within a day after the procedure, but during that time, you can expect to feel some discomfort and stinging pain. Pain medications, ice packs, and proper cleansing methods can help alleviate the discomfort.

Episiotomies used to be a routine part of vaginal child birth, as the procedure could help speed up the birthing process and reduce the risk of tearing the perineum. Due to the risks involved, it is no longer part of routine practice and only performed when necessary, such as when a speedy delivery is medically required, or when the baby is in an abnormal position. Aside from episiotomy pain, risks of the procedure include pain during sex, infection, and fecal incontinence.

After the procedure, your doctor may recommend pain relievers to help alleviate the episiotomy pain. While over-the-counter non-steroidal anti-inflammatory (NSAID) drugs may be adequate, your doctor may prescribe a narcotic pain reliever for severe discomfort. Narcotic pain relievers are addictive, however, and can cause drowsiness or alter your ability to care for you newborn, so they are usually used as a last resort.

Applying cold compresses to the perineum area can help soothe episiotomy pain. Much of the discomfort comes from the fact that the muscle tissue in the area is swollen. Bags of small frozen vegetables, such as peas or corn, make good compresses, as do sanitary napkins that are moistened, frozen, and wrapped in a towel. Wrapping a towel around a plastic bag filled with small ice cubes is also effective. Apply the cold compress for up to 20 minutes at a time as needed, taking a break between applications.

Urinating after an episiotomy can be painful because the urine can sting the sensitive area. Using toilet paper to clean yourself can also add to the discomfort and possible damage the stitches. Instead, doctors recommend using a squirt bottle or special perineum-cleansing bottle to cleanse after urination. Fill the bottle with warm water and leave it next to the toilet. When you are finished urinating, squirt the perineum with the water and pat dry with clean gauze. Warm water is a breeding ground for bacteria, so empty the bottle and use fresh water each time you urinate.

A sitz bath can also help relieve episiotomy pain. Check with your doctor to make sure you are allowed to get the stitches and perineum area wet, then fill your tub with warm water until it covers only your hips and buttocks and sit in it for 15 to 20 minutes. While the warm water alone is often enough to soothe the pain, you may also add baking soda or a saline solution to the water if your doctor allows it.

While some pain and discomfort is to be expected after an episiotomy, contact your physician if it becomes too severe to manage at home. Watch for signs of infection, including foul-smelling discharge, bleeding at the site, fever, or excessive swelling and redness. Contact your physician if you are having problems with loss of urinary or bowel control as well.