An episiotomy occurs when an intentional cut is made between the vagina and anus (called the perineal body) by your doctor or midwife. Perineal tearing occurs as the woman is pushing the baby out due to stretching of that same area between the vagina and anus.

Symptoms/Functional Problems
Pain, swelling, bleeding, discomfort with moving around during daily tasks, redness, dyspareunia (pain with sexual intercourse), urinary and/or bowel (fecal) incontinence, and pelvic organ prolapse (POP).

Causes
An episiotomy may be recommended if your baby becomes distressed during the birth process. This may involve their heart rate dropping or getting faster which could mean the baby is not getting enough oxygen. Other causes of having an episiotomy may be if your baby is breech, the physician or midwife needs to use forceps or vacuum, mother fatigue, or the mother having comorbid conditions. ⁽¹⁾ Perineal tearing, or vaginal tearing, is relatively common during birth when the baby is pushed through the vagina. It may be caused by the baby being too big for the vaginal opening or if the vaginal opening does not stretch enough for the baby as he/she emerges. ⁽²⁾

FAQ

Q: What is a perineum?
A: A perineum is the area of skin/tissue and muscles between your anus and vagina.
Q: How often do women have episiotomies during childbirth?
A: It is less common than perineal tearing. Statistics vary widely, and it has become less common these days. ACOG (American College of Obstetricians and Gynecologists) recommend that episiotomies be done only when it is absolutely necessary.
Q: How often do women have perineal tearing during childbirth?
A: It is common. “At least one third of women in the UK and US have perineal tears that need stitches. About three in 100 women having a vaginal birth have the more severe perineal tears. Tears are slightly more common with a first vaginal birth than in women who have had a vaginal birth before”. ⁽³⁾
Q: How long does it take to recover after an episiotomy or perineal tear?
A: Episiotomies and perineal tears are usually stitched within an hour of giving birth. Your stitches should be healed within 4-6 weeks, and you should follow up with your doctor at your 6-week postpartum visit if you have any concerns about your healing including swelling, pain, redness, discharge, stitches that have not dissolved, and bleeding.
Q: Is there anything I can do to prevent episiotomies or perineal tearing during childbirth?
A: Yes! According to a study published in 2017, women who participated in a pelvic floor training program had lower rates of both episiotomies and perineal tearing during the birth process. ⁽⁴⁾ The program involved pelvic floor exercises and perineal massaging. Also, many studies have shown that perineal massage and warm compresses during the birth may help prevent perineal tearing as the baby is pushed through the vagina. ⁽⁵⁾ “Application of perineal massage during active labor decreased the frequency of episiotomy procedures.” ⁽⁶⁾
Q: How long should I wait to have intercourse if I had tearing during my baby’s birth?
A: Most doctors recommend waiting at least six weeks postpartum before inserting anything into the vagina to allow for optimal tissue healing and recovery. It is normal to not feel ready at six weeks for sexual intercourse, and you should wait to engage in intercourse until you are ready and fully healed. Many women experience insufficient vaginal lubrication postpartum, especially if you are breast feeding, and a water-based lubricant can help. ⁽⁷⁾
Q: How long does the pain last after having an episiotomy or experiencing perineal tearing?
A: Usually 1-2 weeks. ⁽⁸⁾ You may apply an ice pack to the area to help with pain and swelling, take a warm sitz bath, run water over your perineum every time you use the toilet, change position regularly, eat a well-balanced diet, drink plenty of water, and participate in pelvic floor exercises. ⁽⁹⁾
Q: Would I benefit from pelvic floor physical therapy (PFPT)?
A: If you are a postpartum mother and experienced an episiotomy or perineal tearing with any of the residual symptoms described here, you may benefit from PFPT. This specialized therapy is useful in treating many painful and uncomfortable conditions related to postpartum recovery.

Treating and Managing Your Episiotomy or Perineal Tearing
As many as 85% of women who give birth vaginally experience an episiotomy or perineal tearing. ⁽¹⁰⁾ Either of these conditions are reported as being painful and uncomfortable in those delicate days immediately after giving birth. There are several strategies that a pregnant mother can do to prepare her body for birth to prevent tearing or an episiotomy and recommendations that she can do postpartum to maximize her healing and recovery. As pelvic floor specialists, we are here to help you heal safely and comfortably so that you can enjoy your new baby.

At N-Balance Physical Therapy, we offer a comprehensive treatment plan that includes a thorough evaluation to identify the cause of the problems you are experiencing and implement an individualized treatment plan to improve your symptoms, quality of life and enjoyment of your new baby.

References

1. NHS. (n.d.). Episiotomy and perineal tears. NHS Choices. https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/episiotomy-and-perineal-tears/. 
2. Mayo Foundation for Medical Education and Research. (2019, October 11). Slide show: Vaginal tears in childbirth. Mayo Clinic.
   https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129. 
3. NCT (National Childbirth Trust). (2019, November 6). Episiotomy during childbirth. NCT (National Childbirth Trust). https://www.nct.org.uk/labourbirth/you-after-birth/episiotomy-during-childbirth. 
4. Leon-Larios, F., Corrales-Gutierrez, I., Casado-Mejía, R., & Suarez-Serrano, C. (2017). Influence of a pelvic floor training programme to prevent perineal trauma: A quasi-randomised controlled trial. Midwifery, 50, 72–77. https://doi.org/10.1016/j.midw.2017.03.015
5. Aasheim, V., Nilsen, A., Reinar, L. M., & Lukasse, M. (2017). Perineal techniques during the second stage of labour for reducing perineal trauma. The Cochrane database of systematic reviews, 6(6), CD006672. https://doi.org/10.1002/14651858.CD006672.pub3
6. Demirel, G., & Golbasi, Z. (2015). Effect of perineal massage on the rate of episiotomy and perineal tearing. International journal of gynaecology and
   obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 131(2), 183–186. https://doi.org/10.1016/j.ijgo.2015.04.048
7. See note 1 above
8. Perineal Tear: What to Expect at Home. MyHealth.Alberta.ca Government of Alberta Personal Health Portal. (n.d.). https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abn2976. 
9. Recovering from a perineal tear. Tommy’s. Together, for every baby. (n.d.). https://www.tommys.org/pregnancy-information/after-birth/recovering-perineal-tear. 
10. See note 3 above