How to look after an episiotomy or tear after delivery
Did you have a vaginal delivery with stitches? If you are not sure how to look after an episiotomy or tear I have links to reliable instructions here. Not sure when you can do pelvic floor exericses (and how?). Wondering when you can massage the scar … and how to do it?
Let me guide you through the different things you need to do at each stage.
What are you dealing with?
Many mums have stitches after they deliver their baby. The area of the vulva where the cut or tear will form a scar as it heals is called the perineum. The perineum is thick tissue between the opening of the vagina and the opening of the anus. An area you normally don’t think about.
This picture from St Georges NHS scar tissue management guide shows the different areas where you might have had a line of stitches
If you are squeamish it is not always good to look! On the other hand it can be helpful to know where your stitches are. You will feel more confident to avoid disturbing them, as well as caring for them to get the best possible healing.
The reason this area bleeds so much is because it has a great blood supply. This means it heals well too. Your stitches are dissolvable and usually gone by a month. However it is common to wait a full “6 weeks” to be sure that the wounds are fully healed. During these first weeks you want to encourage the healing process, and tissue stretchiness. Balancing being careful not to over exert (which will disrupt the scar as it heals), and avoid an infection in the area.
Nature will heal really well, especially with your help
There are 3 stages to think about to look after an episiotomy or tear, with different priorities to consider and different ways to help at each stage:
Early Days (0-6 weeks)
Initial wound healing and formation of a healed scar
Keep the wound clean & prevent infection
- prevent infection getting into the area
- quickly recognise if there is an infection and seek treatment
- manage the bleeding (lochia) without irritating your skin
Your maternity hospital will usually have given you advice and a booklet or resource. If you didn’t get one, Oxford University NHS Hospital Trust has simple advice on how to keep your stitches clean and cared for: https://www.ouh.nhs.uk/patient-guide/leaflets/files/10929Pperineum.pdf
Leeds NHS Trust made this clear video: Physiotherapist, Jenny Watkins
Follow my RESCue process to reduce pain:
- reduce the discomfort and pain so that you can enjoy being a mum
- help haemmorrhoids, brusing and swelling to go down
- use your pelvic floor exercises to promote blood flow and healing
- keep pressure off your healing bottom
- ensure you eat well and stay hydrated to have regular bowel movements. Learn how to sit on the toilet properly!
REST – ELEVATION – SOOTHE – CUE the pelvic floor muscles. Read the detail here about how to apply ice, sit comfortably, do the gentlest of pelvic floor, promote best healing.
Start Early days exercises to help the scar stretch naturally:
- introduce Movement to Feel Good
- prevent your pelvic floor or gluts muscles tightening up in a guarding pattern around the scar
- encourage the scar to stretch naturally as it heals so that it is comfortable
- avoid straining and excess pressure on the scar as it heals
This great booklet of specialist physio advice on moving well, emptying your bowels, & very first days exercises is free to download.
explore the Supported Mums YouTube playlist or my Pilates classes on Beam for Early Days exercises which will gently stretch the area, encourage connection to your abdominals & pelvic floor but not over-exert or put pressure on your healing body too early.
Picking up the Pace (6 weeks +)
promote formation of a flexible, comfortable scar.
After 6 weeks the scar should be fully healed, the scab is gone. Now you can look after an episiotomy or tear further by helping the body form flexible, collagen rich scar tissue. This type of tissue will comfortably move with you whatever you want to do! And you will soon be able to forget all about it!
This is when you can start scar massage
- use scar massage to encourage the formation of a flexible, comfortable, well formed scar. This leaflet from St Georges NHS Trust is a good starting point. For more depth American Physical Therapist Amy Stein adds detail. In the video, below, my colleague, Clare Bourne explains how to massage your scar from 6 weeks.
- you can use a natural oil like olive, almond or coconut or there are several commercial ones available with blends of essential oils included. Be sure to check for allergies & I would recommend keeping the oil only for this massage of this area.
- return to sex. See our Getting back your Mojo series
- seek help if you are not happy with the way you are feeling
- do pelvic floor exercises with the intention of improving your strength, endurance and co-ordination. This will prevent leaks, support your pelvic organs. Vital preparation before you return to your hobbies and sports around 3 months. See our Pelvic Floor School for ways to progress from the basics. Including how to relax the pelvic floor & stretch it out to prevent pain. Join me for Postnatal Pilates online?
Finding your new normal (12 weeks – 12 years!)
Life and your body are not the same after a baby, and may change again with baby number two or three. What is normal? Perhaps don’t focus on getting “back” to normal as life is a forward journey? Where will your body and your family take you next?
In this phase be sure to sort out any niggly problems
- check in on your scar 1-2 x month to make sure it is happy and to maintain it’s stretchiness
- if you didn’t start scar massage earlier definitely give the scar some love and attention now
- Persistent pain needs assessing further. Definitely seek help from a specialist physiotherapist. If the scar is painful or tugging as you move or during sex. Or you suspect it might be causing a problem like back pain, difficulty working your abdominals or pelvic floor.
- give your love-life the time and attention it deserves. Check in with these suggestions if sex is painful or feels a bit flat.
If you can’t access a physiotherapist or want to learn more yourself first I highly recommend these books:
Please let me know if this post was helpful. Don’t hesitate to be in touch if you have questions.
