Episiotomy

An episiotomy involves making a surgical incision to assist in vaginal delivery by enlarging the birth canal.

Most are done in 2 ways:

1. Medio-lateral episiotomies are either a right or left side vaginal cut. This will engage more muscles, have deeper tissues involved, it take longer to heal.
2. Midline episiotomies are intended to be a cut straight down cut to the anus, but avoiding the anal sphincter and rectum.  This is less extensive and generally heals faster.

How much time needed to heal an episiotomy?

A 1st-degree incision is just a slight cut that does not go all the way into the perineal muscle.  A 2nd-degree incision, a little deeper, is a common practice that cuts into the perineal muscle but not completely through the muscle.  A 3rd-degree incision actually cuts through this muscle, but not through the round sphincter muscle that is next to the anus. As the repair of injuries to this muscle may prevent fecal incontinence, it is of extreme importance to have a skilled and experienced physician such as Dr. Morice do the repair. A 4th-degree tear is a severe tear extending into the rectal tissue and possibly involving periurethral and labial areas.  It must be repaired appropriately to prevent a hole forming between the vagina and rectum.  If not done properly, the hole may convert to a fistula, where gas and feces can pass into the vagina. This can be repaired surgically even years later, however can be avoided by a good surgical repair by an experienced and skilled physician.

Long-lasting pain from an episiotomy may result from:

1. A hasty repair.
2. Not having sufficient visualization of the area repaired during the repair.
3. Excessive bleeding.
4. A moving target (a patient who constantly moves while doing the repair).

Outcomes after episiotomy include:

1. Severity of perineal laceration related to continued pain
2. Fecal or urinary incontinence.
3. Pelvic floor outcomes such as pelvic floor relaxation or prolapse

What measures should be taken during episiotomy?

1. Skillful repair in order to minimize pain and assist healing.
2. Postpartum inspection if any complaints to discover any other damaged areas of the vagina, cervix, perineum or anus.
3. For immediate reduction in pain, injection with numbing medicine in the area or IV administration of pain medicine as needed.
4. Kegel exercises to increase blood flow to the area may improve healing.