How To Care for Your Episiotomy Stitches

An episiotomy is a surgical incision made in the perineum, the area between the vaginal opening and the anus. It is sometimes used to enlarge the vaginal opening before or during vaginal delivery. After the baby is delivered, stitches or sutures are used to close the incision as well as repair any perineal tears.

If you've had an episiotomy during childbirth, you may wonder about the recovery. Taking good care of your episiotomy stitches during your postpartum recovery will minimize the risk of complications like infection and perineal wound breakdown (when the stitches come loose or break down too soon). Proper care can also help manage pain and discomfort.

Here are a few things you should know about caring for episiotomy stitches, including signs of infection and perineal wound breakdown to be on the lookout for as you heal.

What Are Episiotomy Stitches?

After an episiotomy is performed, your doctor or midwife will repair the perineum by stitching the wound closed with dissolvable sutures (also called absorbable sutures). Because episiotomy stitches dissolve on their own, you won't have to return to the hospital to have them removed.

Episiotomy stitches usually start to dissolve within a few days and are completely gone after several weeks. You may notice pieces of the stitches (which can look like little specks left behind on the toilet paper or towel) when you wipe or pat yourself dry after using the toilet or bathing.

The Basics of Episiotomy Care

The most important part of episiotomy care is to keep your perineum area clean. Starting after delivery, use a peri bottle filled with warm water to cleanse the area every time you use the bathroom. Pat the area dry rather than wiping to prevent tugging the stitches.

You will likely feel tenderness in the area of your perineum. There may be a persistent pain or throbbing sensation, or you may feel an occasional tug or jab.

You can often reduce this discomfort by using a covered ice pack for the first day or two—especially if the wound is still swollen and red. The skin in this area is sensitive. Some postpartum people prefer soaking a large sanitary napkin in witch hazel, freezing it, and then applying it to their underwear to provide comfort. These "padsicles" can provide relief from pain, help reduce swelling, and manage the postpartum vaginal discharge known as lochia.

How To Keep Episiotomy Stitches Clean

Here are some other useful tips for keeping the episiotomy site clean and comfortable as you heal:

• Wash your hands or use an antibacterial sanitizer on your hands before touching the perineal area (this helps prevent you from infecting the wound with your hand).
• Use a peri bottle and baby wipes instead of toilet paper to reduce irritation from friction and pat dry rather than wipe.
• Use a blow dryer set on low if you have trouble drying the wound. Hold it at least 8 inches away from your skin.
• Buy a shallow mini-tub called a sitz bath that fits over the toilet seat and allows you to soak the stitches for cleansing and pain relief. (Just remember that warm water soaks are not to be started until at least 24 hours after giving birth.)
• Change your pad every 2 to 4 hours.
• Use cooling medicated pads marketed for hemorrhoids to provide relief. Find a product that is hypoallergenic, pH-balanced, and perfume-free.
• Use a numbing spray or lidocaine gel specifically made for perineal use to reduce pain and discomfort.
• Take over-the-counter pain relievers like ibuprofen to help alleviate discomfort.

Follow-Up Care for Episiotomy

You will typically have your stitches checked at your 6-week postpartum visit. At this appointment, your health care provider will do a quick exam and provide guidance on topics like resuming sexual activity and exercise and dealing with postpartum concerns like constipation, hemorrhoids, and incontinence. They can also answer any other questions you may have.

If you are experiencing issues like incontinence or continued pain, your health care provider might recommend pelvic floor exercises like Kegels to help restore muscle tone around the perineum.

When To Call the Doctor

As with all surgical procedures, complications like infection are possible following an episiotomy. Call a health care provider or go to the emergency room if you experience any of these symptoms following an episiotomy or perineal tear repair:

• Fever of 100 degrees F or more
• Foul-smelling and/or greenish discharge
• Redness and swelling around the stitches
• Severe pain at the incision site
• Visible pus in or around the wound

These symptoms can suggest infection or perineal wound breakdown (when stitches break down too soon and leave an open wound).

Keep in mind that in addition to infection, there are other complications that can occur after an episiotomy—some of which can be serious. If you have any unusual or concerning symptoms, or even if you just have questions about aftercare, don't hesitate to contact a health care provider.