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How to Care for Your Episiotomy Stitches

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

Taking good care of your episiotomy stitches during your postpartum recovery will minimize the risk of infection and can help manage pain. Here are a few things you should know about caring for episiotomy stitches, as well as signs of infection 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. The stitches are often black but can be other colors or be clear. You will probably be able to see them if you look at the area between your vulva and anus.

Dissolvable sutures (also called absorbable sutures) are typically used for an episiotomy. You don't have to have them removed by a doctor; the stitches will break down on their own within 2 to 4 weeks.

You don't have to return to the hospital to have them removed, and there are rarely any complications associated with their use.

Episiotomy stitches usually start to dissolve within a few days, and are gone after a week or two. You may notice pieces of the stitches (appearing as little black specks left behind on the toilet paper) when you wipe yourself.

Tips for Caring for Your Episiotomy Stitches

Once you return home from the hospital, 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 new moms prefer soaking a large sanitary napkin in witch hazel, freezing it, and then applying it to their underwear to provide comfort.

The most important thing is to keep your perineum clean. Starting as soon as you get home, use a squirt 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.

Here are some other useful tips for keeping the area clean:

• Avoid tampons for the first 6 weeks after giving birth.
• 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.
• Choose cooling medicated pads marketed for hemorrhoid use to provide relief. Find a product that is hypoallergenic, pH balanced, and perfume-free.
• Get numbing sprays specifically made for new mothers, which can be found at most drugstores. Lidocaine gels may also help.
• Prevent constipation by increasing water and fiber intake. Talk to your health care provider about the use of stool softeners and laxatives.
• Take over-the-counter pain relievers like Motrin (ibuprofen) to help alleviate discomfort.
• Use an antibacterial sanitizer on your hands before cleaning the perineal area (this helps prevent you from infecting the wound with your hand).
• Use baby wipes instead of toilet paper to reduce irritation from friction.
• Use a blow dryer set on low if you have trouble drying the wound. Hold it at least 8 inches away from your skin.
• Wipe front to back.

Getting Follow-Up Care

You will typically have your stitches checked at your 6-week postpartum visit. At this appointment, your doctor or midwife will also tell you when you can resume sexual relations and can provide guidance for dealing with incontinence or any other postpartum issues you might be experiencing.

If you are experiencing issues like incontinence or continued pain, your healthcare provider might recommend Kegel exercises to help restore muscle tone around the perineum.

When to Seek Professional Help

As with all surgical procedures, infection is possible following an episiotomy. Call your doctor or go to the emergency room if you experience an infection such as:

• 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

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 your healthcare provider.