An episiotomy is a procedure performed during childbirth, typically with specific circumstances. The procedure involves making an incision between the vaginal opening and the anus (through the perineum), which allows for additional room for the baby to exit during birth.

This procedure used to be more common, as it was thought to help prevent large amounts of tearing as well as promote better healing of the tissues and muscles than a natural tear.

However, as childbirth care and research evolves, these aspects have been disproven and it has now become an option only used in certain scenarios.

Some examples of these scenarios include:

• When the baby is large, or in a unideal position for delivery
• When the need for a quicker delivery arises (such as fetal distress)
• When the individual is at a high risk for severe tearing
• If the individual has certain medical conditions (such as heart disease)
• Prolonged labor
• Assisted vaginal delivery
• If the individual has a previous scar or poor elasticity

Episiotomies are great for these specific scenarios, however they do cause a level of discomfort for the individual during the healing period. An episiotomy is different for every person—factors such as the direction and depth of the incision can differ depending on the individual’s needs.

Each person will also have differences in muscle or tissue health, which affects healing times. In some cases, the incision may be larger than what a natural tear would have been in order to allow for a proper delivery.

Additionally, as the incision heals it will leave a scar that, depending on the specifics of the procedure, varies in texture and appearance.

Because of all these different factors, the symptoms one experiences during and after the healing period can vary widely. Some individuals may have minimal issues, whereas others can experience the following:

• Tightness
• Tenderness
• Pain
• Discomfort during certain movements or exercises
• Pain with sex

It is incredibly important to care for the perineum and pelvic floor while recovering from this sort of procedure in order to avoid these symptoms long-term.

One of Hive’s pelvic floor professionals will be able to optimize your recovery and prevent future symptoms or complications that can arise from the incision and scar. However, don’t forget that seeing a professional beforehand can be just as useful.

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There are a lot of reasons as to why future parents should engage in pelvic floor therapy to prepare for childbirth, but an episiotomy is not usually something an individual expects to have or even prepares for.

Childbirth varies widely from person to person—for example, consider the following factors:

• What sort of medications will you be given? Medications can affect your body’s ability to stretch and relax during childbirth.
• What country are you giving birth in? Some countries favor a natural tear over performing episiotomies.
• Are you giving birth to a single baby, or multiple? Individuals having twins (or more) have a higher likelihood of receiving an episiotomy, depending on the country.
• How prepared is your pelvic floor for delivery? If your pelvic floor is already tight, uncoordinated, or inflexible, an episiotomy may be more likely.

These are just a few things that can vary when it comes to childbirth. Even if you know what to expect for each of these aspects, what will happen during the actual delivery is unknown.

When it comes to childbirth, there is a timeline that has to be followed in order to ensure safe delivery for both the parent and baby—and truthfully, you cannot know for sure whether or not an episiotomy will be necessary.

There are many, many scenarios that may make one necessary, so it is very important to be aware of the process, the healing period, and how to prepare ahead of time for an episiotomy in the case that you need one.

This information isn’t meant to scare you, but rather is meant to encourage you to prepare your body for all the possibilities that can occur during childbirth.

Additionally, knowing what could happen beforehand allows you to communicate with your birthing team to make a plan—you have the right to consent to or decline this procedure, after all.

Next, we will discuss how a pelvic floor physical therapist can help you both prepare for and recover from an episiotomy in the next section!

Firstly, let’s talk about preparation. Ideally, an individual would visit a pelvic floor physical therapist beforehand to help optimize their pelvic floor health and better prepare their body for childbirth.

If you are someone who has already gone through childbirth, natural tearing, or an episiotomy and are considering pelvic floor physical therapy, don’t worry—it can still help! We’ll get into that soon.

Preparing ahead of time allows your pelvic floor muscles—the muscles that do almost all the work during both pregnancy and childbirth—to become strong, coordinated, healthy, and flexible. That includes the perineum!

It’s important to recognize that the perineum is not just a single piece of skin, although it is often described as such. Beyond being a patch of skin between your vaginal opening and anus, it is actually a larger, diamond-shaped fibromuscular structure.

It is a central attachment point for many of the pelvic floor muscles, acting as a divider between the anterior (frontal) and posterior (behind) areas of the pelvic floor.

More accurately, you can think of it as the “perineal body.” So when a natural tear occurs, it can occur at varying degrees, each of which affect the perineal body differently.

A first-degree tear is a small tear affecting just the skin. Second-degree tears and beyond actually affect deeper perineal muscle.

The more severe type of tears can extend much deeper and affect muscles such as your anal sphincter (the muscle that controls your anus). Episiotomies can affect your degree of tearing, and depending on the type of incision performed, may either prevent or encourage worsening of the tear.

This is why it could be beneficial to see a physical therapist beforehand. They can help get all those muscles and tissues in the best possible condition for childbirth.

Having a healthy, flexible pelvic floor and perineal body can help minimize tearing and even prevent the need for an episiotomy. You can learn more about what childbirth preparation looks like here, and no worries—pelvic floor physical therapy is totally safe during pregnancy!

Of course, you’ll never know for sure what will happen in the delivery room. In the case that you do experience a tear or a need for an episiotomy, your efforts to prepare beforehand will definitely help during the healing process.

So, what does the healing process look like? How can pelvic floor therapy help?

Healing from an episiotomy usually takes several weeks (generally 6-8 weeks). Still, it may take longer depending on the degree of the episiotomy, if tearing also occurred, and if there were any post-delivery healing complications such as infection or a re-tear.

Pelvic floor physical therapy is very effective at managing pain and discomfort after an episiotomy and can also help maintain scar health and appearance.

Your physical therapist will not only make sure you feel comfortable and pain-free, but will also focus on the long-term function of your perineum and pelvic floor.

They’ll utilize a variety of treatments to help improve tissue mobility, flexibility, function, and comfort. Some examples include:

Mobilization and Manual Therapy: Manual techniques and massage will help loosen scar tissue and lessen the tightness or tension of the area. This will improve flexibility and comfort! Additionally, myofascial release techniques will likely be used to release tight areas and improve blood flow. These treatments can also help reduce sensitivity and pain associated with the scar.

Stretching and Exercises: It is important to stretch and strengthen the pelvic floor and perineal area—therefore, you can expect to learn a variety of stretching techniques as well as exercises to support healing.

Pelvic Floor Training: The body will need time after childbirth to properly re-learn how to engage the pelvic floor muscles. Your physical therapist will utilize biofeedback or neuromuscular re-education treatments to help your body readjust, as well as to prevent future problems with pelvic floor dysfunction.

Behavioral Modifications: As you continue to heal, your physical therapist can provide advice on postures or other mechanics that can help relieve pain or discomfort. Many individuals may find it difficult to sit after an episiotomy, as well as perform other movements. Physical therapists are experts of the body, and can help teach you modifications to minimize pressure on your pelvic area and perineum.

These are just some of the treatments that you can expect while under the care of Hive Therapy and Wellness. Our physical therapists take a holistic approach to treatment, and will utilize whatever methods necessary to help you regain optimal health, function, and comfort.

Therefore, for patients recovering from an episiotomy, Hive physical therapists may utilize any of the following treatments:

• Neuromuscular re-education 
• Manual therapy
• Exercise prescription 
• Dry needling 
• Behavioral modifications 
• Therapeutic activities 
• Electrical muscle stimulation
• Therapeutic modalities