Table of Contents
- What is an episiotomy?
- What are perineal tears? (the four degrees)
- Why an episiotomy is sometimes needed
- How the cut or tear is repaired
- Healing time — what to expect
- How to care for the area and ease pain
- Signs of a problem — when to call your doctor
- Frequently asked questions
An episiotomy is a small, controlled surgical cut made to the perineum (the area between the vagina and anus) to help the baby out during a vaginal birth; a perineal tear is a natural tear in the same area. Both are common, both are repaired with stitches that usually dissolve on their own, and most women heal well within a few weeks with simple care.
What is an episiotomy?
An episiotomy is a planned cut to the perineum, made by your doctor during the pushing stage of a vaginal birth when a little extra room is needed to deliver the baby safely and quickly. It is done under local anaesthetic (or when an epidural is already working), so you shouldn’t feel it at the time. Today, episiotomies are performed selectively — only when there’s a clear reason — rather than routinely.
What are perineal tears? (the four degrees)
Many women tear naturally rather than having an episiotomy. Tears are graded by how deep they go:
- First-degree — a small, shallow tear involving only the skin; often heals on its own or with a stitch or two.
- Second-degree — involves the skin and the muscle of the perineum; usually needs stitches (this is also the depth of a typical episiotomy).
- Third-degree — extends to the muscle that controls the anus (the anal sphincter).
- Fourth-degree — extends through the anal sphincter to the bowel lining. Third- and fourth-degree tears are less common and are repaired carefully, often with a little extra follow-up to protect long-term recovery.
Why an episiotomy is sometimes needed
Your doctor may recommend an episiotomy if the baby needs to be born quickly (for example, signs of distress), if an assisted delivery with forceps or a vacuum is needed, or if a large tear looks likely. The aim is always to protect you and your baby and to give the most controlled, healable result.
How the cut or tear is repaired
After birth, an episiotomy or tear is stitched using dissolvable stitches, so they don’t need to be removed — they gradually disappear as you heal. The repair is done with pain relief in place. Most perineal stitches are internal and settle over the following weeks.
Healing time — what to expect
Discomfort is usually most noticeable in the first few days, eases over 7–10 days, and most women feel largely healed by about 3–4 weeks, though deeper tears can take a little longer. It’s normal to feel soreness when sitting, walking or passing urine at first; this steadily improves day by day.
How to care for the area and ease pain
Gentle, consistent care makes a real difference: keep the area clean by rinsing with plain water after passing urine or stool and always wiping front to back; try warm sitz baths (sitting in a few inches of lukewarm water for 10–15 minutes) once or twice a day to soothe and support healing; use a cool pack wrapped in a clean cloth to reduce swelling in the early days; change sanitary pads every 4–6 hours; and eat plenty of fibre and drink fluids to avoid constipation, which can strain the stitches. For a full routine, see our guide to caring for stitches after a C-section or normal delivery.
Signs of a problem — when to call your doctor
Contact your doctor promptly if you notice increasing pain rather than steady improvement, spreading redness or swelling, pus or a foul smell, a fever, the wound opening, or any leaking of stool or difficulty controlling wind or bowel movements. These are uncommon but need prompt attention. Dr. Richa Gangwar’s team provides gentle postpartum recovery care in Lucknow.
Medically reviewed by Dr. Richa Gangwar — MS, DNB, MRCOG (London), Gomti Nagar, Lucknow. Last reviewed: June 2026. General guidance: NHS.
FAQ:-
How long does an episiotomy take to heal?
Discomfort usually eases within 7–10 days, with most women largely healed by 3–4 weeks. Deeper tears can take a little longer.
Are episiotomy stitches removed?
No — they’re dissolvable and disappear on their own as you heal.
Is an episiotomy better than a natural tear?
Neither is automatically better; today episiotomies are done selectively, only when there’s a clear reason.
How can I ease the pain after an episiotomy?
Warm sitz baths, a cool pack, gentle hygiene (front to back), frequent pad changes, and preventing constipation all help.
When should I worry about my stitches?
If pain increases instead of easing, or you notice spreading redness, pus, a foul smell, fever, the wound opening, or any leaking of stool — call your doctor.
