Broken-down episiotomy: what to know and what to do

Keep the area clean and dry, use prescribed pain relief as directed, and avoid trying to close or treat the wound yourself. A clinician needs to check for infection and decide whether healing without new stitches or another repair is appropriate.

An episiotomy is a cut made in the perineum during birth and usually closed with dissolvable stitches. Breakdown can involve a small gap or a larger opening. You may notice increasing pain, visible separation, new bleeding, pus-like fluid, an unpleasant smell, or red and swollen skin.

Infection or pressure from blood beneath the wound can interfere with healing. The appearance alone does not show how deep the separation is, so an examination is useful even when the gap seems small.

Contact your midwife, maternity unit, obstetric team, or doctor as soon as you notice separation. They may examine the wound, check for infection, and take a swab if discharge is present. Treatment can include antibiotics and pain relief; the timing of any further repair depends on infection and the condition of the tissue.

Rinse gently with water, pat dry from front to back, change maternity pads regularly, and wash your hands before and after touching the area. Avoid scented products, creams not prescribed for the wound, tampons, and sex until your clinician says healing is adequate. Resting on your side may reduce pressure.

Seek same-day medical advice for worsening pain, fever, chills, pus, bad-smelling discharge, spreading redness or swelling, difficulty passing urine, or a wound that is opening further. These features can indicate infection or a more extensive breakdown.

Go to emergency care for heavy bleeding, fainting, severe weakness, confusion, breathing difficulty, or rapidly worsening illness. Do not wait for a routine postnatal appointment when these warning signs are present.

Ask how much of the wound has separated, whether there are signs of infection, and how you should clean the area. You can also ask which pain medicines are suitable while breastfeeding, whether pelvic-floor activity should be modified, what healing changes to expect, and when sex or exercise can resume.