When an episiotomy does not heal as expected

A wound that is not healing as expected can cause pain that intensifies, increasing redness, warmth, swelling, pus, or an unpleasant smell. A collection of blood under the skin may cause marked pressure or one-sided swelling. Sometimes stitches loosen or the wound edges separate. These findings do not identify the cause by themselves, so an examination is needed.

Contact your maternity service or clinician and describe when the change began, whether pain is increasing, and whether you have fever, discharge, bleeding, or difficulty passing urine. Keep the area clean and dry, use pads rather than internal products, and avoid sex or strenuous activity until assessed. Do not apply creams, antiseptics, or leftover antibiotics unless a clinician advises them. Bring your discharge information and medication list to an appointment.

Seek urgent care for heavy bleeding, faintness, severe or rapidly worsening pain, a rapidly enlarging swelling, high fever with feeling very unwell, or new loss of bowel control. Prompt review is also needed for pus, foul-smelling discharge, wound opening, or difficulty passing urine. Treatment depends on the examination and may include wound care, pain treatment, or treatment for infection.

Ask whether the stitches and deeper tissues are intact, whether a swab or other assessment is needed, how to protect the wound, and when follow-up should occur.