Episiotomy types and tear degrees

An episiotomy is an intentional incision, commonly described as midline, mediolateral or lateral according to its path. A tear is classified by the tissues involved: a first-degree tear affects skin, a second-degree tear reaches perineal muscle, a third-degree tear reaches the anal sphincter, and a fourth-degree tear also involves the rectal lining.

An episiotomy can extend and become a more extensive injury, so the final examination and repair record matter more than the incision label alone. The degree helps the team plan repair, bowel care and follow-up. It does not predict exactly how your recovery will feel.

Ask your clinician to explain the incision direction, final tear degree and tissues repaired. Follow wound-care instructions, keep the area gently clean and dry, manage pain as advised, and reduce straining with fluids, fibre and recommended stool-softening treatment. Gradual activity is usually more comfortable than pushing through pain.

Mention bladder symptoms, bowel urgency, leakage, scar tightness or pain with sex at review. These details help identify whether you need additional assessment or pelvic-floor support. Perineal Repair covers repair and recovery considerations.

Call your maternity team if pain, swelling or redness increases, the wound separates, discharge smells unpleasant, or fever develops. Seek urgent care for heavy bleeding, faintness, severe pain, inability to urinate, or new loss of bowel control.

Ask how the incision direction and tear degree were recorded, whether the anal sphincter or rectal lining was involved, how repair was checked, and when specialist or pelvic-floor follow-up is appropriate.