What should you know about a fourth-degree episiotomy?

An episiotomy is a surgical cut in the perineum, the area between the vaginal opening and anus, made during birth in selected situations. A fourth-degree injury reaches the anal sphincter and the lining of the rectum. The tissues are repaired in layers, usually by a trained maternity clinician, with attention to restoring the muscle and protecting bowel function.

Recovery can include soreness, swelling, difficulty sitting, fear of bowel movements, or changes in sexual comfort. Healing is individual, and symptoms should be discussed rather than endured quietly.

Follow the repair team's instructions for pain relief, wound care, rest, and bowel medicines. Keep stools soft with prescribed treatment, fluids, and suitable fibre, and avoid straining. Wash gently and pat dry; do not insert products or resume penetrative sex until the wound has healed and a clinician has advised that it is suitable. A planned follow-up can check healing, continence, pain, and emotional wellbeing. Perineal repair services can explain ongoing care.

Contact the maternity team promptly for worsening pain, increasing redness or swelling, pus, wound separation, fever, difficulty passing urine, loss of bowel control, or inability to control wind. Seek urgent care for heavy bleeding, severe illness, or a rapidly worsening wound. New leakage from the vagina or rectum should be assessed without delay.

Ask how the repair is healing, how long bowel protection is needed, which symptoms are expected, when to resume activity and sex, and whether pelvic-floor physiotherapy or specialist follow-up would help.