Understanding Episiotomy Pain and Perineal Tears

Episiotomy pain may vary each day of recovery and can come and go with different activity levels. Common symptoms during the first 2 to 3 weeks following childbirth include:

• Pain at the incision site
• Painful urination and bowel movements
• Pain during sex

Persistent episiotomy pain that lasts longer than 3 weeks may indicate pudendal neuralgia. Symptoms include:

• Pelvic pain that feels like burning, shooting, or pins and needles
• Numbness or change of sensation
• Increased sensitivity to touch
• Feeling like there’s swelling in your perineum
• Urgency 

Episiotomy pain the result of an episiotomy procedure performed during childbirth. It is estimated that 9 in 10 first-time mothers who have a vaginal birth require an episiotomy or spontaneously tear during labor. An episiotomy is more likely if the baby is over 9 pounds, the baby’s shoulder gets stuck during delivery, or forceps are needed to aid in delivery.

One study has shown that an episiotomy can result in nerve damage for about 20 percent of patients.  

You may be able to reduce the risk of needing an episiotomy by gently massaging the perineum daily in the last few weeks of pregnancy. 

As with any surgical procedure, there is a risk of infection after undergoing an episiotomy. Signs of infection around the perineum include redness, swelling, discharge from the cut, extreme tenderness, and an unusual smell.

In some cases, scar tissue may form around the incision location, causing pain and itchiness. Scar tissue could put pressure on the pudendal nerve and cause further complications.

A medical professional will evaluate your episiotomy and pelvic pain based on your symptoms and medical history, then perform one or more tests to determine a diagnosis and course of treatment.

• Physical exam: the doctor will check for pain when pressure is applied to the pudendal nerve and ask about changes in sensation
• MRI and CT scans: check for tumors or growths that could indicate other causes of chronic pain, such as fibroids, ovarian cysts, or endometriosis
• Nerve study: check how well nerves respond to electrical stimuli with a small device inserted into your rectum

Episiotomy pain relief can come in many forms, depending on the severity of your pain and the treatment plan your care team decides on.

Pain management

You can manage pain during bowel movements by eating plenty of fiber, drinking lots of fluids, and using stool softeners. Taking a sitz bath, icing the incision area, and treating the perineum very delicately when rinsing or wiping it can also help prevent and ease the pain. 

Medication

Your doctor may recommend over-the-counter or prescription painkillers to relieve pain. 

Surgery

In some cases, surgery may be required to relieve episiotomy pain when pudendal neuralgia is present. Surgical treatment options include nerve decompression, nerve repair, or nerve transplantation, although it will depend on the individual case. 

The Institute for Advanced Reconstruction participates in a wide range of insurance plans, including those listed below. However, each physician has their own accepted insurance and hospital affiliations. Before scheduling an appointment, please contact your insurance carrier to confirm that your provider is in-network.

If we are not an in-network provider, our friendly insurance specialists will help you find the most coverage available for your treatment. 

• Horizon Blue Cross Blue Shield of New Jersey
• Medicare
• Railroad Medicare
• Aetna
• Cigna
• United Healthcare
• Oxford (Freedom, Liberty)
• MagnaCare

Visit our resource page for patient forms, information specific to episiotomy pain, and more.

Most instances of episiotomy pain subside a few weeks after childbirth, however, surgical treatment may be required if your pain is persistent and prolonged. If you’re experiencing symptoms of pudendal neuralgia, contact the Institute for Advanced Reconstruction and schedule a consultation to find out if you qualify for episiotomy pain treatment today.