A Review of Episiotomy and Modalities for Relief of Episiotomy Pain

Abstract

Episiotomy is a surgically planned incision of the perineum and the posterior vaginal wall in the second stage of labour. It is one of the most commonly performed surgical procedures in the world. In episiotomy, the vaginal orifice is made larger to facilitate the birth of a baby. The postnatal period is very crucial in every mother's life, especially those who had a vaginal delivery and underwent episiotomy. Maternal benefits of episiotomy include reduced risk of perineal trauma, subsequent pelvic floor dysfunction and prolapse, urinary incontinence, faecal incontinence, and sexual dysfunction. Potential benefits for the foetus are thought to include a shortened second stage of labour. However, an episiotomy can also lead to potential adverse consequences, including the extension to a third-or fourth-degree tear, anal sphincter dysfunction, and dyspareunia. Different approaches can be adopted to reduce these complications in the postpartum period, including cleanliness, cold packs, sitz baths, kegel exercises, perineal care, and topical application of dry heat-infrared lamp therapy. Of all these approaches, infrared lamp therapy and sitz baths are the two most effective and commonly used for episiotomy pain relief and wound healing. In infrared lamp therapy, radiant heat or infrared rays are used to produce heat that is then applied to the episiotomy wound to facilitate pain relief and wound healing, while a sitz bath is a moist heat application process that is also effective for episiotomy pain relief and wound healing. This review aims to offer the most thorough understanding of episiotomy, its current concept, and episiotomy pain relief, with a particular focus on infrared lamp therapy and sitz baths.

Ultrasonographic elastography, a new era showing the improvement of episiotomy scar treated with Er:YAG laser, a case‐series

“…2 Pelvic floor muscle training, TENS, heating with infrared lamp or administration of moist heat using sitz bath and collagen infiltration have been tried. 2 However, lactational atrophic vaginitis caused by the hypoestrogenic state due to hyperprolactinemia should primarily be treated by vaginal estrogen. Local lidocaine ointment, vaginal dilators, and Er:YAG laser are the other therapeutic options.…”

“…Various therapeutic options have been described to treat pelvic pain and dyspareunia associated with episiotomy scars. 2 Pelvic floor muscle training, TENS, heating with infrared lamp or administration of moist heat using sitz bath and collagen infiltration have been tried. 2 However, lactational atrophic vaginitis caused by the hypoestrogenic state due to hyperprolactinemia should primarily be treated by vaginal estrogen.…”

“…Various treatment modalities including medical and surgical interventions have been described to improve wound recovery of episiotomy scar and enable pain relief. 2 Er:YAG laser have recently provided a great versatility in the management of pain associated with episiotomy scars. 3 During the acute inflammatory phase of wound healing, Er:YAG laser application is proposed to modify the tissue response by photo-biomodulation and thermal diffusion.…”

Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third‐ or fourth‐degree perineal tear: Systematic review and meta‐analysis of randomized clinical trials

“…Episiotomy aims to prevent severe perineal tears, and third and fourth degree perineal tears may increase the risk for postpartum anal incontinence. [8][9][10][11][12] The major risk factors for third and fourth degree perineal tear are instrumental delivery, increased birthweight and prolonged second stage of labor. 13 Pelvic floor disorders such as UI, anal incontinence, pelvic organ prolapse and pelvic floor pain may negatively affect a woman's desire and ability to be physically active and are therefore a threat to womens' health in general.…”

“…While there is conflicting evidence that episiotomy is a risk factor for UI it may be associated with perineal pain and sexual dysfunction. Episiotomy aims to prevent severe perineal tears, and third and fourth degree perineal tears may increase the risk for postpartum anal incontinence 8–12 . The major risk factors for third and fourth degree perineal tear are instrumental delivery, increased birthweight and prolonged second stage of labor 13…”