Episiotomy: what it is, recovery timeline, and healing tips

If you've had an episiotomy during childbirth, you're probably focused on one thing right now: healing.

It's completely normal to feel sore, swollen, and concerned about how long recovery will take. You may also have questions about everyday activities — from sitting to resuming exercise and having sex after an episiotomy.

An episiotomy is a surgical incision made during childbirth to help widen the vaginal opening in certain situations. While episiotomies are much less common than they once were, they may still be recommended when a healthcare provider believes they are the safest option for you or your baby. If you do have an episiotomy during childbirth, simple, at‑home relief strategies — including targeted exercises and some lifestyle changes — can help ease pain and discomfort as your body heals.  

Read on to learn more about episiotomy recovery, including what to expect, how long healing takes, and expert-backed tips, including targeted exercises recommended by Hinge Health that can further support your postpartum recovery.

What is an episiotomy?

An episiotomy is a surgical incision made in the perineum — the area between the vaginal opening and anus — during the second stage of labor. This is the part of childbirth after your cervix is fully dilated (open) and you’re actively pushing your baby out. The goal is to widen the vaginal opening to help facilitate delivery when there are concerns about the health of the birthing parent or baby.

While episiotomies were once routinely performed, they are now reserved for situations where they are medically necessary, such as when a baby needs to be delivered quickly or when forceps or vacuum assistance is required.

There are two main types of episiotomy:

• Midline episiotomy. A straight incision extending from the vaginal opening toward the anus.

• Mediolateral episiotomy. An angled incision extending away from the vaginal opening toward one side of the perineum.

If you received an epidural, you likely won't feel the incision being made. If you didn’t, your provider will use a local anesthetic to numb the area before performing the procedure.

Episiotomy vs. natural tearing

For many years, healthcare providers believed routine episiotomies could help prevent more severe tearing during childbirth and protect pelvic floor function after delivery. We now know that isn't necessarily the case.

Research suggests that natural tears often heal just as well — and sometimes better — than an episiotomy. Because of this, organizations such as the American College of Obstetricians and Gynecologists (ACOG) recommend that episiotomies be performed only when medically necessary.

That said, there are situations when an episiotomy may be the safest choice. For example, your provider may recommend one if:

• Your baby is showing signs of distress and needs to be delivered quickly

• Forceps or vacuum assistance is needed

• Your baby is in a breech position

• Shoulder dystocia occurs (when the baby's shoulder becomes stuck during delivery)

• Labor has been prolonged and delivery needs to be expedited

Whether you experienced a natural tear or an episiotomy, it's important to remember that neither outcome reflects anything you did wrong. Both are common childbirth experiences, and both can heal well with proper care and support.

Symptoms and what to expect

Knowing what's normal during episiotomy healing can help ease some of the uncertainty that often comes with postpartum recovery. Common symptoms include:

• Pain and tenderness around the incision site

• Swelling and bruising in the perineal area

• Discomfort when sitting or having a bowel movement

• Mild bleeding or discharge in the first few days

• A sensation of tightness or pulling as the stitches dissolve

Most people heal after an episiotomy without problems. But in some cases, the procedure may contribute to other conditions, such as:

• Fecal incontinence

• Urinary incontinence or urgency

• Constipation

• Painful sex (once you get your doctor’s ok)

• Painful urination

However, if you develop severe pain, worsening swelling, fever, foul-smelling discharge, or signs of infection, it’s important to contact your healthcare provider immediately.

Episiotomy recovery timeline

Everyone heals differently after an episiotomy. Factors such as the size and depth of the incision, whether you experienced additional tearing, your overall health, and how your body heals can all influence your recovery. Here's a general idea of what to expect:

• First few days: This is typically when pain, swelling, and tenderness are at their peak. Sitting, walking, and bowel movements may feel uncomfortable. Your stitches will begin dissolving as healing gets underway.

• 1 to 2 weeks: Many people notice a significant improvement in pain and swelling. Everyday activities often become more comfortable, and at this stage, most of the stitches have dissolved or are beginning to dissolve.

• 3 to 6 weeks: The surface of the incision is usually well healed, but deeper tissues are still recovering. Many people feel ready to return to most daily activities during this stage.

• 6+ weeks: Most people receive clearance to resume exercise, sex, and other activities around this time, though healing isn't always complete. Tissue remodeling and scar healing can continue for several months.

Keep in mind that healing isn't always linear, and, again, not everyone will be on this same timeline. Some days may feel better than others, and that's completely normal. If pain is getting worse instead of better, or you're concerned about how you're healing, check in with your healthcare provider.

How movement can help with episiotomy healing

When you've just given birth, exercise is probably the last thing on your mind. And in the first weeks after delivery, rest is absolutely important.

But movement is also an important part of recovery.

Once your healthcare provider clears you for activity — usually at or after your postpartum checkup — gentle movement can help improve blood flow, reduce swelling, prevent stiffness, and support tissue healing. "Movement helps promote circulation and restore normal function to the pelvic floor and surrounding muscles," says Caitlin Warner, PT, DPT, a pelvic health physical therapist at Hinge Health.

As healing progresses, targeted pelvic floor exercises can help improve strength, coordination, flexibility, and muscle awareness. These benefits can support everyday activities and may help reduce postpartum symptoms such as urinary leakage, bowel problems, pelvic discomfort, or pain during sex.

Regularly practicing these exercises, once you’re cleared for exercise by your medical provider, can support pelvic floor recovery after an episiotomy and childbirth. Diaphragmatic breathing and reverse Kegels help promote relaxation and reduce pelvic floor tension, while alternating pelvic tilts, cat cow, and standing child’s pose improve mobility, flexibility, and body awareness. Together, these movements can increase blood flow, ease stiffness, and help you gradually return to everyday activities with more comfort and confidence.

 The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

Episiotomy healing tips

Supporting episiotomy healing often involves a combination of comfort measures, good hygiene, pain management, and a gradual return to activity. The right approach depends on your symptoms and stage of recovery, but these strategies can help ease discomfort and support healing:

• Keep the area clean and dry. Use a peri bottle with warm water after using the bathroom, and gently pat the area dry instead of wiping.

• Use ice during the first 24 to 48 hours. Applying an ice pack wrapped in a cloth for 10 to 15 minutes at a time may help reduce pain and swelling.

• Try sitz baths. Sitting in a shallow bath of warm water for 10 to 15 minutes a few times a day can soothe discomfort and promote healing.

• Take pain medication if needed. Over-the-counter medications such as ibuprofen or acetaminophen may help manage discomfort. Follow your healthcare provider's recommendations, especially when breastfeeding.

• Prevent constipation. Staying hydrated and eating fiber-rich foods can help prevent straining, which may place stress on healing tissues.

• Wear loose, breathable clothing. Comfortable clothing can reduce friction and irritation around the healing area.

• Ease back into movement. Short walks can help improve circulation and reduce stiffness. As your provider clears you for more activity, you can gradually return to exercise.

• Consider pelvic floor physical therapy. A pelvic floor PT can help address scar tissue restrictions, pelvic floor tension, weakness, and discomfort that sometimes develop after childbirth.

• Ask about scar tissue massage. Once your provider says it's safe, scar massage may help improve tissue mobility and reduce discomfort around the incision site. “It may also help to prevent or improve pain with intercourse, bowel problems, and other symptoms of pelvic floor dysfunction that may occur after episiotomy and birth,” says Dr. Warner.

When to see a doctor

Episiotomy pain typically improves steadily over the first few weeks with at-home care and self-management strategies. But if your pain is severe, getting worse, not improving over time, or making it difficult to care for yourself or your baby, contact your healthcare provider. It's also important to seek medical care if you have:

• Fever higher than 100.4°F (38°C) or chills

• Increasing redness, warmth, swelling, or drainage from the incision site

• Sudden or worsening pain

• Foul-smelling vaginal discharge

• Heavy bleeding, passing large blood clots, or bleeding that returns after slowing down

• Pain or burning with urination

• Severe pain during bowel movements or difficulty controlling your bowels

• Separation or opening of the incision site

When can I have sex after an episiotomy?

There's no one-size-fits-all timeline for resuming sex after an episiotomy, but most healthcare providers recommend waiting at least six weeks after childbirth and until you've been cleared at your postpartum checkup. That’s because having intercourse too soon can increase discomfort and may interfere with your healing.

It's also important to remember that physical healing is only one part of the equation. You may need more time to feel emotionally ready, and that's completely normal. "There is absolutely no rush to getting back to penetrative intercourse after recovering from an episiotomy," says Dr. Warner. "Take things slow and focus on connection with your partner to ensure you and your body are both ready."

When you do feel ready to resume intimacy, these strategies may help make sex more comfortable:

• Use plenty of lubricant. Hormonal changes after childbirth, especially if you're breastfeeding, can contribute to vaginal dryness and increase friction around the healing area.

• Experiment with different positions. Positions that allow you to control depth and pace may feel more comfortable as you ease back into intercourse.

• Don't push through pain. Mild discomfort can be common at first, but pain is a signal to slow down, adjust, or stop.

• Communicate openly with your partner. Share what feels comfortable, what doesn't, and any concerns you have as you navigate this transition together.

If pain persists after a few attempts, talk with your healthcare provider. A pelvic floor physical therapist can help address scar tissue restrictions, pelvic floor muscle tension, and other issues that may contribute to discomfort during sex.

PT tip: Take recovery one day at a time

Healing from an episiotomy is only one part of your postpartum journey. You're also adjusting to life with a newborn and the many changes that come with it. "Taking each day one at a time as you recover and slowly reintroduce activity is important," says Dr. Warner. "And listening to your body's signals along the way is key."

Some soreness or stretching sensations can be normal as you heal, but symptoms should gradually improve over time. If an activity consistently increases discomfort, consider scaling back and giving your body a little more time. Recovery isn't a race.

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Dillon, S. J., Nelson, D. B., Spong, C. Y., McIntire, D. D., & Leveno, K. J. (2021). Episiotomy: Evolution of a Common Obstetric Practice at a Public Hospital. American Journal of Perinatology. doi:10.1055/s-0041-1739410

3. Episiotomy and perineal tears. (2020, December). Nhs.uk. https://www.nhs.uk/pregnancy/labour-and-birth/episiotomy-and-perineal-tears/

4. Episiotomy Procedures - Advantages & Complications. (2012, April 26). American Pregnancy Association. https://americanpregnancy.org/healthy-pregnancy/labor-and-birth/episiotomy/

5. Episiotomy: What to Expect at Home. (2021). Kaiser Permanente. https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.episiotomy-what-to-expect-at-home.zc2338

6. Kirts, E. (2024). ICEA Position Paper Episiotomy Position. https://icea.org/wp-content/uploads/2022/09/ICEA-Position-Paper-Episiotomy.pdf 

7. What is an episiotomy? (2020, October). Www.acog.org. https://www.acog.org/womens-health/experts-and-stories/ask-acog/what-is-an-episiotomy