Painful scarring after childbirth

Painful scarring after childbirth

What is Fenton′s Procedure?

Fenton’s Procedure refers to the procedure in which scar tissue is removed from the perineum and surrounding vaginal areas. This procedure is more than likely performed after childbirth where a tear occured causing scar tissue during the healing process.

Laceration Severity Classification

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Indicates an injury to the skin and hypodermis (most inner layer of the skin) of the perineum and vaginal epithelium only. The perineal muscles stay undamaged.
Source: uptodate.com

Affecting the tissue right below the skin of the perineal body, which includes the deep and superficial transverse perineal muscles and fibers of the pubococcygeus and bulbocavernosus muscles. The anal sphincter muscles remain intact.
Source: uptodate.com

Affecting the tissue right below the skin of the perineal body and involve some or all of the fibers of the external anal sphincter and/or the internal anal sphincter.
Source: uptodate.com

Affects the perineal structures, EAS, IAS, and the rectal mucosa
Source: uptodate.com

Why is an episiotomy performed?

An episiotomy is performed during childbirth. This is needed sometimes when the vaginal opening needs to be widened for the baby to pass through. Sometimes a woman will tear causing a much more severe tear.

An episiotomy can prevent a more severe tear in some pregnancies, especially first-time vaginal births. It’s more common to have severe injuries in the anal muscles and rectum if the perineum spontaneously tears opposed to having an episiotomy performed. 

How is it performed?

Typically a simple procedure, an episiotomy is done during childbirth. A local anesthetic is used to numb the area around the vagina. A small diagnonal cut from the back of the vagina is made.

After child birth, the cut is then stitched up with dissovable stitiches. You are not required to return to the doctors office unless an infection or post-cut complications occur.

How is an episiotomy prevented?

According to the American Pregnancy Association, preventing an episiotomy may include the following:

  • Good nutrition
  • Kegels
  • A slowed second stage of labor where pushing is controlled
  • Warm compresses and support during delivery
  • Use of perieum massage techniques
  • Avoiding lying on your back while pushing

What can I expect from recovery?

Pain killers will help relieve any post-procedure pain as it’s common to be in some discomfort.

YOU SHOULDN’T take ibuprofen if you are breastfeeding, if your baby was born before 37 weeks or pregnancy, had a low birth weight or has a medical condition. Aspirin is also not recommended. Since prescription medication can be passed through breast milk, here are other ways you may relieve the pain.

  • Place a towel wrapped ice pack on the incision. Avoid placing ice directly on your skin.
  • Use a donut shaped cushion while you are sitting or squeeze your buttocks together while sitting.
  • Expose your stitues to fresh hair to encourage healing

Keep the cut and the surrounding area clean to prevent infection. After going to the toilet, pour warm water over your vaginal area to rinse it.

Pouring warm water over the outer area of your vagina as you pee may also help ease the discomfort.

You may find squatting over the toilet, rather than sitting on it, reduces the stinging sensation when passing urine.

When you’re passing a stool, you may find it useful to place a clean pad at the site of the cut and press gently as you poo. This can help relieve pressure on the cut.

When wiping your bottom, make sure you wipe gently from front to back. This will help prevent bacteria in your anus infecting the cut and surrounding tissue.

If you find passing stools particularly painful, taking laxatives may help. This type of medication is usually used to treat constipation and makes stools softer and easier to pass.

There are no rules about when to start having sex again after you’ve given birth.

In the weeks after giving birth, many women feel sore as well as tired, whether they’ve had an episiotomy or not. Don’t rush into it. If sex hurts, it won’t be pleasurable.

If you’ve had a tear or an episiotomy, pain during sex is very common in the first few months.

Studies have found around 9 out of 10 women who had an episiotomy reported resuming sex after the procedure was very painful, but pain improves over time.

If penetration is painful, say so. If you pretend everything is all right when it isn’t, you may start to see sex as a nuisance rather than a pleasure, which won’t help you or your partner. 

You can still be close without having penetration – for example, through mutual masturbation.

Get tips on talking about sex.

Pain can sometimes be linked to vaginal dryness. You can try using a water-based lubricant available from pharmacies to help.

Don’t use an oil-based lubricant, such as Vaseline or moisturising lotion, as this can irritate the vagina and damage latex condoms or diaphragms.

You can get pregnant as little as three weeks after the birth of a baby, even if you’re breastfeeding and your periods haven’t started again.

Use some kind of contraception every time you have sex after giving birth, including the first time (unless you want to get pregnant again).

You’ll usually have an opportunity to discuss your contraceptive options before you leave hospital (if you’ve had your baby in hospital) and at the postnatal check.

You can also talk to your GP, midwife or health visitor, or go to a contraception clinic at any time.

Look out for any signs that the cut or surrounding tissue has become infected, such as:

  • red, swollen skin
  • discharge of pus or liquid from the cut
  • persistent pain
  • a smell that isn’t usual for youTell your GP, midwife or health visitor as soon as you can about any possible signs of infection so they can make sure you get any treatment you need.

Strengthening the muscles around the vagina and anus by doing pelvic floor exercises can help promote healing, and will reduce the pressure on the cut and surrounding tissue.

Pelvic floor exercises involve squeezing the muscles around your vagina and anus as though to stop yourself from going to the loo or passing wind (farting).

Your midwife can show you how to perform the exercises correctly. You can also read pelvic floor exercises for women (PDF, 68kb) for advice.

For a few women, excessive, raised or itchy scar tissue forms around the place where a tear happened or where an episiotomy was performed. If your scar tissue is causing problems for you, tell your doctor.

Scar tissue doesn’t stretch, so you may need an episiotomy again if you have excessive scar tissue and you have another baby. You can talk to your midwife or doctor about this.

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