What is the best wound care after a mediolateral episiotomy?

From the Guidelines

For optimal wound care after a mediolateral episiotomy, it is essential to prioritize measures that promote healing, reduce the risk of infection, and minimize discomfort, as evidenced by the most recent and highest quality study 1.

Key Principles of Wound Care

• Keep the area clean and dry, gently cleansing with warm water after urinating or bowel movements, and patting dry from front to back.
• Change sanitary pads frequently, at least every 4-6 hours, to prevent bacterial growth and reduce the risk of infection.
• Apply ice packs for 10-20 minutes several times a day for the first 24-48 hours to reduce swelling and discomfort.

Sitz Baths and Pain Management

• Take sitz baths (sitting in a few inches of warm water) for 15-20 minutes, 2-3 times daily, to promote healing and relieve pain.
• Use pain relief medication as prescribed, typically ibuprofen 400-600 mg every 6-8 hours or acetaminophen 500-1000 mg every 6 hours, to manage pain and discomfort.

Additional Measures

• Apply topical anesthetic spray or cream (e.g., lidocaine 2%) before urinating to reduce stinging.
• Use a peri-bottle filled with warm water to rinse the area while urinating to minimize discomfort.
• Avoid constipation by maintaining a high-fiber diet and staying hydrated, and use stool softeners if needed.
• Resume Kegel exercises gradually as comfort allows to promote healing and strengthen pelvic floor muscles.

Postoperative Wound Dressing

According to the World Health Organization's Global Guidelines for the Prevention of Surgical Site Infections, as referenced in 1, there is no evidence that advanced dressings reduce the risk of surgical site infections (SSIs) in primarily closed surgical wounds. Therefore, a standard dressing or no dressing at all may be sufficient for postoperative wound care after a mediolateral episiotomy.

Sexual Intercourse and Follow-up

• Avoid sexual intercourse for 4-6 weeks or until cleared by your healthcare provider to allow for proper healing and reduce the risk of infection. By following these guidelines, individuals can promote optimal healing, reduce the risk of infection, and minimize discomfort after a mediolateral episiotomy, as supported by the most recent and highest quality evidence 1.

From the Research

Wound Care after Mediolateral Episiotomy

• The key elements of post-operative wound care include timely review of the wound, appropriate cleansing and dressing, as well as early recognition and active treatment of wound complications 2.
• Dry heat application has been shown to promote episiotomy wound healing and reduce perineal pain among primipara women compared to moist heat 3, 4.
• A systematic review and meta-analysis found that dry heat therapy, especially using a hair dryer, significantly reduced pain and improved episiotomy site healing in postnatal women compared to moist heat 4.
• The use of certain herbal remedies, such as Commiphora myrrha (myrrh), has also been shown to improve episiotomy wound healing in primiparous women 5.
• A review of evidence-based practices in episiotomy care highlighted the need for further research on the topic, with limited studies available on the care of episiotomy wounds 6.

Comparison of Wound Care Methods

• Dry heat therapy has been compared to moist heat therapy in several studies, with dry heat showing superior results in terms of wound healing and pain reduction 3, 4.
• The use of herbal remedies, such as myrrh and frankincense, has also been compared to traditional methods, such as betadine sitz-baths, with myrrh showing greater efficacy in promoting wound healing 5.
• Further research is needed to fully understand the effectiveness of different wound care methods and to inform evidence-based practice 6, 4.