There are four degrees of episiotomy, which is an incision that is sometimes made in the perineum during childbirth. The point of this type of surgical incision is to increase the opening of the vagina so that it does not tear during delivery of the baby. One of the most minor types of episiotomy is the first degree, in which just the skin is cut. During a second degree episiotomy, both the skin and muscle are cut. Among the most severe types of episiotomy is the third, in which the skin, muscle and rectal sphincter are cut, and a fourth degree involves also cutting into the anal wall.
A first-degree episiotomy is the smallest one possible, and it involves a small cut in the skin near the vaginal opening. This might be necessary when the baby's head is slightly too large to deliver without tearing the vagina. This superficial cut rarely requires stitches and usually heals within a few days.
One of the most common types of episiotomy is the second-degree type, in which both the skin and muscle are cut. This type of incision usually extends about halfway between the vagina and anus, and it typically requires a few stitches to heal. A second-degree episiotomy usually causes discomfort in the perineum for a few weeks, making it painful to walk or sit during the recovery period.
Among the more serious degrees of episiotomy is the third-degree type, which involves the skin, muscles and anal sphincter. This typically requires several stitches and can take at least a month to heal. It might be painful to urinate or strain for a bowel movement during this time, so pain medication and stool softeners might be needed during the recovery period. Additionally, cold compresses, sitz baths and pads soaked with witch hazel can be soothing for patients who have had the most severe degrees of episiotomy.
Patients with a fourth-degree tear suffer from the least common and most serious of the four degrees of episiotomy. This often requires several stitches and might take months to heal because it involves cutting into the anal wall as well as the skin, muscle and anal sphincter. A fourth-degree cut usually has the same uncomfortable side effects as a third-degree incision, though the pain is often more severe because the anal wall is also cut. The discomfort and possible complications — such as infection — that an episiotomy might cause are why many women prefer alternative methods to help the baby's head fit through the vaginal opening. These often include massaging the perineum to help it stretch and allowing the area to tear naturally, if necessary.