A perineal cut (Episiotomy) is the most common obstetric procedure ever. Its purpose is to widen the vaginal entrance by cutting into the perineum (the region between the vagina and anus).
This should make it easier for the child to step through and relieve the mother's pelvic floor.
In this respect, a perineal incision usually represents the “lesser evil” compared to a possible uncontrolled perineal tear.
The gynecologist can either already before birth Make the decision to have a perineal incision, such as a Multiple pregnancy or certain Position variants (see below).
This is then referred to as early perineal incision.
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On the other hand, a so-called timely perineal cut occur, for example with an unexpectedly large child or when the doctor notices that the mother's pelvic floor is about to tear.
A distinction is made depending on the cut different types of perineal incision.
The most common cut is the mediolateral, in which, starting from the middle of the dam, the cut is made at a 45 ° angle to the side. This incision creates a relatively large amount of space, can be expanded if necessary during the birth and contains a relatively large amount of space low risk of intestinal injuries.
During a medians The incision (from the perineum vertically downwards) creates relatively little space, but is also best healed lateral Incision (from the side of the perineum outwards) is only used for particularly difficult births, as it can create the most space, but also the most difficult healing process entails.
Some of the causes that can lead the gynecologist to consider a perineal incision are initially pure mechanical Aspects. So hide large head circumference of the child and a narrow basin diameter the mother is at an increased risk of needing a perineal incision.
$config[ads_text2] not foundIn addition, some special positions of the child require a perineal incision, especially the Breech position. In this position variant, it is not the child's head that precedes the child, but his pelvis.
Based on other aspects (child weight, pelvic dimensions, gestational age, etc.) it is decided whether the child should be Caesarean section or to be born naturally.
In the latter case there is often a Perineal cut required in order to be able to guarantee the child sufficient space to pass through. It is also used in the natural birth of Multiples often a perineal incision is necessary.
In addition, is a Premature birth usually an occasion for a perineal incision, since the mother's pelvic floor is not yet sufficiently prepared for the birth.
Even if the mother has already had a perineal incision during one birth, there is often a need for a new perineal incision in another birth.
This results from the possible Hardening and tissue tightening in the area of the perineal scar, which can complicate the birth of the second child.
A particularly urgent need for a perineal incision can occur if it is during childbirth Complications comes.
If the gynecologist notices a drop in the child's heartbeat, for example, he can make a perineal incision to accelerate the birth and thus to save the child.
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The perineal incision itself usually causes hardly noticeable pain in the mother. This is because before an early perineal cut Narcotics in the perineal area are injected, while with a perineal incision during labor, the pelvic floor is already stretched so much that its Sensitivity to pain is largely reduced.
$config[ads_text2] not foundGreater discomfort, especially pain, is caused by the perineal incision in the course of it Healing after the birth.
These are in the first days and weeks completely normal and should only give cause for concern if they do not decrease or even increase significantly over a period of at least a week.
In these cases the Doctor or midwife to point out the complaints in the area of the perineal incision scar during the follow-up examination.
Often it takes up to two to three monthsuntil the perineal incision scar is completely painless.
During sexual intercourse, pain can occur for up to a year after the birth, which in extreme cases even completely prevents intercourse.
In these cases, it is advisable to consult a specialist again, who may have a new one small intervention to correct the adhesions in the area of the perineal scar.
To Self therapy the pain of a perineal scar are first of all the common painkillers and anti-inflammatory drugs such as Ibuprofen or ASS (aspirin) an effective means.
In addition, they are also very diverse Home remedies an effective treatment option such as this Cool the perineal scar with cooling batteries or short ones Hip baths with beneficial essences.
It is also advisable to spend as little time as possible in the day Sit to spend and to keep the seam as dry as possible.
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Surprisingly, if a perineal scar itches is in most cases a good sign. Because it signals you progressive healing process and a Loosen the sutures.
However, itching of the perineal scar can also be Signs of inflammation be.
Therefore, if itching persists, one should Specialist or midwife can be consulted, who can examine whether the itching is due to inflammation and, if necessary, assess the need for certain measures.
The same applies to itching, which only occurs after the threads have been removed. Since the itching here can no longer signal the detachment of the threads, it is all the more likely that a inflammation that needs medical advice and treatment.
Following a perineal incision, the tissue around the perineal incision often hardens.
In addition, it can lead to the formation of superfluous scar tissue, a so-called Keloid, come.
Although these developments are harmless and very common, they often cause great inconvenience for women, such as a foreign body sensation in the genital area or pain when sitting or during sexual intercourse.
To counteract the hardening, the person affected can massage the hardened perineum incision scar 1-2 times a day with special massage oils. In this case, however, it is recommended to choose the massage oil in the pharmacy if possible and after consulting the doctor or pharmacist in order to avoid intolerance in the area of the vaginal mucosa or the suture.
In addition, one or two short Sitz baths per day with chamomile or oak bark extract are advisable to soften the hardened perineum scar. However, these Sitz baths should not last longer than 5 minutes each to prevent the perineum incision scar from becoming too softened.
If the hardened perineal incision scar causes discomfort when sitting, special seat cushions (such as hemorrhoidal pillows) can be used to relieve the area of the perineal incision scar.
If, even after several months, no significant progress can be made in the treatment of the hardened perineal incision scar, the gynecologist can perform surgical suture correction if necessary.
Also read the article: How does the vagina change after childbirth?
$config[ads_text1] not foundA perineal incision scar is prone to developing one because of its anatomical proximity to the anus inflammation.
This is because stool contains various bacteria that perform useful functions in the intestines, but can cause inflammation if they come into contact with open skin wounds.
An inflammation of a perineal incision scar is usually expressed by a Burn and itch, as well as a Redness.
If these symptoms occur, an inflammation should therefore be considered and the gynecologist should be consulted.
Because of the anatomical conditions described above, an inflammation of a perineal incision scar tends to spread rapidly, so that a quick start of therapy is necessary.
For the treatment of an inflamed perineal incision scar are suitable in milder cases anti-inflammatory hip baths in combination with pain reliever and anti-inflammatory drugs like ibuprofen or ASA (aspirin).
In more severe cases, however, a surgical wound cleaning become necessary.
Under the term "Suppress" a perineal scar is understood as a concept from the field of holistic medicine. As part of this scar removal, with the help of e.g. Battery function, laser therapy or injections with homeopathic remedies the healing of the scar tissue is promoted.
Since the treatment concepts of scar removal have not yet been confirmed by scientifically founded studies, it can be assumed that possible treatment successes can be explained in particular by a placebo effect.
For this reason, and also because of the sometimes immense costs, from a scientific point of view, no generally valid recommendation can be given for carrying out scar removal.
However, if the person concerned has already had good experiences with similar concepts of holistic medicine with other diseases or complaints, such a procedure for clearing the scar may possibly be considered Supplement to conventional medical care by the gynecologist should be considered.
Due to the unclear scientific situation, the question of how the health insurance company will assume the costs is also problematic. This should be clarified before the start of the consultations in order to avoid unpleasant surprises.
