Labor & Delivery: Complications of Episiotomies

What Is an Episiotomy?

Episiotomy refers to a surgical incision of the skin between the vagina and anus made during child delivery. Believed in the past to prevent certain complications, such as vaginal tearing, the procedure may not actually be as effective as once thought, according to the Mayo Clinic.

The procedure is no longer routine, but it may still be necessary for some women. Learn about the possible complications of episiotomy.

Increased Long-Term Discomfort

Some doctors have suggested that episiotomies result in increased long-term discomfort, including discomfort during intercourse. However, no clinical studies confirm this idea. In fact, most studies have found that the amount of long-term pain a patient experiences is more closely related to the length of the second stage of labor (when the mother is pushing and the baby is passing through the birth canal). If the second stage of labor is prolonged, there is an increased risk for later discomfort with intercourse. One study reported that delayed pain (long-term pain that was found eight weeks after delivery) occurred in only 4% of women who had a medio-lateral episiotomy; among women who had a midline episiotomy, fewer would be expected to have long-term pain.


Episiotomy is performed in an area that is abundant with bacteria. Therefore, one risk associated with episiotomies is infection. In most cases, these infections are superficial (involving only the outer tissues) and are easily treated with antibiotics. On rare occasions, an infection may extend deeper into the tissues, and may be difficult to treat with antibiotics alone. In these cases, the episiotomy may need to be re-opened to allow the infection to drain.

Hematoma Formation

When bleeding is not completely stopped during repair of the episiotomy, a collection of blood may form behind the suture line. This formation is called a hematoma. In cases of hematoma formation, the incision must be re-opened to drain the collection of blood. Once the area has been cleaned, the episiotomy may be sutured once again or the site may be allowed to heal naturally over time.

Leakage of Stool or Gas

Third and fourth degree episiotomies may result in dysfunction of the anal sphincter, resulting in leakage of stool or gas. When this occurs, an additional operation may be required to repair the sphincter and restore normal function. Another problem may be the formation of a recto-vaginal fistula (a passage that connects the rectum to the vagina). When a fistula is present, the patient may experience symptoms such as leakage of stool or gas from the vagina. A fistula requires surgical repair.

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