Episiotomy and Perineal Rehabilitation

An episiotomy is a surgical cut made in the perineum during vaginal birth, and healing varies from person to person. During recovery you may feel pain, tenderness or a pulling sensation when sitting, walking or using the toilet. A physiotherapy assessment looks at how your symptoms affect daily life, how you breathe, and how well your pelvic floor muscles can contract and relax. Once the wound has fully healed, tissue mobility and the scar itself are also assessed. Rehabilitation includes comfortable positions, breathing and relaxation work, pelvic floor coordination and a gradual return to daily activities.

Book an Appointment

Tuğçe Atalay

Perineal Rehabilitation After Episiotomy: Pain, Healing and Physiotherapy

What Does the Physiotherapy Assessment Cover?

We start by talking about the injury that occurred during birth, how healing is going and which activities are difficult for you. The physiotherapist assesses your symptoms during movements such as sitting, walking and getting out of bed, as well as your breathing and your pelvic floor muscles’ ability to contract and relax.

Caring for the Perineal Scar and Tissue Sensitivity

Once the wound has fully healed, the perineal scar is assessed for sensitivity to touch, how it moves with the surrounding tissue and the tension it creates during daily activities. Depending on the findings, gentle touch, sensory awareness work or movement around the scar may be planned.

Pelvic Floor Recovery and Returning to Daily Activities

Rehabilitation is not only about strengthening muscles; being able to relax the pelvic floor when needed and use it correctly during movement matters just as much. Depending on your needs, the work focuses on breathing coordination, muscle awareness, adapting everyday movements and a gradual return to exercise. If you had a third- or fourth-degree tear, physiotherapy can be planned in coordination with your postpartum care team.

Would you like information or an appointment?

Book an Appointment

Common and Treatable

A review of 19 studies including about 1,900 women with an episiotomy or birth-related perineal injury reported that some supportive treatments may help signs of healing appear earlier.

"When I sit, I feel stinging and pulling at my stitches."

"My perineal scar hurts during sex."

"The wound has healed, but the area around the scar is still tender."

Kurnaz D, Fışkın Siyahtaş G, Demirgöz Bal M. The effect of postpartum interventions on healing and pain in women with perineal trauma: A systematic review and meta-analysis. International Journal of Nursing Studies. 2025;162:104976.

Episiotomy and Perineal Rehabilitation FAQ

When should I see a physiotherapist after an episiotomy?

You can ask for an assessment if you have perineal pain when sitting or walking, tightness around the scar or sensitivity to touch. Also share any difficulties you have with using the toilet, exercising or having sex with your physiotherapist. The assessment helps clarify which tissues and movements your symptoms may be related to.

Is perineal rehabilitation just Kegel exercises?

No. Along with pelvic floor muscle strength, your ability to relax, coordinate and engage these muscles at the right moment is also assessed. Depending on your needs, the plan may include breathing work, movement adjustments, muscle awareness or, once the wound has fully healed, work on the scar tissue.

When can physiotherapy for a perineal scar begin?

Wound healing comes first. Touch or massage of the scar tissue is considered only after the wound has fully closed and a healthcare professional has said it is appropriate. If you have any concerns about how your wound is healing, talk to your midwife or doctor before starting physiotherapy.