EpistemisDehiscence or severe pain in the episiotomy scar
Specialty: Gynecology and breast.
Why it occurs
- Bacterial infection of the perineal surgical wound due to fecal or vaginal contamination
- Inadequate suturing technique or excessive tension on the edges of the wound
- Underlying vulvar perineal hematoma that dissects the muscular planes
- Early onset of sexual relations or physical overexertion
- Urinary or fecal incontinence that keeps the area moist and contaminated
Initial workup
Direct perineal inspection under good lighting (separation of edges, erythema, edema and exudate are evident). Taking a smear from the wound for microbiological bacterial culture before starting treatment. Perineal or transrectal ultrasound in consultation if there is suspicion of deep hematoma or occult involvement of the external anal sphincter.
red flags
Unbearable and localized perineal pain of sudden onset, presence of foul-smelling purulent secretion through the edges of the suture, visible macroscopic separation of the perineal muscular planes, fever, extreme dysuria due to the passage of urine over the exposed wound, fecal retention due to fear of pain.
Standard management
- Amoxicillin/clavulanic acid 875/125 mg orally every 8 hours for 7-10 days
- Clindamycin 300 mg orally every 8 hours if there is an allergy to penicillin
- Ibuprofen 600 mg orally every 8 hours alternating with Paracetamol 1000 mg every 8 hours for analgesic control
- Sitz baths with warm water and neutral soap, thoroughly drying the area without rubbing after each urination or defecation (note: immediate resuturing of an infected dehiscence is not recommended; healing by secondary intention should be prioritized after cleaning the bed, or performing delayed resuturing once the wound has been disinfected).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 5
- Treatment options
- 4