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Healing after a third / fourth degree tear or episiotomy
Most women are told their tear or episiotomy cut has “healed” and sent on their way, but healing is about so much more than stitches closing. In this article, I walk you through what real recovery after a third-degree tear or episiotomy should look like: what’s normal, what’s not, and when to seek extra support. From pelvic floor function to scar tissue and emotional recovery, this is about helping you understand your body, ask the right questions, and feel confident in your healing journey moving forward.
1. Women’s Health Physiotherapy
This is one of the most recommended supports after a third-degree tear or episiotomy. A specialised pelvic health physiotherapist can assess:
They may use:
Many hospitals in Australia actually recommend routine referral after a third- or fourth-degree tear or episiotomy.
2. Therapeutic ultrasound (used by physios)
Therapeutic ultrasound can be a helpful tool, particularly when used by a trained Women’s Health Physiotherapist.
It may help by:
However, it is usually used as part of a broader treatment plan, not the only therapy. The physio will decide if it’s appropriate based on:
Some women notice improvement in scar tenderness or tightness with this treatment.
3. Scar tissue mobilisation
Once healing has occurred (often around 6 to 8 weeks postpartum, depending on the woman):
A physio may guide gentle techniques such as:
This can help reduce:
4. Pelvic floor rehabilitation
Because the anal sphincter is involved in a third-degree tear and episiotomy, strengthening and coordination of the pelvic floor is essential.
Therapy may include:
Many women are surprised to learn it’s not always just about tightening, sometimes it’s about restoring balance and function.
5. Bowel management during healing
Early healing is helped by reducing strain on the repair.
Common recommendations include:
This protects the sphincter repair while the tissue regains strength.
6. Pain relief and tissue comfort
Simple supports can help significantly in early healing:
7. Emotional and trauma recovery
A third-degree tear or episiotomy can also be emotionally significant, especially if the birth was intense or unexpected.
Support can include:
This is often overlooked but can be just as important.
Red flags after a third-degree tear (that should NEVER be brushed off)
Some discomfort is expected… but these are not “just part of healing”:
Ongoing or worsening pain
This can indicate scar adhesions, nerve involvement, or improper healing.
Bowel control issues (this is a big one)
Because the anal sphincter is involved, this is never something to “just live with” and early physio support is critical here.
Pain with sex (once resumed)
Often linked to scar tissue restriction or pelvic floor over-tightening.
Heaviness or pressure
Could indicate pelvic floor dysfunction or prolapse changes.
Emotional distress or avoidance
This matters just as much as the physical healing
The main message:
If a woman is told “that’s normal” but it doesn’t feel right in her body, it deserves follow-up.
Questions women should ask at their 6-week check
This is where so many women get a quick “you’re fine” and sent on their way. We need better questions.
Instead of:
“Am I healed?”
Ask your care provider:
1. “Has my anal sphincter healed well?”
(Not always checked thoroughly unless asked).
2. “Can you assess my pelvic floor function?”
Not just strength, but coordination and relaxation.
3. “Is my scar tissue healing well and moving normally?”
This is HUGE for long-term comfort.
4. “Should I be referred to a Women’s Health Physio?”
(Answer should almost always be YES for a third-degree tear or episiotomy).
5. “Are there any signs I should watch for that would indicate a problem?”
6. “What does a safe return to exercise and sex look like for me?”
Why some tears take longer to heal (and no one explains this properly)
When healing feels slow, women often think their body is failing, but there are real reasons.
1. It’s not just skin – it’s muscle repair
A third-degree tear or episiotomy involves:
Muscle healing takes longer and needs rehabilitation, not just time.
2. Scar tissue isn’t always flexible
Scar tissue can become:
What can make a real difference is things like:
3. Pelvic floor can become over-tight (not weak!)
After trauma, the body can respond by:
This leads to:
4. Lack of follow-up care
Many women:
So, issues go unaddressed early.
5. Birth experience matters
If the birth was:
The nervous system can stay on high alert, affecting healing.
Women are often told:
“You’re healed”
………….when what they actually need is:
“Let’s make sure you’re functioning well, comfortable, and confident in your body again.”
When discussing with your care provider at your 6-week checkup:
Don’t just ask: “Did it heal?”
But also ask:
“How is it functioning?”
If you are in Perth, Western Australia, we have some amazing Women’s Health Physiotherapists that you can reach out to and here are 3 that I refer my clients to regularly:
Nicole Weir Physiotherapy
https://nicoleweirphysio.com.au/
Alison Wroth – Consano Pelvic Health Centre
https://www.consano.com.au/
Sam Ziegelaar
https://www.birthsweet.com.au/
If you have any questions or would just like more information please don't hesitate to get in touch by clicking the button below and filling out the contact form.
Contact Vicki