Written by Jessica Patella, ND. This first study of its kind found that 2% cinnamon extract ointment is beneficial in healing and reducing the pain of the episiotomy wound.
Episiotomy, a common obstetric intervention, involves cutting of the skin between the vagina and anus to ease delivery (1). The prevalence of episiotomy is about 33% of births in the United States, which experts says is too high, although rates in South America, Asia and the Middle East can be as high as 100% (4). Perineal pain after an episiotomy is about four times more than in those without an episiotomy (2).
Healing from an episiotomy can impair a woman’s ability to care for her child(ren) and can make lactation more difficult (3). Non-steroidal anti-inflammatory drugs (NSAIDs) are most commonly given for the pain. More recently, the first study of its kind found that 2% cinnamon extract ointment is beneficial in healing and reducing the pain of the episiotomy wound (1).
Cinnamon is most widely used as a spice, but is also known for its anti-inflammatory, anti-oxidant and anti-microbial qualities (5). Because it is used as a spice, it is generally well tolerated and no significant side effects are reported (1, 6).
The recent research included 144 women who had an episiotomy during birth. The women were randomly assigned to either the cinnamon ointment group (n=72) or placebo group (n=72). They were instructed to apply the ointment every 12 hours with a sterile pad for 10 days (1). Perineal pain and wound healing was assessed before the intervention, 1 hour after episiotomy repair, 4 hours and 8 hours after ointment administration and 10-11 days after delivery (1).
The visual analog scale was used to measure pain (scale 0-10, 0=no pain, 10=maximum imaginable). The REEDA scale was used to measure episiotomy wound healing (redness, edema, ecchymosis, discharge and approximation; each rated on a scale of 0-3, with a lower score indicating better healing) (1).
The average pain intensity at baseline was 5.0 +/- 1.8 in the cinnamon group and 4.6 +/- 2.0 in the placebo group. The following chart shows the pain reduction compared to baseline:
| 4 Hours | 8 Hours | 10-11 Days | |
|---|---|---|---|
| Cinnamon Group | 16% reduction in pain | 26% reduction in pain | 76% reduction in pain |
| Placebo Group | 2% reduction in pain | 4% reduction in pain | 43% reduction in pain |
| Average difference between Cinnamon and Placebo Group (95% CI) | -0.6 (-0.1 to -0.2) | -0.9 (-1.4 to -0.3) | -1.4 (-2.0 to -0.7) |
| p-value | 0.003 | 0.002 | <0.01 |
The average REEDA score at baseline was 3.4 +/- 1.6 in the cinnamon group and 3.2 +/- 1.5 in the placebo group. The following chart shows the REEDA score reduction compared to baseline:
| 8 hours | 10-11 Days | |
|---|---|---|
| Cinnamon Group | No significant change from baseline | 53% reduction in REEDA score |
| Placebo Group | No significant change from baseline | 6% reduction in REEDA score |
| Average difference between cinnamon & placebo group (95%CI) | -0.2 (-0.4 to -0.04) | -1.6 (-2.0 to -1.1) |
| p-value | 0.01 | <0.01 |
*There was no significant change form baseline at 4 hours for any measure
At 10-days post-delivery, the following was observed:
| No Redness | No Edema | No Ecchymosis | No Discharge | Complete Closure | |
|---|---|---|---|---|---|
| Cinnamon Group | 39% | 71% | 95% | 13% | 65% |
| Placebo Group | 15% | 34% | 82% | 23% | 39% |
| p-value | <0.01 | <0.01 | 0.021 | 0.1 | 0.003 |
In conclusion, cinnamon ointment on an episiotomy wound for 10-days reduced intensity of perineal pain and improved healing of the incision, with no significant side effects. This is the first clinical trial on the anti-inflammatory and analgesic (pain reducing) properties of cinnamon for wound-healing in humans (1). Future research should include a larger number of participants to confirm results and various doses (1).
Source: Mohammadi, Azam, et al. “Effects of cinnamon on perineal pain and healing of episiotomy: a randomized placebo-controlled trial.” Journal of integrative medicine 12.4 (2014): 359-366.
Copyright © 2014, Journal of Integrative Medicine Editorial office.
E-edition published by Elsevier (Singapore) Pte Ltd. All rights reserved.
Posted January 20, 2016.
Jessica Patella, ND, is a naturopathic physician specializing in nutrition and homeopathic medicine and offers a holistic approach to health. She earned her ND from Southwest College of Naturopathic Medicine in Tempe, AZ, and is a member of the North Carolina Association of Naturopathic Physicians. Visit her website at www.awarenesswellness.com.
References:
- Mohammad A, et al. Effects of cinnamon on perineal pain and healing of episiotomy: a randomized placebo-controlled trail. J of Integr Med. 2014; 12(4):359-366.
- Francisco AA, et al. Evaluation and treatment of perineal pain in vaginal postpartum. Acta Paul Enferm. 2011: 24(1): 94-100.
- East CE, et al. Perineal pain following childbirth: prevalence, effects on postnatal recovery and analgesia usage. Midwifery. 2012; 28 (1): 93-97.
- Episiotomy Rate Too High, Say Experts. WebMD.
- Jakhetia V, et al. Cinnamon: a pharmacological review. J Adv Sci Res. 2010; 1 (2): 19-23.
- Ranasinghe P, et al. Response to Akilen et al. Efficacy and safety of “true” cinnamon (Cinnamomum zeylanicum) as a pharmaceutical agent in diabetes: a systematic review and meta-analysis. Diabet Med. 2013: 30(4): 506-507.
