What it is
You have stitches, or a tear, or both, and you want to know how long this will hurt. The perineum is the skin and muscle between the vagina and the anus. It stretches a great deal during birth, and it often tears.
Tears are graded one to four. A first-degree tear is skin only. A second-degree tear goes into the muscle and is the most common kind that needs stitches. Third- and fourth-degree tears reach the muscle around the anus. Those happen in about three to six of every hundred vaginal births. The stitches dissolve on their own.
What's typical
The first three days are the sorest. Sitting, standing up, and peeing all sting. By the end of week one, most mothers can sit without planning it. By two weeks, the sharp pain is usually gone and what is left is tenderness. Stitches dissolve between two and six weeks. A second-degree tear is usually healed by six weeks, though the tissue keeps softening for months. Bits of stitch may show up on the pad. That is fine.
What's known
ACOG and the Royal College of Obstetricians and Gynaecologists both describe cold packs in the first two days, warm sitz baths after that, and keeping the area clean and dry as the main care. Views on the donut cushion are mixed. Some mothers love it, and some pelvic floor therapists say it pulls on the stitches. Third- and fourth-degree tears get extra follow-up, and many hospitals refer those mothers to pelvic floor therapy as a matter of course.
What helps
- Peri bottle: squirt warm water over the area while you pee and after. It takes the sting out.
- Cold for the first 24 to 48 hours: a padsicle, or crushed ice in a cloth, for 10 to 20 minutes at a time.
- Sitz bath after day two: a few inches of warm water, two or three times a day, about ten minutes.
- Pat dry, front to back. Change pads often. Lie on a towel and let air reach the area.
- Hold a clean pad against the stitches when you poop. It feels safer, and it is.
When to call someone
- Nowbleeding from the tear that soaks a pad in an hour, or a fever with chills and feeling very ill.
- Todayfever of 100.4 or more, pus, a bad smell, redness spreading, or pain that gets worse after day three instead of better.
- Todaythe stitches have come apart, or you cannot control gas or stool.
- At your next visitstill painful at six weeks, a lump or hard spot, pain with sex, or a feeling of heaviness.
Who helps
Tools: Postpartum Prep Checklist · Birthworker Directory
Related
- Perineal massage, tearing, and episiotomyGetting Ready for Birth
- The first poop, constipation, and hemorrhoids after birthPostpartum: Your Body
- Your pelvic floor after birthPostpartum: Your Body
- Scar care: cesarean and perineal scarsPostpartum: Your Body
- Signs of infection after birthPostpartum: Your Body
- Sex after birth: when, pain, dryness, desirePostpartum: Your Body
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Sources
- American College of Obstetricians and Gynecologists — Practice bulletin on prevention and management of obstetric lacerations at vaginal delivery
- Royal College of Obstetricians and Gynaecologists — Perineal tears during childbirth: patient information
- NHS — Episiotomy and perineal tears
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