Care of your perineum after the birth
perineum; birth; vagina; pelvic; floor; vaginal; area; episiotomy; tear; stitches; skin;
The perineum is the area of skin and muscle between your vagina and your anus. The perineum stretches and thins out over your baby's head as he or she is born.
- You will probably experience pain and swelling in the perineal area after the birth.
- Even women with no visible signs of damage to the perineum often feel perineal pain.
- Pain levels are commonly greatest on the second day, and have usually eased by 7 to 10 days.
- In 4 to 6 weeks your perineum should have healed and feel more comfortable.
- Sometimes it may take up to 6 months to feel completely comfortable.
- The first time that you need to empty your bowels (do poo) it may feel strange and possibly uncomfortable. It is normal to worry about this - but it will not cause damage and it is safe to do.
- If your perineum can't stretch enough to allow your baby's head to come out it will either tear or require cutting (this is called an episiotomy).
- Tears may involve just the skin of the perineum or the area around the outer part of the vagina (the labia).
- Sometimes the back wall of the vagina will tear as will some of the muscle layers of the perineum. Rarely tears extend into the anus.
An episiotomy is a cut made by the midwife or doctor which goes through the skin, into the vagina and through all the muscle layers.
- It is recommended that episiotomies are only cut if your baby's heartbeat is low, if you need forceps to help your baby to be born or there are other reasons why your baby needs to be born more quickly.
- Some studies show that episiotomy increases the risk of tears into the anus.
- Some studies have found that episiotomy does not prevent incontinence (leaking of urine or faeces), reduce severe tearing or improve healing. There is no difference in the rates of incontinence between normal birth and caesarean birth.
Normally stitches are offered if you have an episiotomy and for
- Tears that involve the muscles layers of the perineum
- Tears which are bleeding
- Tears that are not well aligned (jagged).
Stitches stop any bleeding from a tear and join the tissues together.
A doctor or midwife will do the stitching, usually soon after the birth of your baby. It takes about 45 minutes to do the stitches. The stitches dissolve so they do not have to be removed.
It is recommended that babies are breastfed in the first hour after birth, so if your tear is not bleeding you may choose to breastfeed before having the stitches.
Some women find having stitches painful. Local anaesthetic is used to numb the area. Tell the doctor or midwife doing the stitching if you feel pain so more anaesthetic can be given.
Disadvantages of having stitches
- Women who have their perineum stitched commonly report pain and tightness and a pulling feeling.
- Occasionally the stitches do not dissolve and need to be removed.
Choosing whether to have stitches
- If you have a small tear you can choose not to have stitches. Ask your midwife or doctor if the tear is small enough that it is likely to heal well without stitches. Some studies suggest that small tears can heal normally, although long-term effects on comfort during sex and on continence are not known.
- If you are worried about the possible effects of not having stitches you may be best to choose to have the tear stitched.
- Some women without stitches report a burning sensation in their perineal area and similar levels of pain to women who have stitches.
To help the perineum to heal
- Keep the area cold by using a wrapped ice pack every 1 to 2 hours or so for the first 24 to 48 hours. This decreases the pain and swelling which is important for healing and comfort. Have the wrapped ice pack on for 10 to 20 minutes at the most each time.
- Change sanitary pads often to keep the perineum dry.
- Rest as much as possible. You may want to lie with a pillow under your hips to elevate the area, or raise the foot of the bed.
- To keep the perineum clean, have at least one shower or bath each day, preferably after you have a bowel action. Gently pat the perineum dry with a soft towel.
- It is normal to worry about opening your bowels (dooing poo) after giving birth – but it will not cause further damage, and it is safe to do.
∞Sit forward on the toilet when opening your bowels (straight back, tummy relaxed, knees higher that hips, feet on a footstool) and relax.
∞Keep breathing and wait, make a 'mooo' or 'ssss' sound to help open your bowel.
∞It's helpful to support the perineum with a folded pad or with toilet paper, as this helps support the pelvic floor muscles.
∞For more information have a look at the topic Bowel Care.
- Exercising your pelvic floor muscles improves and strengthens your muscle tone in this area. Have a look at the topic on Pelvic floor exercises.
- Keep your bowel motions soft. Try not to become constipated. Increase the amount of fibre in your diet (bran cereal is a good source of fibre). Increase the amount of water you drink to 6 to 8 glasses per day, or more.
What to avoid
- Salt or antiseptic baths
- Talcum powder, lotions or creams until the skin has healed
- Sitting on a circular (doughnut) cushion (as it can cause swelling of the perineum)
- Heat (hot packs, hot water bottles, heat lamps)
- Squatting, or any position where your legs are opened wide (eg sitting cross-legged, taking stairs 2 at a time) – this is particularly important if you have a tear and you have chosen not to have stitches.
Checking your perineum
It is only necessary for your midwife or doctor to check your perineum
- if you have increasing pain, or if the pain does not decrease
- if you have a foul-smelling discharge
- if you have an infection (increasing tenderness, swelling and feeling unwell).
Frequent pulling apart of the perineum delays healing.
If you have increasing pain or pain that continues, problems when you have sexual activity or problems with control of your bladder or bowels see your midwife, doctor or a physiotherapist.
Physiotherapy Department, Women's and Children's Hospital, South Australia.
- 'Looking after your perineum (pelvic/vaginal area) after the birth of your baby'
- 'Perineal tears in childbirth - physiotherapy management'
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see your doctor or midwife.