How long will my perineum be sore after birth?

The perineum will be sore for a couple of weeks due to the intense stretching during childbirth. Intense pain and swelling will subside within a week with continued care and application of ice packs.

What not to do after perineal stitches?

Don't strain during bowel movement. Avoid lifting heavy things. Don't scrub, rub, or wipe the area. Don't use powders or ointments unless prescribed by your doctor. Avoid tampons, baths, intense workouts and sexual intercourse until 4-6 weeks.

Recovering From Vaginal Birth: Complete Guide For Postpartum Perineal Care

The perineum is the tissue between the vaginal opening and the anus. During vaginal birth, it stretches to accommodate the baby’s passage, leading to tearing, bruising, or episiotomies in the area, which requires stitching for first-time mothers. Neglecting perineal care increases swelling and delays collagen synthesis, which lengthens the recovery period.

The postpartum period requires a consistent healing routine for both C-section and vaginal birth. Perineum healing is influenced by blood circulation, inflammatory response, hormonal functions, nutrition, and pelvic floor function. Properly caring for wounds, practising pain management techniques, engaging in proactive mobility exercises, and pelvic floor rehabilitation foster healing.

What Happens to the Perineum During Vaginal Birth

During vaginal birth, the area between the vagina and anus, the perineum, experiences stress as it stretches to allow the baby’s head and body to pass through the birth canal. This stretching or expansion leads to thinning, tearing, or bruising. Baby’s size, labour duration, and delivery position significantly influence the perineum trauma.
The perineum stretches up to three times its resting length as the baby's head crowns and descends. The elastic fibres in the perineum increase and cause micro-tears or full-thickness lacerations. Post delivery, the area swells due to fluid retention and inflammation.
The first birth increases the tear risk, often due to the baby's position. Larger babies over 4 kg also increase trauma. Second-stage labour exceeding 2 hours also increases the strain.
Types of Perineal Trauma

First-degree Tear: Only tears the skin and takes 1-2 weeks to heal.
Second-degree Tear: Skin and perineal muscles tear and require at least 4-6 weeks of healing time.
Third-degree Tear: Damages the muscle and anal sphincter, which requires suturing and 6-12 weeks to heal.
Fourth-degree Tear: Both the anal sphincter and rectal mucosa are torn and risk long-term pelvic function. It requires more than 12 weeks to heal.

Postpartum Perineal Care at Hospital

Immediate Care: Right after birth, hospitals follow certain protocols to manage swelling, pain and infection risk. Right after birth, nurses inspect the perineum to classify the trauma and structure if needed. Then they clean the area with sterile gauze and apply sanitary pads.
Cold Therapy: Ice packs or witch Hazel Pads are applied for the first 24-48 hours to reduce swelling. The hospital may provide gel packs to apply for 10-20 minutes. Witch Hazel Pads reduce bruising and have anti-inflammatory properties.
Sitz Baths: Soaking the hips and buttocks in a shallow, warm water to cleanse and soothe the perineal area is called a sitz bath and is done after 24-48 hours. It helps relieve pain and itching and aids in treating haemorrhoids.
Avoiding Heat: For the first 2 to 3 days, avoid hot water during cleaning and sitz baths. Skip warm baths or heating pads for the first 2-3 days to reduce the risk of inflammation.
Breastfeeding Position: The side-lying or football-hold breastfeeding position reduces strain on the perineum.
Early Movement: The fear of worsening the pain or tear can be high right after birth. Lying for a long time increases swelling and reduces blood circulation. Gentle walking, side-lying, and light movement minimise pressure on the perineum.

How to Clean and Care for the Perineal Area

Hygiene helps healing, reducing infection and discomfort. Wiping or scrubbing the area can irritate the wound. You can use the peri bottle to cleanse. Fill the peri bottle with warm water at approximately body temperature. Use plain warm water to soothe swelling.

Sit on the toilet and gently squeeze the bottle after urination
Pat dry the area with a tissue or air dry
Apply the spray or ointment prescribed
Change the pad every 2 to 3 hours
Don't use soaps or harsh liquids to clean the area
Use cotton breathable underwear

Vaginal Birth Recovery: Pain Management Strategies

Cold Therapy: Apply ice packs or gel pads on the area for 10-20 minutes every 2 hours to reduce swelling and pain.
Warm Compress: After 48 hours of warm water, apply warm compression or a sitz bath to soothe pain, boost blood circulation, and promote muscle relaxation.
Doctor-prescribed Medications: Apply topical creams or medications prescribed by your doctor to relieve discomfort.
Witch Hazel Pads: These have anti-inflammatory properties compared to standard ice packs, helping soothe itching and bruising.

How to Care for Stitches After Vaginal Birth

After vaginal birth, stitching the area is common due to perineal tears or episiotomies to ensure healing. Avoid straining bowel movements, sexual intercourse, and tampons until 4-6 weeks. These can reopen the stitches and allow bacteria to build up. Use a stool softener to prevent constipation and reduce straining movements.
Inflammatory Phase: During the first 3 days, the area looks swollen and red due to clotting and inflammation. During this time, avoid hot water or heat compression, as they can worsen inflammation.
Proliferative Phase: By week 2, the soreness starts to ease, and collagen deposition starts building new tissue, which results in itching.
Maturation Phase: Around week 3-6, scar tissue matures, and pain subsides by almost 90%.

Nutrition and Lifestyle to Boost Vaginal Birth Recovery

Nutrition and a healthy lifestyle play a crucial role in postnatal healing. Adding protein, vitamin C, and zinc to your diet helps collagen synthesis and reduces inflammation. Add collagen-rich foods, including bone broth, chicken, fish, eggs, berries, kiwi, and easy green vegetables, to combat oxidative stress and support healing.
Adequate hydration maintains tissue flexibility and flushes lochia. Dehydration thickens blood and impairs nutrient delivery. Drink herbal tea, such as chamomile and fennel, to improve blood circulation. Limit caffeine to avoid drying tissues.
Micro tears caused by the extensive stretching during delivery contribute to perineal trauma. Pain in the area should subside within a few days to a few weeks. If you experience persistent pain, it may be due to an infection or delayed healing. Maintain proper care every day, after each use of the toilet, to minimise infection and support tissue repair.
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FAQs on Recovering From Vaginal Birth: Complete Guide For Postpartum Perineal Care

How long will my perineum be sore after birth?
The perineum will be sore for a couple of weeks due to the intense stretching during childbirth. Intense pain and swelling will subside within a week with continued care and application of ice packs.
What not to do after perineal stitches?
Don't strain during bowel movement. Avoid lifting heavy things. Don't scrub, rub, or wipe the area. Don't use powders or ointments unless prescribed by your doctor. Avoid tampons, baths, intense workouts and sexual intercourse until 4-6 weeks.