Postpartum perineal pain

Postpartum perineal pain

Postpartum pelvic or perineal pain and discomfort is common after a vaginal birth, and can take between a week to several months to heal, depending on the degree of swelling or tearing. There are some steps you can take to reduce pain, including warm baths, ice packs, anesthetic spray, and exposing the wound to air. If the pain and swelling aren’t going away, however, it’s important to talk to your healthcare provider.

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Why might I experience postpartum pelvic or perineal pain?

The three most common reasons you might be experiencing this type of pain are all related to things that occur during delivery.

Vaginal delivery

Vaginal birth puts enormous pressure on the perineum (the skin and muscle between your vagina and anus), which must stretch to accommodate your baby’s head.

If you gave birth vaginally without tearing, your perineum may be swollen or tender afterward, but it will likely feel fine within a week, or even after just a day or two.

Tearing during birth

Your perineum may tear during childbirth; in fact 9 out of 10 women will experience some form of tear – even if it’s just stretching of the vagina skin – during delivery. Also called perineal lacerations, these types of tears occur when the baby is descending through the birth canal. The position of the baby’s head during delivery as well as the speed that baby descends can affect the risk for tearing.

Episiotomy

Your provider may decide to do a surgical procedure called an episiotomy to make a wider opening for the baby’s head to pass through. This only happens if there is a need to expedite delivery for the baby due to distress, but this may increase the risk of perineal pain and discomfort as the wounds heal.

How long will the pain last?

Pain will diminish as you heal. Healing times vary, but in general, the deeper the cut or tear, the longer the recovery time. A small, or first-degree, tear involves the skin only (not muscle), and stitches may not even be necessary. These tears generally heal quickly with little discomfort.

A typical second-degree tear involves skin and muscle. These usually require stitches and heal in two to three weeks. (The stitches dissolve on their own during this time.) Some women feel little pain after a week, while others have discomfort for a month.

If you have a third- or fourth-degree laceration, which is a more serious tear that extends to the rectum, you may have pain and discomfort for a month or even longer. (These tears can happen to anyone but are more likely if you have an episiotomy.) In the first few days after birth, you may have trouble urinating and passing bowel movements. You’re also more likely to have problems controlling gas or bowel movements (anal incontinence) for months, or even years.

Can I prevent tearing during birth?

There are some proactive things you can do to decrease the risk of severe tears, although these won’t necessarily prevent them completely:

  • As you push, aim for more controlled and less expulsive pushing, which may allow your tissue to stretch more easily.
  • Place a warm cloth on your perineum as a way to soften those tissues.
  • Your healthcare provider may exert mild pressure with a perineal massage during labor, and might recommend that you do this type of massage as you get closer to your delivery date.
  • There are some delivery positions that may be beneficial, such as lying on your side, or delivering in hands and knee position.

How to heal vaginal tears

Your nurses and provider will give you detailed instructions on how to care for any vaginal tearing. It may shorten healing time to:

  • Refrain from sitting for long periods of time while your perineum is still very sore.
  • Start taking warm soaks or sitz baths 24 hours after you give birth. Do this for 20 minutes, three times a day. For a sitz bath, you fill a shallow plastic basin with warm water and position it over your toilet seat, then sit on it, with your perineum in the water. This way, you can soak your perineal area several times a day without having to fill a tub and completely undress. Most hospitals will provide you with a sitz bath basin, and they’re also available at most drugstores. You can also take a shallow bath after you get home; the warmth will likely feel soothing.
  • Start doing Kegel exercises the day you give birth. These help restore muscle tone, stimulate circulation, and speed healing. (Contracting your pelvic floor muscles supports the wound so you’ll feel less of a pulling sensation on your stitches when you move.)
  • Get plenty of rest when you can.
  • Use your perineal bottle to spray the area with water, to remove any urine or feces that may remain after wiping. In fact, you may not want to wipe with toilet paper for a few days after birth and may want to just spray with water and pat dry.

If you have a tear that involves your anal sphincter (a third- or fourth-degree tear), it’s also especially important that you drink plenty of fluids and get enough fiber in your diet to prevent constipation. Start taking a stool softener right after you deliver and continue for a few weeks. Avoid suppositories, enemas, and other rectal treatments.

What to do about pelvic or perineal pain and discomfort

When addressing pain and discomfort, you might want to try several different tactics to see which ones work best for you. Some to consider are:

  • Apply an ice pack with a soft covering to your perineum right after you give birth to reduce swelling and discomfort. Ask for a new ice pack every few hours over the next 12 hours or so.
  • Take ibuprofen or acetaminophen for pain relief. (Don’t take aspirin if you’re breastfeeding.) If you have an extensive tear, you may need prescription pain medication.
  • Consider trying an anesthetic spray. Some women swear by these, and most hospitals still prescribe them, although limited research suggests they don’t help much, if at all.
  • Change your sanitary pad every time you use the bathroom.
  • Use a squirt bottle to pour warm water on your perineum while you’re urinating. The water dilutes your urine so it doesn’t burn as much when it comes in contact with your skin. Cleanse the area with another squirt afterward.
  • Pat yourself dry from front to back to avoid introducing germs from the rectum into the vaginal area.
  • Apply cotton pads soaked in witch hazel to the sore area. Try putting these in the refrigerator before using them for a cooling effect.
  • Expose the wound to air as much as possible. This can be hard to do if you still have lochia, the postpartum bloody discharge, but you can always lie on an old towel or disposable pad while airing your wound.

When to call your doctor about pelvic and perineal pain

Call your provider if you have pain or swelling that’s not going away or is getting worse, or even if you’re just not finding relief. You may be referred to a urogynecologist or a pelvic rehab physical therapist.

Also call if you have a fever or other signs of infection, such as foul-smelling discharge from your vagina or the site of the episiotomy or tear. Lastly, if you have bleeding or tissue coming from the site of the tear, call your healthcare provider.

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