Childbirth often results in a tear or a surgical incision, known as an episiotomy, in the perineum, the area between the vagina and the anus. These injuries frequently require stitches for proper healing and tissue restoration. Discomfort in the postpartum period is a standard part of the recovery process, but understanding the nature of the injury and the typical healing timeline can help manage expectations. This guide explores the types of injuries, the progression of pain, methods for relief, and when to seek medical advice.
Understanding Perineal Injuries and Stitches
The severity of the pain and the required healing time relate directly to the depth of the perineal injury sustained during vaginal birth. Perineal tears are classified into four degrees, ranging from the least to the most severe. A first-degree tear is the most superficial, involving only the skin and vaginal lining, and sometimes does not require sutures.
Second-degree tears extend deeper to involve the muscles of the perineum but not the anal sphincter. Third-degree tears involve the skin, perineal muscles, and the anal sphincter muscle complex, which controls bowel movements. A fourth-degree tear extends completely through the anal sphincter and into the lining of the rectum.
Episiotomies are surgical cuts performed to widen the vaginal opening and are typically comparable in depth to a second-degree tear. For all repairs, doctors use absorbable sutures that the body naturally breaks down over time, eliminating the need for removal. These stitches begin to dissolve within the first one to two weeks and are mostly absorbed within four to six weeks post-delivery. Discomfort can linger even after the stitches are gone, as the physical presence of the suture material disappearing is separate from the sensation of pain subsiding.
The Expected Healing Timeline for Pain
The most intense pain from postpartum stitches is concentrated in the first 24 to 72 hours following delivery. During this initial phase, the tissues are swollen and inflamed due to the trauma of birth and subsequent suturing. Most women find that a noticeable reduction in sharp pain occurs within the first three to five days postpartum.
By the end of the first week, most people experience improvement, and the pain transforms from a sharp sensation into a duller, more manageable soreness. For those with a minor second-degree tear or an episiotomy, the pain is often waning considerably by the two-week mark. Discomfort may still be present with activities like sitting or having a bowel movement, but the constant pain should be gone.
The recovery period for resolution of major discomfort is typically four to six weeks, especially for more severe third- or fourth-degree tears. Although the wound surface is generally healed by this time, some residual tenderness, itching, or pulling sensations may persist as the deeper tissue repairs and the scar tissue matures. A full return to pre-pregnancy comfort levels may take several months, depending on the tear’s severity and individual healing rates.
Effective Strategies for Pain Relief
Managing the initial soreness after a perineal repair involves a combination of medication and comfort measures. Over-the-counter pain relievers are the first line of defense, with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and acetaminophen commonly recommended. These medications are generally considered safe while breastfeeding and should be taken regularly as prescribed, rather than waiting for the pain to become severe.
Applying cold to the perineum helps reduce swelling and numb the area, providing immediate relief. Commercial cold packs or ice cubes wrapped in a clean cloth can be applied for 10 to 20 minutes at a time during the first few days postpartum. The use of a sitz bath is another effective method, where the perineum is soaked in a shallow basin of warm water for about 15 to 20 minutes several times a day.
Proper hygiene reduces the stinging sensation often felt when urinating near the stitches. Using a peri-bottle to squirt warm water over the perineum while voiding helps dilute the urine and prevent irritation. Many women find relief from using medicated pads or compresses soaked in witch hazel, which offer a cooling effect when placed directly on the sanitary pad.
To avoid strain on the stitches during bowel movements, maintaining a high-fiber diet and taking a stool softener as recommended by a provider can be helpful.
Recognizing When Medical Attention is Needed
While some degree of pain is normal during healing, a worsening of symptoms can signal a complication like infection or wound breakdown, known as dehiscence. Contact your healthcare provider if your pain begins to increase after the first few days, rather than gradually decreasing, or if the pain makes walking or sitting difficult. A fever over 100.4°F or a general feeling of being unwell, such as flu-like symptoms, suggests a systemic issue requiring immediate evaluation.
Signs of a localized infection require prompt medical advice:
- A foul odor coming from the vaginal discharge or the wound itself, which may appear yellow or green.
- Spreading redness, increased heat, or hardness around the stitched area that is not resolving.
- Pus draining from the wound.
- Stitches appearing to separate or the incision opening.
Early identification of these symptoms allows for quick treatment, typically with antibiotics, and helps prevent complications.