Childbirth often requires stitches to repair soft tissue tears or an intentional surgical incision (episiotomy). A significant number of women who have a vaginal birth will need this perineal repair. These stitches are typically made from absorbable material, which the body breaks down naturally, usually within four to six weeks. The primary focus after delivery is to support natural healing, keep the area clean to prevent infection, and manage expected discomfort. Proper care helps the tissues of the perineum—the area between the vagina and the anus—heal smoothly.
Daily Practices for Cleaning and Maintenance
Maintaining strict hygiene in the perineal area is necessary to prevent bacteria from entering the healing wound. After using the toilet for urination or a bowel movement, the area should be gently cleansed with warm water. Using a peri bottle, a small squeeze bottle provided by the hospital or purchased separately, allows for a targeted rinse that washes away urine and lochia (postpartum bleeding) without causing irritation from rubbing.
It is helpful to spray warm water over the vulva while urinating, as this dilutes the urine and can reduce the stinging sensation on the delicate tissue. After cleansing, the area must be dried carefully by gently patting it with a clean towel or toilet paper, moving from front to back to avoid introducing germs from the anal area. Rubbing the area can cause friction and damage the healing tissue.
Sanitary pads must be changed frequently, ideally every time the toilet is used, to keep the perineal area as dry and clean as possible. Changing pads often reduces the buildup of bacteria and the risk of developing an infection. Additionally, taking a daily shower or bath using only water, or a mild, unperfumed soap, helps to keep the entire region clean.
Sitz baths, where the perineum is soaked in a few inches of warm water, can be a soothing method of cleansing a few times a day. The warm water promotes cleanliness and can ease discomfort. Allowing air to circulate around the wound, such as by lying down on a clean towel without underwear for about 10 minutes once or twice a day, can also support the healing process.
Managing Pain and Discomfort
Applying cold therapy is a method for reducing swelling and numbing the immediate discomfort in the first few days postpartum. This involves using an ice pack or a cold compress, which should be wrapped in a clean cloth or towel before being applied to the skin.
Cold packs can be applied to the perineum for about 15 to 20 minutes at a time, with a rest period of at least an hour in between applications. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, are effective first-line treatments for managing acute pain. Ibuprofen also offers an anti-inflammatory effect that helps with swelling. A healthcare provider should always be consulted regarding medication use while breastfeeding.
Adjusting your sitting posture can also provide significant relief by reducing direct pressure on the stitches. Using a padded ring or a specialized cushion can make sitting more tolerable in the early days. Minimizing long periods of sitting is generally advised. Additionally, a diet rich in fiber and drinking plenty of water helps to prevent constipation, which reduces the strain on the wound during a bowel movement.
Recognizing When to Contact a Healthcare Provider
While some soreness and discomfort are normal parts of the healing process, certain signs indicate a complication, such as infection or wound breakdown, and require prompt medical evaluation. A significant increase in pain that is not relieved by pain medication, or pain that begins to get worse instead of better, is a warning sign. If the area around the stitches becomes increasingly red, hot to the touch, or swollen beyond the expected initial bruising, it may signal a developing infection.
Other signs of infection include a fever, typically defined as a temperature above 100.4°F (38°C), or chills. The presence of an abnormal or foul-smelling discharge, or pus, coming from the wound also indicates a need for immediate attention. Rarely, the stitches may separate or the wound may open, a condition called perineal wound dehiscence.
If there is a sensation that the stitches have come undone, or if a woman can visibly see that the wound is gaping, a healthcare provider should be contacted right away. Excessive bleeding, particularly if it is heavy or sudden, is also a reason to seek medical advice. Any concerns about difficulty controlling gas or bowel movements should also be reported, as this can be a sign of a more extensive tear.