A suture of the perineum refers to the stitches used to repair tears or cuts in the perineum, which is the area of skin and muscle located between the vagina and the anus. This procedure is commonly performed following vaginal childbirth to help the affected tissues heal properly, restoring the anatomy and supporting recovery.
Reasons for Perineal Sutures
Perineal sutures are typically needed for two main reasons: spontaneous perineal tears during childbirth or an episiotomy. During vaginal delivery, the perineum stretches significantly, and natural tearing is common, affecting up to 9 in 10 first-time mothers. These tears are classified by their depth. First-degree tears involve only the skin or superficial vaginal tissue and may not always require stitches if not bleeding.
Second-degree tears extend deeper, involving the skin and muscles of the perineum, and generally require sutures for proper healing. More extensive injuries, known as third-degree tears, involve the skin, perineal muscles, and the anal sphincter muscle, which controls bowel movements. The most severe, fourth-degree tears, extend through the anal sphincter and into the rectal lining. Episiotomies are deliberate cuts to enlarge the vaginal opening, often performed to prevent more severe tears or to expedite delivery when there is fetal distress or if instruments like forceps or a vacuum extractor are used.
The Suturing Procedure
The repair of a perineal tear or episiotomy typically occurs shortly after childbirth, often in the same delivery room. Before beginning, a local anesthetic is administered to numb the affected area, ensuring the procedure is not painful. If an epidural is already in place, its dosage can be increased to provide adequate pain relief for the repair.
The healthcare provider stitches the layers of tissue, including the vaginal wall, muscle, and skin, using absorbable sutures. These stitches are designed to dissolve on their own, usually within a few weeks, eliminating the need for a follow-up visit to have them removed. A rectal examination may be performed afterward to confirm no stitches inadvertently passed into the rectum.
Healing and Aftercare
Recovery from perineal sutures involves managing discomfort and promoting healing in the weeks following childbirth. Pain can be managed with over-the-counter pain relievers like paracetamol or ibuprofen, which are safe for breastfeeding mothers. Applying cold compresses or ice packs to the perineum for 10-15 minutes at a time, every few hours during the first few days, can help reduce pain and swelling. Taking a sitz bath, soaking the hips and buttocks in warm water, also provides soothing relief several times a day.
Maintaining good hygiene is important to prevent infection and facilitate healing. Gently rinsing the perineal area with warm water after using the toilet, perhaps with a peri bottle, is recommended instead of wiping. Pat the area dry with a clean towel. Regular changing of sanitary pads, every 3-4 hours, is also advised to keep the wound clean.
To enhance comfort, avoid prolonged sitting or standing. Using a donut pillow can alleviate pressure when sitting, and resting or feeding the baby in a side-lying position may be more comfortable. Preventing constipation is also important to avoid straining stitches during bowel movements; drinking plenty of water and consuming fiber-rich foods like fruits, vegetables, and whole grains can help, and a stool softener may be recommended. Gently engaging in pelvic floor exercises as soon as comfortable can increase blood flow to the area, aiding in healing.
Recognizing Complications
While the perineum typically heals well, be aware of signs indicating a complication requiring medical attention. An increase in pain, especially if it worsens, can signal a problem. New or foul-smelling vaginal discharge, or pus draining from the wound, indicate a possible infection.
Other signs of infection include increased redness, swelling, warmth around the wound, or developing a fever. Stitches may loosen or the wound may open, a condition known as perineal wound breakdown or dehiscence. If you notice stitches coming apart, an open or gaping wound, or new bleeding from the site, contact a healthcare professional promptly. Seeking timely medical advice for these symptoms helps ensure appropriate treatment and prevents further issues.