Perineal wound dehiscence is the reopening of a repaired perineal tear or episiotomy following childbirth. This complication occurs when the stitches fail to hold the tissue edges together, resulting in a visible gap in the wound area. While discovering a reopened wound can be deeply unsettling, it is a known complication that requires prompt medical attention. Understanding the signs of dehiscence and the appropriate next steps is the first step toward effective management and complete healing.
Identifying the Signs of Reopening
Recognizing the symptoms of a reopened wound is important for seeking timely care, as the signs often involve a sudden worsening of recovery. The most noticeable indication is a change in the wound’s physical appearance, where the edges of the incision or tear have separated, leaving an open or gaping space. You may also notice that some of the suture material seems loose or has come away completely, especially since dissolving stitches are designed to loosen around seven to ten days postpartum.
A significant increase in pain, particularly a throbbing or sharp sensation that makes sitting or walking difficult, frequently accompanies dehiscence. This new or worsening discomfort is often localized to the wound site and goes beyond the expected tenderness of the initial healing period. Swelling, redness, or hardness around the separated wound edges can also develop, signaling an inflammatory response or potential infection.
The presence of new or altered discharge is a strong indicator of a problem, particularly if it is pus-like, yellow, or green. This purulent discharge, sometimes accompanied by a foul odor, suggests that a bacterial infection has developed in the wound bed. A general feeling of being unwell, flu-like symptoms, or a fever should prompt immediate concern, as these are signs that a localized infection could be affecting the rest of the body.
Immediate Steps When Dehiscence is Suspected
If you suspect your perineal wound has reopened, the immediate and most important action is to contact your healthcare provider, such as your obstetrician, midwife, or primary care physician. They can offer guidance based on your symptoms and arrange for an urgent clinical assessment. Do not attempt to manage the wound by yourself or wait for your next routine appointment, as prompt intervention can significantly influence the healing process.
While awaiting medical instruction, you should prioritize basic wound hygiene to keep the area as clean and dry as possible. Gently wash the area with water only, particularly after using the toilet, and avoid using soaps or shower gels. Changing your maternity pad frequently helps reduce moisture and the risk of bacterial contamination in the wound bed.
You may manage localized discomfort using approved over-the-counter pain relievers like acetaminophen or ibuprofen, which is safe to use while breastfeeding. Limiting physical strain is also advisable, which means avoiding heavy lifting to reduce pressure on the pelvic floor and perineum. However, certain signs require immediate emergency attention, including heavy, uncontrolled bleeding, slurred speech, severe breathlessness, or confusion, as these can be signs of a serious systemic infection.
Professional Assessment and Treatment Pathways
Once you are seen by a healthcare professional, the initial assessment will involve a visual inspection of the wound to determine the degree of separation and check for signs of infection. The provider will look for tissue health, swelling, and the presence of pus, often taking a wound swab to identify any specific bacteria contributing to the breakdown. The presence and severity of infection are the primary factors that dictate the subsequent treatment pathway.
If an active infection is present, the wound will not be immediately re-sutured, as stitching up infected tissue can trap the bacteria and lead to a deeper, more serious complication. Instead, the initial management focuses on treating the infection, typically with antibiotics, and allowing the wound to heal through a process known as Secondary Intention. In this pathway, the open wound gradually closes by forming new granulation tissue from the base upward.
The second major pathway is Surgical Repair, or secondary suturing, which involves surgically closing the wound again. This option is typically considered only after any infection has been completely cleared and the surrounding tissue is healthy and non-swollen. Surgical closure can expedite the healing time, minimize discomfort, and improve the long-term cosmetic outcome compared to healing by secondary intention.
Supporting Healing and Preventing Further Issues
Nutritional support is essential once a professional treatment plan is in place. Wound healing requires sufficient intake of specific macronutrients and micronutrients. Protein intake is particularly important, as amino acids are the foundational building blocks for new tissue and collagen synthesis.
Focusing on vitamins and minerals like Vitamin C and Zinc also supports the body’s ability to repair tissue and fight infection. Consuming a diet rich in fiber and ensuring adequate fluid intake is important for managing bowel movements. Preventing constipation and straining minimizes physical pressure on the weakened perineal muscles.
Incorporating gentle pelvic floor exercises, once approved by your provider, can assist healing by promoting blood circulation to the area. Patience is necessary, as the healing process for a dehisced perineal wound may take several weeks to fully resolve. Regular follow-up appointments are necessary to monitor the wound’s progress and ensure that any complications are addressed quickly.