Perineal stitches are sutures used to repair tears or an episiotomy following childbirth, and the resulting discomfort is a near-universal part of postpartum recovery. These stitches reconnect the skin, muscle, and tissue of the perineum, the area between the vagina and the anus, which becomes stretched or torn during delivery. The initial pain is a natural response to the tissue injury, swelling, and subsequent healing process. Understanding the expected timeline and pain management strategies is key to focusing on recovery.
The Typical Healing Timeline
The severity of the perineal injury directly influences how long the pain from the stitches lasts. For most people who experience a first- or second-degree tear, or an episiotomy, the most acute pain tends to subside within the first three to five days postpartum. This rapid decrease in pain corresponds to the initial reduction in post-delivery swelling and inflammation in the area.
Tenderness, localized discomfort, and a feeling of stretching or pulling often persist for a longer period, lasting between one and three weeks. For common repairs (first or second-degree), the surface wound is usually healed enough that the pain is gone by the end of the third or fourth week. The deeper the tear, the longer the recovery period will be.
More extensive repairs, such as third- and fourth-degree tears, involve the muscle of the anal sphincter and require a longer internal healing process. For these deeper injuries, the pain can last four to six weeks or longer before the area feels healed. Full internal tissue strength may take several months, but the worst of the pain should resolve within the first six weeks.
The stitches are made of dissolvable material, such as catgut or synthetic polymers. The dissolution process often begins around one to two weeks postpartum, which can be accompanied by an itching, tingling, or tugging sensation distinct from the wound pain. While the stitches begin to break down early, they may take four to six weeks to fully disappear, and small pieces may occasionally be noticed on sanitary pads or in the toilet.
Practical Strategies for Pain Relief and Comfort
Managing the initial acute pain involves a combination of pharmaceutical and non-pharmaceutical approaches. In the first 24 to 72 hours, cold therapy is effective for reducing swelling and numbing the area. This can be achieved using an ice pack or a frozen gel pad wrapped in a clean cloth, applied to the perineum for 10 to 20 minutes at a time.
Warm water treatments can provide relief, especially after the first few days. Sitting in a shallow bath of warm water, known as a sitz bath, for 15 to 20 minutes a few times a day can soothe the area and promote cleanliness. To keep the stitched area clean and reduce stinging during urination, use a peri-bottle or jug of warm water to gently rinse the area while urinating.
Over-the-counter pain relievers like acetaminophen and ibuprofen are effective for mild to moderate pain. Taking these medications on a regular schedule, rather than waiting for the pain to become severe, helps maintain consistent comfort. If the pain is more intense, a healthcare provider may prescribe stronger medication, and it is important to discuss any medication use, particularly if breastfeeding.
Managing bowel movements is crucial, as straining can put pressure on the stitches. Drinking plenty of water and eating high-fiber foods helps keep stool soft, and a doctor may recommend a stool softener for the first few days or weeks. When sitting, using a donut-shaped cushion or lying on your side can help relieve direct pressure on the perineum.
When to Seek Medical Attention
While discomfort is expected, certain signs suggest the wound is not healing as it should, requiring medical evaluation. A key indicator of a potential complication is pain that suddenly worsens or fails to improve after the first week, rather than gradually getting better. This worsening pain can signal an infection or other issue.
Infection signs include increasing redness, swelling, or a foul odor or colored discharge coming from the wound site. A fever of 100.4°F or higher is another symptom that requires contacting a healthcare provider. These symptoms indicate the body is fighting a bacterial infection that may require antibiotics.
Watch for signs of wound separation, known as dehiscence, characterized by the stitches feeling undone or the wound edges visibly separating. If any of these symptoms—worsening pain, fever, unusual discharge, or wound separation—occur, contact a doctor or midwife right away for an assessment.