Caring for your perineum after the birth of your baby
This video is for women who have had tears or stitches during delivery. It provides information to support recovery and advice for those who have experienced a third or fourth degree tear.
Up to ninety percent of women may tear during childbirth as the baby moves through the vagina. The perineum, the area between the entrance of the vagina and the back passage, is where most women tear. Some women may have an episiotomy, which is a surgical cut in the perineum to assist with the baby’s birth.
Tears are classified from first to fourth degree. A first degree tear is a small tear in the skin that usually does not require stitches. A second degree tear extends into the perineal muscle and skin and generally needs stitches. Third and fourth degree tears, which occur in up to six percent of women, go deeper into the muscle. A third degree tear involves the muscle surrounding the back passage, while a fourth degree tear extends past it.
Pain is common for a few days to weeks after a tear or episiotomy, but this should improve over time. If stitches become more painful, if there is an increase in discharge or an unpleasant smell, you may have an infection and should contact your GP or midwife.
Some women may have reduced control over their bladder or bowel after delivery. If this happens, ask your midwife to refer you to physiotherapy.
To reduce the risk of infection and promote healing, it is essential to keep the area clean, bathe or shower at least once a day, and change pads every two to three hours. Always wash your hands before and after changing pads. Change positions regularly to avoid discomfort and take medication for pain if necessary, as advised by your midwife. You can use ice packs or gel packs wrapped in a clean layer for up to 10 minutes at a time to reduce swelling, but check the skin frequently to prevent burns. Avoid tight clothing and opt for cotton underwear.
Maintain a healthy diet with plenty of fruits and vegetables and drink up to 2 to 3 litres of water daily. Avoid straining during bowel movements, and some women find it more comfortable to support the stitches with tissue during bowel movements.
Pelvic floor muscle exercises can aid healing. Start them when you feel comfortable after delivery, but do not do them if you still have a catheter in place. The pelvic floor muscles, which span from the pubic bone to the tailbone, are crucial for preventing bladder and bowel leakage and supporting the pelvic organs.
Two pelvic floor exercises include the quick squeeze, where you tighten around the back passage and front passage as if stopping gas and urine, hold for a second, and relax. Repeat up to 10 times. The second exercise involves holding the muscle; squeeze around both passages, hold for up to 10 seconds, and relax. Repeat up to 10 times.
Perform these exercises three to four times a day and continue for life. Most women recover well from third or fourth degree tears. Follow the advice in this video, and you will have received medication in the hospital to prevent infection, ease bowel movements, and provide pain relief.
Women with a third or fourth degree tear will be referred to physiotherapy and will have an appointment at a perineal clinic about 10 to 12 weeks post-delivery. This check-up is to monitor recovery and address any bladder or bowel issues. You can also discuss the birth with the doctors at this appointment.
The physiotherapy department will contact you by letter to check if you have any bladder, bowel, or perineal issues. Contact your physiotherapist if you experience difficulty controlling your bladder or bowel, urgency to reach the toilet, feelings of incomplete bladder or bowel emptying, or any other concerns. Advice will be given, and if needed, an appointment with the physiotherapy team can be arranged.