Postpartum perineal pain is a common occurrence in women after childbirth. This pain mostly occurs due to lacerations in the perineal area during vaginal deliveries. These lacerations are necessary to ensure the smooth passage of the baby’s head through the birth canal.
According to a study by the American College of Obstetrics, lacerations occur in about 53 to 79% vaginal deliveries, and they are followed by no complications except pain (1).
Read on to learn more about the causes, signs, treatment, diagnosis, and treatment of perineal pain after childbirth.
Why Do Women Have Postpartum Perineal pain?
The discomfort in the perineum after childbirth is known as postpartum perineal pain.
The perineum is the delicate area between the vagina and the anus. Mostly, women who go through normal delivery experience pressure and stretching in the perineum area. As the baby’s head is pushed out of the vaginal opening, the doctor may make a small cut in the perineum to make the passage easier. This surgical procedure is called episiotomy (2).
The cut is sutured later, but the pain in that area is felt until it gets healed. Even if there is no surgical tear in the perineum during delivery, the childbirth process can leave the area tender and swollen. All of this might lead to perineal pain.
The pain is temporary, and the wound eventually heals on its own.
How Long Does The Pain Last?
- For normal delivery without any tear: The perineal area may remain tender and swollen, and the pain may last for about six weeks or so (3).
- Episiotomy: If the surgical incision made in the perineal area is severe, the pain might decrease in the eighth and twelfth week after delivery (4). As the tear is sutured, the wound takes time to heal, and the soreness will persist for some time. The tears are classified based on their size and the type of tissues involved.
- 1st-degree tear: A thin tear of perineal skin with no muscle tissues involved. Such tears may need a few stitches.
- 2nd-degree tear: A tear of the perineal skin and muscle tissues. It needs stitches, and the wound may take around six weeks or so to heal.
- 3rd-degree tear: The doctor cuts through the perineal muscle tissues and the muscle layers surrounding the anal canal. Stitches are required and take almost the same time as that of 2nd-degree tear for recovery.
- 4th-degree tear: The cut is through the anal sphincter to the anal canal. Proper pain management that includes pain medications, diet, physiotherapy, and personal hygiene can help overcome the discomfort. However, some women may experience problems like urinary and anal incontinence, which will require medical consultations (5).
- Labor before a C-section: There is no room for the perineal tear in the case of a c-section unless you have gone into labor before an emergency c-section. Depending on the length of labor and the closeness of the baby to the vaginal opening, the perineal area could become swollen and tender.
Medication can help deal with the pain after delivery. Keep reading to know more about that.
Are Painkillers Safe For Perineal Pain?
A study indicates that a single dose of non-steroidal anti-inflammatory drugs (NSAIDs) after childbirth, in non-breastfeeding mothers, offered pain relief four to six hours after administration.
Also, these women required no additional pain relief medication four or six hours after the first dose of NSAIDS, compared to women who did not take any treatment. The NSAID was also found to be more effective than paracetamol in relieving the postpartum perineal pain (6).
The study also revealed that these medications had no adverse effects on the mother and the baby. However, there is no data available on the effects of these medications in breastfeeding mothers. So, if you are a breastfeeding mother, talk to your doctor before considering NSAIDs for perineal pain.
Note that medicines are not the final resort for pain relief. You can also try to reduce the pain through some simple measures.
11 Ways To Get Comfort From Perineal Pain
Follow these DIY measures to ease the perineal pain and discomfort (7):
- Keep the area clean: Always try to keep the perineum area clean to prevent bacterial infections. Use warm water to clean the area as it prevents skin irritation. Pat dry that area from front to back to prevent any room for bacterial growth. Also, change the sanitary pads at regular intervals.
- Warm baths: Consider sitting in a bathtub filled with warm water, with your hips and buttocks immersed in it, for 20 minutes for relief from the perineal discomfort. You can do this 2-3 times a day. You can also go for a sitz bath, in which a plastic basin filled with warm water is positioned over the toilet seat. You can sit over that with only the perineal area immersed in the water.
- Ice packs: You might also take some ice made from filtered water and put it inside surgical gloves. Apply it to the perineal area for pain relief. This might also help in speeding up the healing process.
- Take rest: Avoid putting any pressure on the lower body post-delivery. Make sure not to stand and sit for long hours. Lie on your side to prevent exerting pressure on the perineum.
- Kegel exercises: These might help in strengthening the pelvic muscles and improving blood circulation, which could speed up the healing process.
- Hot compresses: The use of hot compresses might provide some relief from the pain and discomfort.
- Wear comfortable undergarments: Consider wearing loose, cotton underpants that allow airflow and do not irritate the skin. This might help in the quick recovery of the wound.
- Drink fluids: In the case of difficult bowel movements, drink plenty of water, and consume fiber-rich food. It might help to relieve constipation and prevent pressure on the perineum area.
- Expose the wound: If you have any vaginal discharge, it would be difficult to keep the wound exposed to air. In such a case, use a disposable pad or towel while lying down, to let some air to the wound.
- Cotton pads: It is believed that placing cold (refrigerated) cotton pads might help in relieving the pain.
- Medications: You can use pain-relieving medicines as prescribed by the doctor if the pain is unbearable. Avoid taking any OTC medicines without seeking advice from the doctor.
After delivery, regular doctor visits are necessary to ensure that the perineum wounds are healing properly. The following section describes the after-care steps.
Follow-Up For Postpartum Perineum Care
Fix an appointment with your doctor for a postpartum check six weeks after delivery. If the perineum pain is persistent, then:
- The doctor will check for any infection of the episiotomy stitches. In the case of infection, the doctor will remove the stitches to let the infection drain and the wound heal.
- If clotted hemorrhoids are present in the rectal area, then stitches will be removed to drain off the collected blood.
- The doctor might prescribe antibiotics depending upon the type and severity of infection at the perineum stitches.
If the pain persists or you have a fever or foul-smelling discharge, call the doctor immediately. The doctor may refer you to a urogynecologist or a pelvic rehab therapist.
Frequently Asked Questions
1. How do I know if my perineal tear is infected?
Reddish discoloration, swelling, fluid or pus oozing out, lingering pain, and foul smell are some signs of a perineal infection (8).
2. How long do perineal stitches take to heal?
The sutures may take seven to ten days to heal (9). Make sure to keep the stitches and the area clean using warm water only.
3. Is it normal for my perineum to hurt after childbirth?
Yes, it is common for the perineum to hurt after childbirth if you experienced labor pain or delivered the baby vaginally (9). Some women recover within a few days, while some may take months.
4. What is the perineal area of a female?
The perineum is the area between a woman’s vagina and anus (9). It is in the shape of a diamond and is located between the thighs.
Most mothers experience postpartum perineal pain, especially after vaginal deliveries, due to stretching and lacerations of the perineal tissue during the birth process. Mothers who had an episiotomy or assisted deliveries are more likely to feel severe perineal pain after childbirth. It is also common for women who had emergency cesarean sections after going into labor to feel pain due to changes in the tissue. NSAIDs are often prescribed for postpartum perineal pain. In addition, Kegels, warm compresses, keeping the perineum dry and clean could promote healing and reduce pain.
2. Hong Jiang, Xu Qian, Guillermo Carroli, and Paul Garner; Selective versus routine use of episiotomy for vaginal birth; Cochrane Library
3. Adriana Amorim Francisco, et al.; Evaluation and treatment of perineal pain in vaginal postpartum; Scielo
4. İsmet Gün, Bülent Doğan, and Özkan Özdamar; Long- and short-term complications of episiotomy; Turkish Journal of Obstetrics and Gynecology
5. Ryan Goh, Daryl Goh; Hasthika Ellepola; Perineal tears – A review; Australian Journal of General Practice
6. Anti-inflammatory drugs for relief of perineal pain after childbirth; Cochrane
7. Care of the perineum after the birth of your baby; National Health Service
8. Episiotomy and perineal tears; NHS
9. Recovering from Delivery (Postpartum Recovery); American Academy of Family Physicians