Perineal wound healing – August 2022
August 30, 2022
This month’s blog comes from Amanda Argyle, Perinatal Pelvic Health Midwife
Up to 9 in 10 first time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy (cut). A tear happens spontaneously as the perineum stretches during birth. An episiotomy is a cut to the perineum that is sometimes made by a doctor or midwife to make more space to deliver the baby.
Types of tears:
- Labial tears: mostly superficial skin breaks which heal naturally, but if they are bleeding or occur on both sides they should be stitched.
- First degree tears: very small tears of the perineum, involving only the skin, which usually heal naturally.
- Second degree tears: deeper tears affecting the muscle of the perineum as well as the skin. These usually require stitches.
- Third degree tear: extends downward from the vaginal wall and perineum to the anal sphincter, the muscle that controls the anus.
- Fourth degree tear: extends to the anal canal and maybe into the rectum (bottom).
If you do have stitches for a tear or a cut, the stitches are dissolvable so you will not need to have them removed.
It is common to feel some pain after a tear or episiotomy. Painkillers such as paracetamol can help and are safe to take if you are breastfeeding. Check with your midwife which painkillers are safe to take if you are not sure.
Exposing stitches to fresh air can help the healing process. Try taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day.
Keep the area clean. Have a bath, shower or use a bidet at least once a day and change your sanitary pads regularly. There is no need to add anything to your bath to promote healing.
Try to drink plenty of water and other fluids and eat a healthy, balanced diet including fruit, vegetables, cereals and wholemeal bread and pasta.
A healthy balanced diet will give you iron and vitamins to promote healing and it will prevent you becoming constipated.
It’s unusual for the pain from a tear or episiotomy to last longer than 2 or 3 weeks. If the pain does last longer than this, speak to a doctor, health visitor or another health professional.
It is a good idea to use a mirror to keep an eye on how your perineum is healing. Look out for any signs that the area or surrounding tissue has become infected, such as:
- Red, swollen skin
- Discharge or pus or liquid from the cut
- Persistent pain
- An unusual smell
- Gaping of the wound
Tell a midwife, GP or health visitor as soon as you notice any possible signs of infection, so that they can make sure you get the treatment you might need.
Pelvic floor exercises
Pelvic floor exercises are very important as these will increase the circulation of blood to the area helping the tear or cut to heal.
Pelvic floor exercises will also help to reduce the pressure on the cut and the surrounding tissue.They will also help you to regain the muscle tone preventing incontinence (leaking urine). These exercises can be started immediately and are very easy to do.
To find out how to exercise these muscles, please click on the Workout Programme tab and begin at the “Stage one” exercises.
If you are not sure if you are exercising your pelvic floor muscles or if you are worried, please speak to a health care professional for advice.