Perineal Stitches and How to Take Care of Them — The Baby Cubby

If you’re pregnant, this thought has most likely crossed your mind: how does such a large baby come out of my vagina? Well, it’s a great question, and I can answer that: most often it doesn’t come out very easily. Many women tear or have an episiotomy (the doctor cuts the perineum to allow more room for the baby to exit) during the birthing process and need stitches afterward. So how do you take care of perineal stitches and to let your body heal most effectively? 

Types of Tearing/Cuts

There are four types of tearing/cuts:

• First degree: this type of tear only affects the skin and usually heals quickly. It doesn’t require treatment.
• Second degree: this type of tear affect the muscle of the perineum as well as the skin. These tears require stitches.
• Third and fourth degree: these tears go deeper and also affect the muscles that control the anal sphincter. They also require stitches.
• An episiotomy: this procedure is done by making an incision in the muscular area between the vagina and anus. This incision require stitches to close up. Your stitches will not need to be removed–your body will absorb them naturally after about 1 month.

How to Ease Pain from Tearing/Episiotomy

• Use ice packs on the area. Wrap the ice pack in a towel or cloth to avoid placing directly on the skin, or Frida Baby’s Instant Ice Maxi Pads or Postpartum Recovery Kit are great options.
• Take an over-the-counter pain medication like Tylenol or Ibuprofen. These medications are safe for breastfeeding mothers. If your pain is more talk to your doctor. They may decide you need a stronger medication.

How to Care for Your Stitches 

Keep the Area Clean 

• Shower every day.
• Opt for showers over full-tub baths: Sadly, even when all you want to do is soak your aching bones in a sudsy bubble bath, it is best to stick with showers for the first month or so after delivery. Your stitches are dissolvable and sitting too long in a full tub of hot water could compromise the stitches. You also don’t want to cause an infection from dirty tub water.
• Don’t scrub too hard with soap: You don’t want to damage your stitches with over-zealous scrubbing. Instead, let the water and suds trail down during showers and wash yourself very gently.
• After showering, gently pat your perineum dry with a clean towel. 

Be Careful When Going to the Bathroom

• After going to the bathroom, ALWAYS clean your perineum with warm water using a spray bottle. This helps avoid infection.
• After a bowel movement, remember to gently wipe front to back to keep bacteria from infecting your wound.
• Change your pad every 2-3 hours.
• Avoid straining too much with bowel movements. Postpartum pooping can be difficult if you’re dealing with constipation. A gentle laxative or stool softener can help ease this process. And remember to drink lots of water and eat plenty of fiber.

Take a Sitz Bath

Although you should avoid taking a regular bath, you can take what is called a Sitz bath. Unlike a regular bath, a Sitz bath generally doesn’t last as long as a typical soak in the tub (only about 10 minutes) and requires sitting in just a few inches of water. This bath can help soothe pain and itching if you have hemorrhoids and clean and soothe the perineum.

It’s recommended to take a Sitz bath for 10 minutes, three times a day. The warm water can help promote healing and provide relief.

To take a sitz bath in a tub:

1. Make sure your bathtub is clean. Fill a clean bathtub with 3 to 4 inches of warm water. In some cases, your healthcare provider may tell you to use cold water instead.
2. Add salt or medicine to the water if advised by your healthcare provider.
3. Gently lower yourself down into the bathtub and sit on the bottom of the tub. Don’t get into the bath unless the water temperature is comfortable.
4. Hold on to a railing. Or ask for help from a family member, friend, or caregiver if needed.

Take a sitz bath using a sitz bowl:

1. Lift the toilet lid and seat. Place a cleaned plastic sitz bath bowl on the rim of your toilet. Make sure the bowl is firmly in place and won’t move around.
2. Fill the sitz bath bowl with warm water from a pitcher or other container. The water should cover your perineum. Make sure the water temperature is comfortable.
3. Add salt or medicine to the water if advised by your healthcare provider. Or follow the package instructions about how to fill the bowl. Some kits come with a plastic bag and tubing. This lets you stream water into the bowl and at the area of your body that needs treatment. The bowl may have a slot or hole in the back. This lets water flow out so it doesn’t overflow onto the floor. If there is no hole, be careful not to fill the bowl too full.
4. Gently sit down on the sitz bath bowl. Hold on to a railing. Or ask for help from a family member, friend, or caregiver if needed.

These instructions were from saintlukeskc.org

Take it Easy

Don’t start lifting heavy weights or running marathons anytime soon! Relax and enjoy your time with your baby on the couch or in bed. Going for walks can help the healing process and your mental state, but don’t over do it. Listen to your body, and take your time returning to normal activity.

Don’t Use Tampons or Menstrual Cups

You should wait six weeks before using internal menstrual sanitary products again. Vaginal bleeding after birth (called lochia) is to be expected and can last from 2 to 6 weeks. The place where the placenta was attached to your womb is still an open would and needs time to heal, and there may be tears or cuts within your vagina. These are still vulnerable to infection, so keeping internal sanitary products out of your body is best for avoiding infection.

Stick to pads, and remember to change them frequently, especially while the bleeding is heavy in the first week or two after delivery.

No Sex

I know this one will be a hard one to follow, because after you have a baby rip through you, having sex is the first thing you’d like to do, but you have to steer clear of it for 6 weeks. 😉

You shouldn’t be putting anything up your vagina until your doctor clears you, which is usually around 6 weeks. Your vagina and perineum need that time to heal.

Even then, though, talk to your partner and make sure you have clear boundaries of what you are and are not ready for. If you are still not feeling ready at 6 weeks, there is no need to have sex. Your doctor may have said you are physically capable, but maybe mentally you are just not feeling it yet, or perhaps the thought it still too scary. That is totally normal. Wait until you are most comfortable. 

If you’ve had a tear or episiotomy, sex can be painful, even after 6 weeks. You aren’t doing yourself or your partner any favors if sex is hurting, so talk to your doctor if the pain isn’t easing. 

Let Your Stitches Breathe

Fresh air can help speed up the healing process. From time to time, try removing your underwear, lying on a clean towel, and letting your stitches get some much-needed fresh air for ten minutes or so.

When to Call the Doctor

• Your pain gets worse or seems persistent with no improvement.
• You go for 4 or more days without a bowel movement.
• You pass a blood clot larger than a walnut.
• You have a discharge with a bad odor.
• The wound seems to break open.
• You see discharge of pus or liquid from the cut.
• You notice an unusual smell.

I know it totally seems overwhelming and scary, and it just kind of is. It feels like a war zone down there! On top of all of this you have a brand new baby to take care of, your boobs feel like they’ll explode, and your hormones are all over the place.

But remember, it will get better! Truly it will. And then maybe one day when they’re teenagers sneaking out you’ll wish for these times again (but probably not). 

You can find more info on pooping after a perineal tear or hear about how my stitches ripped open on The Baby Cubby Blog.