Perineal Stitches…Now What? Our Top 10 Tips For Recovery

Mother in pain in bed beside baby

Written By Mandy Rempfer-Kuncio, MScPT, BSc, CD(DONA)

My name is Mandy Rempfer-Kuncio and I am passionate about the pelvis! As a pelvic health physiotherapist and a birth doula, my dream is for everyone to feel strong at their centre.  Thank you for visiting the Nurturance Health blog!

December 26, 2021
***This article is for informational purposes only and should not substitute advice from your healthcare/maternity care professional.***

OMG.  I have stitches in my perineum after birth…. Now what?!?!

If you’ve had stitches in your perineum or vagina after birth, this post is for you.  This post is also for you if you might end up with stitches in your perineum after birth… and spoiler alert – that means most birthers!

During pregnancy, many of us dream about what life will be like after birth – when we can finally meet our babies and hold them in our arms.  Often we imagine these idyllic scenes, full of newborn snuggles and perhaps a wee little hand clasped around our pinky finger.  Our dreams are beautiful. We are building a family!
Idyllic ewborn and parent
Realistically, many of us also understand life after birth won’t be easy – you just know there will be some sleep deprivation (although that’s hard to truly understand until you live it 🤣).  You expect some time will be needed for your physical recovery.

But what you might not anticipate is what can happen when you have a vaginal delivery and you end up needing stitches in your perineum.

It. Can. Really. Suck.

Regrettably, many women are totally shocked and blindsided when dealing with a perineal injury because they had no idea that pain, infection, and bladder/bowel leakage could be part of the deal after having a baby (as if caring for a completely dependent newborn wasn’t hard enough!).

It’s true though – perineal injuries can lead to immediate postpartum issues like poor healing, infection, pain, sexual dysfunction, and bladder or bowel incontinence. 

There can also be long term consequences… birth injuries sometimes contribute to challenges which are extremely distressing later in life, especially as we travel through menopause and continue to age (no one wants to start pooping their pants in their 60’s)
incontinence pad postpartum

What Also Sucks:

Perineal injuries are also very common. 

In Canada, ~⅔ of women who give birth vaginally report stitches.  Further to that, Canada also has alarmingly high rates of severe perineal injury when compared to other similar countries across the world.  Severe perineal injury is classified as a 3rd or 4th degree tear (and includes damage to the anal sphincter in additoin to the perineum) and here it happens in about 5-7% of vaginal births.

So Here’s The GOOD NEWS/BAD NEWS…

Bad News:  

If you have a vaginal birth, there’s a good chance you are going home with stitches.  This can increase your risk for pain, infection, bladder leakage, sexual dysfunction, etc.

Good News:  

There are things you can do in the early postpartum period to decrease your risk of complications and to help you feel more comfortable! PLUS: vaginas and perineums are awesome healers. 💖

 

We all deserve those idyllic moments of newborn snuggles.  Let’s ditch the suffering!

Here are 5 tips you need to know to help optimize your postpartum perineal recovery…

(and if you would like another 5, sign up for my Top 10 list below ⬇️)

1. Prepare For The Pain

Pain can be a normal part of postpartum recovery if you have stitches in your perineum. As I mentioned in this blog about C-section recovery, pain after birth is crummy since we already have a lot on our plate – like feeding and caring for a newborn, and adapting to an ever-changing body and hormones.

So it can be normal for it to hurt when we get in and out of bed, get up and down from a chair, or go to the bathroom. HOWEVER, it is vitally important that you stay on top of your pain.  Even if you are a person who typically doesn’t take pain medication, have a plan.  Know your options.

Keeping your pain well controlled is essential to decrease the stress on your body.

We need to decrease our fight-or-flight response and stress in our bodies in the postpartum period for two very important reasons: 

    1. To help establish lactation (feeding and bonding with our infants is not particularly helped by pain).
    2. To heal well (higher levels of stress slow the healing process)

Again, to optimize your postpartum recovery, know your options and have a plan for pain.  Now is not the time to be tough.  Now is exactly the kind of time pain meds are meant for. 

black woman breastfeeding baby

2. Sitting Can Suck, So Try These Tips:

✴️  If it hurts to get up out of a chair, try squeezing your glutes (your butt muscles) just BEFORE you stand up to see if it helps.

✴️  Try and use chairs with arm rests as much as possible so that you can use your arms to help push yourself up out of the chair.

✴️  If sitting is uncomfortable, try sitting on a pillow for more cushion.

✴️  You could also try perching on the edge of the chair for shorter periods of time so its easier to get up afterwards.

✴️  Don’t sit! Getting up from a reclined position on the couch or a lounge chair can be really tough.  If you can, lay down instead (especially when you are relaxing).

sitting in pain postpartum with perineal stitches

3. Peri-Bottles For The Win

Peri-bottles are often touted as a birther’s best friend.  They are a must-have and they can help in a number of ways:

 

  1. The water is thought to dilute the urine, so if the urine is stinging because its concentrated, that should help.
  2. The sensation of pressure from the water and the temperature are messages that can travel very quickly to the pain.  These can move faster the pain messages and offer a welcome distraction.
  3. They spare you from needing to wipe aggressively

Here’s How To Use Them:

✴️ Fill the bottle – ideally with warm water – lukewarm water really; remember, our vulvas are sensitive; hot water that feels okay on your hand might actually feel much too hot on your perineum.

✴️ In a pinch, you can use cold water.  It’s not quite as comfortable but it will still help.  I can remember a few times hurrying to the bathroom and knowing I didn’t have time to wait for the water to get hot.  I just had to fill it with cold before the pee was coming!

✴️ Start the flow of water just before you start peeing if you can.  Use the whole bottle so you have water going the whole time you pee

✴️ Do not wipe!!  If you are worried about how clean things are, you can also gently part the labia and use a little water flow gently down over your inner labia.  But just pat dry.  I have also been known to use a little hair dryer action

✴️ If you have any stitches around the sides or top of your vaginal opening, like up by the uretrha or your clitors, parting the labia likely will NOT feel good and really isn’t necessary.  Experiment to figure out where you feel like the water flow from the peribottle serves you best.

✴️ Gentle, gentle, pats dry.

4. Get A Stool Softener

There are a lot of scary stories floating around the internet about that first poop after having a baby.  Perineal stitches do not make the idea of pooping any less scary…   

However, this is one area you can also make it easier on yourself.

Constipation
It’s really important to consider all the tips and tricks possible to banish constipation in the postpartum period. After birth we are prone to constipation for a number of reasons:

  • fluids going to milk production
  • a lack of physical body movement
  • the use of pain meds

All of this can all be constipating. 

However, your pelvic organs need as much support as possible during this time.  The ligaments that hold up your uterus and pelvic organs are by no means healed yet and they are still soft and stretchy.

Plus, the muscles helping to support your organs have now also been injured. 😥  While they are actively healing and recovering, we don’t want to put them in any unnecessarily difficult situations.

You have to poop, but you can make it easier.

 

So be nice to your organs and be nice to your muscles!  And that means no pressure or straining to have a bowel movement!  Don’t wait for your stool to become large or hard before you address constipation.  Be proactive in this area and get a stool softener in advance to help your recovery.  Not sure what kind or which brand? Talk to your doctor or pharmacist (if you are lactating, you will want to consider what’s safe, so definitely ask an expert).

 

Also, if you don’t have a stool or a Squatty Potty in your bathroom yet, you’d better get one of those!! (Why? This video has a good explanation). 😉😉😉

5. Don’t Rush Sex

Postpartum people are often cleared for sex at their 6-week postpartum check.

But, listen – many people don’t feel ready yet. Lots of my clients don’t feel ready until closer to the 12 week mark postpartum. And if you have had a 3rd or 4th degree perineal tear, you should definitely wait.

 

Waiting is A-OKAY.

In fact, I generally recommend waiting a little longer if you’ve had stitches in your perineum (often closer to 8-12 weeks).  And especially wait if you don’t feel ready yet.
postpartum sex

Sex is complex. Our relationships are complex.

There are a lot of factors we need to consider, like desire… and opportunity (is the baby sleeping?!?!)… and of course, physical body readiness and healing.

Even the definition of sex is complex.  In this case, I am referering to penis-in-vagina penetrative sex. 

However, I am not saying you should wait when it comes to intimacy, connection and pleasure.  

 

I’m just saying honour how your body feels and how it is healing.

You, my friend, are also a complex being – and I am too – and that means one-size-fits-all recommendations don’t really work!

Postpartum recovery when you have perineal stitiches involves healing from injury and from giving birth.  Your body has been through a lot, but it is truly amazing.  Our bodies have this miraculous capacity to create and give life, and they also have a breathtaking capacity to heal.  I hope these tips help you feel better as you go through your healing process and your postpartum recovery.

~Mandy

 

And guess what, there’s more!!! 

I’ve put together a great pdf that includes these 5 tips + 5 more!  You can sign up and grab our Top 10 Tips below.  There are many things you can do to optimize your healing and recovery! 💗💗💗

Get It Here! ⬇️

.

You May Also Like…

Are You Good At Peeing?

Are You Good At Peeing?

***This article is for informational purposes only and should not substitute advice from your healthcare/maternity...