Home › Postpartum & Mum Care

Perineal Tears and Stitches: Healing and Aftercare

What tears are, how stitches heal, how to ease the pain and the signs of infection or other problems.

Before you use this guide: This is general educational information, not an individual medical assessment. We do not identify a clinician reviewer on this page, so please confirm personal health decisions with your doctor, midwife or paediatrician.

Many women have some tearing in the perineum, the area between the vagina and the anus, during a vaginal birth. It is especially common after a first birth. Most tears are small and heal well with good care.

Degrees of tears

• First degree: a small tear in the skin. It may need a stitch or may heal alone.
• Second degree: the tear goes into the perineal muscle. This is the most common type that needs stitches.
• Third and fourth degree: the tear extends to the muscles around the anus, and in fourth degree also into the lining of the anus. These are repaired in an operating theatre, usually with anaesthetic, and need follow-up care.

Stitches are usually dissolving ones that fade over a few weeks. Soreness and tenderness are common for the first one to two weeks and then ease gradually.

Easing the discomfort

• Use cool packs or a cold, wrapped gel pad on the area for 10 to 20 minutes, never directly on the skin.
• Take pain relief that your midwife or doctor recommends.
• Change maternity pads often and wash your hands before and after.
• Rinse with warm water after using the toilet and pat the area dry from front to back.
• Lie down to rest and avoid sitting for long periods. A soft cushion may be more comfortable than a ring.
• Do not use tampons while you are bleeding.
• Avoid heavy lifting and straining.

Going to the toilet

• Pour warm water over the area while you pass urine if it stings.
• Hold a clean pad gently against the stitches when you open your bowels, so that you feel supported.
• Avoid constipation by drinking plenty of water and eating fibre. Ask about a stool softener if you need one.
• Do not strain. Your stitches will not come apart when you open your bowels, so try not to worry.

Contact your doctor or midwife if

• The pain is getting worse rather than better
• You notice increasing swelling or redness, or a foul-smelling discharge
• The wound seems to be opening
• You have a fever or feel generally unwell
• You cannot pass urine, or you leak urine or stool, or cannot control wind (this can be treated)

Getting back to normal

Gentle pelvic floor exercises can start when you feel ready and help healing. There is no fixed time to resume sex. Many couples wait until the bleeding has stopped and the area feels comfortable. A water-based lubricant can help. Mention any pain to your doctor at your postnatal check. If you had a third or fourth degree tear, you should be offered a follow-up appointment, and your care team can discuss your options for future births.

Can tears be prevented?

Perineal massage from around 35 weeks, warm compresses during the second stage of labour and upright or side-lying birth positions may reduce the risk of severe tears. Ask your midwife about them.

This content is for general information only and is not medical advice. Every pregnancy and every baby is different. Always talk to your doctor, midwife or paediatrician about your own situation, and seek urgent care if you are worried.