Postpartum Tears: Healing and Care After Natural Birth

Postpartum perineal tear

Dear Doctor: It has been 7 days since my natural delivery, and I recently noticed that the area between my vagina and anus, where I had stitches, gets irritated when I have a bowel movement.
No matter how I clean it, there is still a little residue left.
Is this normal, or will it improve once the wound heals? Thank you!

Aa, 20~29 year old female. Ask Date: 2016/07/10

Dr. Lü Lizheng reply Obstetrics and Gynecology

Please consult an obstetrician-gynecologist for confirmation, as there is a possibility of poor wound healing, and a small number of individuals may experience issues with rectovaginal fistulas.
Sincerely, Dr.
Lu Li-Cheng, Taoyuan Hospital.

Reply Date: 2016/07/10

More Info

Postpartum healing, especially after a natural birth, can be a complex process, particularly when it involves tears or episiotomies. It's important to understand that the area between the vagina and anus, known as the perineum, can be quite sensitive and may take time to heal fully.
In your case, experiencing discomfort or noticing that bowel movements irritate the stitched area is not uncommon. After a natural birth, especially if you had a significant tear (such as a fourth-degree tear), the healing process can be prolonged and may require special care. Here are some key points to consider regarding your situation:
1. Healing Timeline: Generally, the healing of perineal tears can take several weeks. While some women may start to feel better within a week, others may experience discomfort for a longer period. The stitches used to repair the tear are typically absorbable and should dissolve on their own within a few weeks. However, the surrounding tissue may still be sensitive and require gentle care.

2. Hygiene Practices: Maintaining proper hygiene is crucial during the postpartum period. After bowel movements, it is advisable to gently clean the area with warm water. Using a peri bottle can help rinse the area without causing additional irritation. Avoid using toilet paper directly on the stitches initially, as this can lead to discomfort or infection.

3. Diet and Bowel Movements: To minimize straining during bowel movements, consider increasing your fiber intake through fruits, vegetables, and whole grains. Staying hydrated is also essential. If you find that bowel movements are painful or difficult, consult your healthcare provider about safe stool softeners or other remedies.

4. Signs of Complications: While some discomfort is normal, you should be vigilant for signs of complications. If you notice increased pain, swelling, redness, or discharge that has a foul odor, these could indicate an infection or other issues that require medical attention. It’s also important to monitor for any changes in your bowel habits or if you experience severe pain during bowel movements.

5. Follow-Up Care: It’s crucial to attend your postpartum check-up, usually scheduled around six weeks after delivery. During this visit, your healthcare provider can assess the healing of your perineum and address any concerns you may have. If you feel that your healing is not progressing as expected, do not hesitate to reach out to your provider sooner.

6. Emotional Support: The postpartum period can be emotionally challenging, especially when dealing with physical discomfort. Consider discussing your feelings with a trusted friend, family member, or healthcare provider. Support groups for new mothers can also provide valuable emotional support and practical advice.

In summary, while some discomfort and irritation in the perineal area after a natural birth are common, it is essential to maintain proper hygiene, monitor for signs of complications, and seek medical advice if you have concerns. Healing takes time, and being proactive about your care will help ensure a smoother recovery. If you have any further questions or if your symptoms worsen, please consult your healthcare provider for personalized advice and treatment options.

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