Postpartum Pain: Why Does My Natural Birth Wound Still Hurt?

Doctor, I gave birth to my son over a year ago, and I'm wondering why my natural delivery incision still hurts?

Hello, doctor.
After giving birth last March, I stayed in the hospital for three days, and at that time, I didn't feel any pain from the incision.
After being discharged, I had to take my son back to the hospital for observation due to jaundice.
While sitting on a metal chair in the hospital, I shifted my weight slightly and suddenly felt a sharp pain as if the incision was being pulled.
On the way home, I could only sit sideways in the car.
My husband later bought me a cushion with an air ring, which helped alleviate the pain, and I also soaked in a sitz bath with warm water.
That day, I took a stool softener because I was afraid of pain and thought it would help with bowel movements.
By evening, when I tried to have a bowel movement, I was in so much pain that I broke out in a sweat and cried.
When I strained my abdomen and anus, it also pulled on the vaginal incision.
My husband immediately checked the incision and said the doctor had stitched it well, and the stitches were intact.
I pointed out where I felt the pain, and he said it was likely the stitch ends.
Eventually, the abdominal pain became unbearable, and I forced myself to go, and suddenly the incision didn't hurt as much; it seemed like the tension was released when I strained.

After that, I continued to use the sitz bath, but I didn't do it several times a day because I was taking care of the baby myself.
I would only soak for about 15 minutes when my mother could help, at most twice a day.
Later, during my one-month postpartum check-up, I told the doctor that my incision still had a stabbing pain.
Whenever I slightly opened my legs, it would pull on the vaginal incision, whether I was sitting cross-legged, putting on pants, or wiping after urination, I often experienced this stabbing sensation.
When the doctor performed an internal examination, he pressed down hard on my incision while saying, "Your incision is healing very well; the stitches are fine, how could it possibly hurt?" I told him that his pressing was genuinely painful.
The doctor advised me to continue with the sitz baths, saying it would improve.
After returning home, I immediately did the sitz baths, and the doctor did not schedule a follow-up appointment.
During this time, any sexual activity with my husband was very painful.
Positions I used to enjoy were no longer possible because any penetration would press against the incision underneath the vagina.
Using lubricant helped a bit, but it was still very painful, significantly reducing the quality and frequency of our sexual life.

Now, a year and five months later, I still experience pain.
I worry that the doctor may have stitched too tightly, causing the opening to become smaller, which leads to discomfort during intercourse.
Many of my mom friends have suggested that I might need to have the stitches reopened and re-stitched, which frightens me even more.
However, I don't want to go through another pregnancy just to address this issue.
I'm unsure what other solutions might be available.
Thank you, doctor.

Kai, 30~39 year old female. Ask Date: 2017/08/29

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Last March, after giving birth, I stayed in the hospital for three days.
At that time, I didn't feel any pain from the incision.
After being discharged, I had to bring my son back to the hospital for observation due to jaundice.
While sitting on a metal chair in the hospital, I shifted my weight slightly and suddenly felt a sharp pain as if the incision was being pulled.
On the way home, I could only sit sideways in the car.
My husband later bought me a donut cushion, which helped alleviate the pain a bit, and I also soaked in a sitz bath with warm water.
That day, I took a stool softener because I was afraid of pain and thought it would help with bowel movements.
By the evening, when I tried to have a bowel movement, I was in so much pain that I broke out in a sweat and cried.
When I strained my abdomen and anus, it also pulled on the vaginal incision.
My husband immediately checked the incision and said the doctor had done a good job stitching it up, and the stitches were intact.
I pointed out where I felt pain, and he said it was probably the stitch ends.
Eventually, the abdominal pain became unbearable, and I forced myself to go, which surprisingly relieved the pain at the incision, as if the tension had been released.

After that, I continued to take sitz baths, but not multiple times a day because I was taking care of the baby.
I would only soak for about 15 minutes when my mother could help, at most twice a day.
Later, during my one-month postpartum check-up, I told the doctor that I still felt sharp pain at the incision.
Whenever I slightly opened my legs, it would pull on the vaginal incision, whether I was sitting cross-legged, putting on pants, or wiping after urination.
There were many instances of sharp pain.
When the doctor performed an internal examination, he pressed down hard on my incision while saying, "Your incision is healing well; the stitches are fine.
How could it possibly hurt?" I told him that his pressing was indeed very painful.
The doctor advised me to continue with sitz baths, saying it would improve.

After returning home, I immediately took sitz baths, and the doctor didn't ask me to come back for a follow-up.
During this time, sexual intercourse with my husband was very painful.
Positions I used to enjoy were no longer possible because any penetration would press on the incision underneath the vagina.
Using lubricant helped a bit, but it was still very painful, significantly reducing the quality and frequency of our sex life.
Now, a year and five months later, I still experience pain.
I worry that the doctor may have stitched too tightly, causing the opening to become smaller, which leads to discomfort during intercourse.
Many of my mom friends have told me that I definitely need to have the stitches reopened and re-stitched.
Hearing that makes me even more anxious, but I don't want to go through another pregnancy just to fix the incision.
I'm unsure what other solutions might exist.

Answer: A personal examination is necessary to reach a conclusion.
It is advisable to diligently seek out specialists.
Ultimately, if this issue is not resolved, it could lead to lifelong pain.

Reply Date: 2017/08/29

More Info

Postpartum pain, especially after a natural birth, can be a distressing experience for many women. Your description of the ongoing pain at the site of your perineal tear or episiotomy is not uncommon, and there are several factors that could contribute to this discomfort.

Firstly, it’s important to understand that the healing process after childbirth can vary significantly from person to person. While some women may feel completely healed within weeks, others may experience lingering pain for months or even longer. The pain you describe, particularly when moving or during activities such as sitting or having intercourse, can be attributed to several factors:
1. Nerve Sensitivity: After childbirth, the nerves in the perineal area may become hypersensitive. This can lead to pain that feels sharp or stabbing, especially when the area is stretched or manipulated.

2. Scar Tissue Formation: If you had a tear or an episiotomy, scar tissue can form as the area heals. This scar tissue may not have the same elasticity as the surrounding tissue, which can lead to discomfort during certain movements or activities.

3. Infection or Complications: Although you mentioned that your doctor checked the stitches and found them to be intact, it’s still possible to have an infection or other complications that could cause pain. Symptoms of infection may include increased redness, swelling, or discharge from the wound site.

4. Pelvic Floor Dysfunction: The pelvic floor muscles can become weakened or overly tense after childbirth, leading to pain during activities that involve these muscles, such as lifting, sitting, or sexual intercourse.

5. Psychological Factors: The experience of childbirth can be traumatic for some women, leading to anxiety or fear surrounding activities that may cause pain. This can create a cycle of tension and discomfort.

Given your ongoing pain, it’s crucial to seek further evaluation from a healthcare provider who specializes in postpartum care. Here are some recommendations that may help alleviate your discomfort:
- Physical Therapy: A pelvic floor physical therapist can provide targeted exercises and treatments to help strengthen and relax the pelvic floor muscles, which may alleviate pain.

- Warm Sitz Baths: Continuing to use sitz baths can help soothe the area and promote healing. Adding Epsom salts may provide additional relief.

- Pain Management: Over-the-counter pain relief medications, such as ibuprofen or acetaminophen, can help manage pain. Always consult with your healthcare provider before taking any medication.

- Gentle Stretching and Exercises: Engaging in gentle stretching and pelvic floor exercises can help improve blood flow and promote healing.

- Follow-Up Appointments: If the pain persists, it’s essential to have follow-up appointments with your healthcare provider. They may consider additional interventions, such as a referral to a specialist or imaging studies to assess for any underlying issues.

- Open Communication: Discuss your concerns about sexual activity and pain with your partner and healthcare provider. They can provide guidance on alternative positions or techniques that may reduce discomfort.

In conclusion, while it’s understandable to be concerned about the ongoing pain and the possibility of needing further intervention, many women experience similar issues after childbirth. With appropriate care and management, there is a good chance that your symptoms can improve over time. Don’t hesitate to advocate for your health and seek the support you need to ensure a comfortable recovery.

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