Postpartum Complications: Managing Pain and Infection After Natural Birth - Obstetrics and Gynecology

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Postpartum complications, particularly after a natural birth, can be a source of significant concern for new mothers. Your experience of pain, swelling, and the sensation of pressure in the vaginal area is not uncommon, but it does warrant careful attention and management.

Firstly, the swelling and pain you describe at the site of your perineal incision could indicate an infection, especially since you mentioned that your doctor diagnosed it as "化膿" (purulent). This suggests that there may be pus formation, which is a sign of infection. It is crucial to address this promptly, as untreated infections can lead to more severe complications, including abscess formation, which may require drainage.

The treatment you received, which included pain medication and topical ointment, is a common initial approach. However, if you have not seen improvement after two days of treatment, it is essential to follow up with your healthcare provider. They may need to reassess the wound, possibly perform a culture to identify the specific bacteria causing the infection, and determine if drainage is necessary. In some cases, oral antibiotics may also be required to help clear the infection.

Regarding the sensation of pressure and discomfort when standing or sitting, this can be attributed to several factors. After a natural birth, the pelvic floor muscles and surrounding tissues can be stretched or injured, leading to a feeling of heaviness or pressure. This is often referred to as pelvic congestion or pelvic floor dysfunction. The pain you feel when pressing on the vaginal area could also be related to muscle tension or inflammation in the pelvic region.

To improve your symptoms, consider the following recommendations:
1. Follow-Up Care: Ensure you have a follow-up appointment with your healthcare provider to reassess the wound and discuss your symptoms in detail. If necessary, seek a second opinion if you feel your concerns are not being adequately addressed.

2. Warm Sitz Baths: Continuing with warm sitz baths can help soothe the area and promote healing. Adding Epsom salts may provide additional relief.

3. Pain Management: If over-the-counter pain medications are not effective, discuss with your doctor about stronger pain relief options or alternative medications.

4. Pelvic Floor Exercises: Once cleared by your doctor, gentle pelvic floor exercises (Kegel exercises) can help strengthen the muscles and improve symptoms. However, avoid any exercises that cause pain.

5. Rest and Positioning: Try to rest as much as possible and find comfortable positions that alleviate pressure on the perineal area. Using a cushion when sitting can help reduce discomfort.

6. Hydration and Nutrition: Staying hydrated and maintaining a balanced diet can support overall healing and recovery.

7. Physical Therapy: If symptoms persist, consider consulting a pelvic floor physical therapist. They can provide specialized exercises and techniques to help manage pain and improve pelvic floor function.

In summary, while some discomfort and complications can occur after a natural birth, it is essential to communicate openly with your healthcare provider about your symptoms. Prompt evaluation and appropriate management can significantly improve your recovery and overall well-being. Remember, postpartum recovery is a process, and seeking help when needed is crucial for your health and peace of mind.