Postpartum Pain and Healing: Perineal Tears and Care - Obstetrics and Gynecology

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Postpartum pain and healing, particularly concerning perineal tears, can be a significant concern for many women after childbirth. It’s important to understand the nature of these tears, the healing process, and when to seek further medical attention.

Perineal tears can occur during vaginal delivery, especially if the baby is large or if there is a prolonged labor. These tears can range from minor (first-degree) to more severe (fourth-degree), which involves the anal sphincter and rectal tissue. The healing process typically involves rest, proper hygiene, and sometimes pain management. However, if you are experiencing ongoing pain, especially if it has worsened or if you notice bleeding or unusual discharge, it is crucial to consult with your healthcare provider.

In your case, it sounds like you have experienced recurrent tearing in the perineal area, which has led to pain during intercourse and possibly other symptoms like residual stool on your underwear and itching. The fact that you have had some healing but are now experiencing increased pain suggests that there may be a few factors at play.

1. Depth of the Tear: If the tear is deeper than before, it may not heal properly on its own, and you might require a medical evaluation. A healthcare provider can assess whether the tear needs to be re-stitched or if there are other complications, such as scar tissue formation that could be causing pain.

2. Hygiene and Infection: The presence of residual stool and itching could indicate issues with hygiene or even a potential infection. It’s essential to maintain proper hygiene in the perineal area, especially after bowel movements. If you are experiencing itching, it could be due to irritation or an infection, which may require treatment.

3. Pelvic Floor Health: After childbirth, the pelvic floor can be weakened, which may contribute to issues like incontinence or discomfort. Engaging in pelvic floor exercises, such as Kegel exercises, can help strengthen these muscles and improve symptoms over time.

4. Consultation with a Specialist: Given your ongoing symptoms, it would be wise to consult with a gynecologist or a pelvic floor specialist. They can perform a thorough examination to determine the extent of any tears, assess for any infections, and provide tailored advice for your recovery.

5. Pain Management: In the meantime, managing pain with over-the-counter medications, warm sitz baths, and topical anesthetics may provide some relief. However, these should not replace professional medical advice.

6. Addressing Other Conditions: You mentioned having some issues with hemorrhoids (痣瘡). While they can cause discomfort and may contribute to hygiene issues, they typically do not directly cause perineal tearing. However, if they are causing significant discomfort, they should also be addressed.

In summary, while some perineal tears can heal on their own, your ongoing pain and symptoms warrant a thorough evaluation by a healthcare professional. They can provide you with a comprehensive treatment plan that addresses both the pain and any underlying issues. Don’t hesitate to seek help, as postpartum recovery is crucial for your overall well-being and quality of life.