Perineal Tear: Healing, Recovery, and When to Call Your Doctor

If you had a perineal tear during childbirth, you may wonder how long you’ll be sore and what you can do to make recovery easier. You may also worry about your stitches or wonder which symptoms aren’t part of normal healing.

A perineal tear affects the tissue between the vaginal opening and anus. Doctors group these tears into four degrees based on how deep they are:

First-degree: The tear involves the skin.
Second-degree: The tear extends into the muscles of the perineum.
Third-degree: The tear reaches the anal sphincter, the muscle that helps control bowel movements.
Fourth-degree: The tear extends through the anal sphincter and into the lining of the anus or rectum.

Some first-degree tears can heal without stitches, while second-degree tears usually require them. Third- and fourth-degree tears, also called obstetric anal sphincter injuries, need more extensive repair.

What Does Normal Healing Feel Like?

Soreness and tenderness are normal after a perineal tear. You may be uncomfortable when sitting, walking, getting out of bed, or urinating. The discomfort should gradually improve as you heal.

Stitches used to repair a perineal tear dissolve on their own and don’t need to be removed.

A deeper tear can take longer to heal because both skin and muscle need to recover. The area may continue to feel tender or tight as scar tissue forms.

What Helps With Pain and Swelling?

Cold therapy can reduce pain and swelling during the first few days after delivery. You can place an ice pack or cold gel pack wrapped in cloth over the perineum for about 10 to 20 minutes at a time.

Other ways to stay more comfortable include:

Taking ibuprofen or another pain reliever recommended by your doctor
Using a cushion if sitting puts pressure on the sore area
Soaking in a warm sitz bath
Using a squeeze bottle filled with lukewarm water while you urinate to reduce stinging

How Should You Care for the Stitches?

Keep the area clean with water and allow it to dry. Change sanitary pads regularly, and wash your hands before and after using the bathroom or changing a pad.

What About Bowel Movements?

You may be nervous about your first bowel movement after a perineal tear. A normal bowel movement shouldn’t cause your repaired stitches to come apart.

Soft stools can make bowel movements easier and reduce straining. Drink plenty of water and eat fiber-rich foods such as fruits, vegetables, and whole grains.

If you had a third- or fourth-degree tear, your doctor may prescribe a stool softener or laxative for a short time while the anal sphincter heals.

When Can You Exercise Again?

You can start with light activity when you feel comfortable. Pelvic floor exercises can also strengthen the muscles surrounding the vagina and anus as you recover.

If you had a deeper tear, your doctor may recommend pelvic floor physical therapy. You may also need to avoid strenuous activity for several weeks and slowly increase your activity as you heal.

When Can You Have Sex After a Perineal Tear?

It’s normal to feel nervous about having sex again after a perineal tear. Give your body time to heal and wait until postpartum bleeding has stopped and you feel ready.

Tenderness or vaginal dryness can make sex uncomfortable at first, especially if you’re breastfeeding. Talk with your doctor during your postpartum visit if you have questions or continue to have pain.

When Should You Call Your Doctor?

Your soreness should gradually improve. Contact your doctor if you notice:

Pain that gets worse instead of better
Increasing redness or swelling
Pus, unusual discharge, or an unpleasant odor
Fever or feeling generally unwell
New bleeding from the wound
An opening or gap where the tear was repaired
Trouble controlling gas or bowel movements
Pain during sex that doesn’t improve

Passing stool or gas through the vagina isn’t part of normal healing. Contact your doctor right away if this happens.

Get Help With Perineal Tear Recovery

Most perineal tears heal without long-term problems, but recovery takes time. Pain, swelling, and tenderness should improve rather than get worse.

If you’re concerned about a perineal tear or how you’re healing after childbirth, don’t wait to ask for help. Contact Women’s Health Center of Southern Oregon for postpartum care in Grants Pass. We also provide gynecology services in Ashland, Oregon.