How long does the perineum take to heal after birth?
The perineum is the area between the vaginal opening and the anus. During birth it stretches to its limit, so straight after the birth it is sore and swollen, even if it did not tear. According to mp.pl, healing after an episiotomy or tear is very individual and usually takes about 2-3 weeks. The NHS says stitches should heal within a month of the birth.
The sources differ in the details because they describe different things: the skin healing, the pain going away and the tissues fully recovering. The Royal College of Obstetricians and Gynaecologists (RCOG) writes that after any tear, pain or soreness can last 4-6 weeks, especially when walking and sitting, and that most tears heal within 6 weeks with no long-term problems. The table shows a typical course, not a fixed schedule.
| When | What usually happens | What to watch for |
|---|---|---|
| First days | The perineum is swollen and hurts most. Passing urine may sting, and many women feel anxious about the first trip to the toilet. | Pain relief, cooling and washing after every trip to the toilet. The first home visit from your POZ midwife within 48 hours of the birth being reported. |
| 1-3 weeks | The pain clearly eases and the stitches gradually dissolve. You may notice small threads on your pad. According to the RCOG the stitches can irritate during this time, and this is a normal part of healing. | According to the NHS, pain that lasts longer than 2-3 weeks is unusual and should be checked by a health professional. |
| About a month | According to the NHS the stitches should have healed by now. | Soreness when sitting or walking for longer may still be there, but it should not be getting worse. |
| 4-6 weeks | The postpartum period ends. According to the RCOG most tears heal by then with no long-term problems. | A visit to an obstetrician after the postpartum period. Mention any pain, trouble holding urine, wind or stool, and pain during sex. |
| Up to 3 months and beyond | After a third- or fourth-degree tear, the stitches around the anal sphincter can be felt for up to 3 months. | The RCOG advises seeing a doctor if symptoms after such a tear continue after 6 months. |
Perineal tears: what are the degrees and how do they differ from an episiotomy?
Perineal tears and grazes are very common. The NHS says up to 9 in 10 women having their first baby vaginally have some sort of tear, graze or episiotomy. Tears are described on a four-degree scale, and the degree determines how they are stitched and how long they take to heal.
| Type of injury | What it involves | How it is repaired |
|---|---|---|
| First-degree tear | Skin only, a small, superficial tear. | According to the RCOG it usually heals naturally. |
| Second-degree tear | Skin and the muscle of the perineum. | Usually needs stitches straight after the birth. |
| Third-degree tear | Extends into the muscle that closes the anus (the anal sphincter). | According to the RCOG, repair in the operating theatre under anaesthetic, then antibiotics, laxatives and a physiotherapy appointment. |
| Fourth-degree tear | Also involves the lining of the anus or rectum. | As for a third-degree tear. The RCOG also recommends a follow-up appointment at the hospital 6-12 weeks after the birth. |
| Episiotomy | A cut made by a midwife or doctor through the vaginal wall and perineum, usually diagonally to the side. | According to the NHS it is done under local anaesthetic and usually stitched within an hour of the birth. |
Third- and fourth-degree tears are less common. According to the RCOG they happen in about 3 in 100 women having a vaginal birth: 6 in 100 at a first birth and 2 in 100 if the woman has given birth vaginally before. The Polish perinatal care standard lists such a tear as a risk factor for complications that is also taken into account in the next pregnancy.
An episiotomy is not a routine procedure in Poland. The perinatal care standard states plainly that whoever attends the birth protects the perineum and uses an episiotomy only when it is medically justified. The NHS gives as examples a baby who needs to be born quickly, a forceps or ventouse birth, or a risk of a tear reaching the anus. The RCOG notes that an episiotomy can extend into a deeper tear. You can write down your preferences in your birth plan.
Stitches after birth: when do they dissolve?
The perineum is usually stitched with dissolvable stitches, so according to the NHS you do not need to go back to hospital to have them removed. An episiotomy is usually repaired within an hour of the birth. The stitches gradually soften and fall out, and you may notice small threads on your pad or in the shower. This is normal and does not mean the wound has opened.
After a third- or fourth-degree tear there are also stitches under the skin and around the anal sphincter. The RCOG says some of them can be felt for up to 3 months. According to the RCOG, irritation around the stitches while they heal is normal.
Before discharge, ask what kind of tear or episiotomy you have, what stitches were used and whether any need removing. If they do, your POZ midwife can do it at home: the perinatal care standard lists removing stitches from a perineal wound among her tasks during home visits (wizyty patronażowe).
How do I care for my perineum after birth?
What matters most is keeping it clean, dry and rested. The UK NICE postnatal care guideline recommends showering the perineum daily, changing sanitary pads often and washing your hands before and after doing this. The RCOG adds that you should wash the perineum with water only and not use any products on it.
- After every trip to the toilet, rinse your perineum with warm water, for example from a bottle or the shower.
- Wipe and dry from front to back, towards the anus, so you do not carry bacteria to the wound.
- Pat dry gently with a clean towel or a paper towel, without rubbing.
- Change your pads often, even before they are full.
- Wash your hands before and after changing a pad and after using the toilet.
- Let air get to the stitches: the NHS suggests lying on a towel without underwear for about 10 minutes once or twice a day.
- If passing urine stings, pour water over the area while you go, or try squatting rather than sitting.
Postpartum bleeding (lochia) lasts for several weeks, and it is the reason pads need changing often. How it changes over the weeks is described in our article on how long the postpartum period lasts.
How can I ease perineal pain and when can I sit down?
Perineal pain after birth is common, and after an episiotomy or tear it can be really troublesome. The NHS suggests ice wrapped in a towel, never directly on the skin. Of the painkillers, the NHS considers paracetamol safe while breastfeeding. Ibuprofen is also thought to be safe, but check with a doctor first, and avoid aspirin. Agree doses with a doctor or pharmacist.
No regulation or guideline sets a day from which you may sit after an episiotomy or tear. The RCOG writes that for several weeks pain is worse especially when sitting and walking, and some women find it hard to sit for long. So go by how you feel:
- Sit when it feels comfortable, and do not stay in one position for long. Change position, stand up and walk around the flat.
- You can lie on your side to feed. The RCOG suggests positions other than sitting and cold packs for women who find sitting painful.
- Rest lying down whenever you can, especially in the first days.
- Pelvic floor exercises, described below, help healing and reduce pressure on the wound, according to the NHS.
The pain should ease day by day. The NICE guideline points out that perineal pain that does not go away or gets worse in the first weeks is linked to a higher risk of long-term pain, problems with daily life and low mood. So tell your midwife if you need more and more painkillers or if sitting still hurts a lot after 2-3 weeks.
The first poo after birth: can the stitches come apart?
Many women dread their first bowel movement after the birth. The RCOG reassures that opening your bowels should not affect your stitches. What matters is that your stool is soft and that you do not have to strain hard.
- Drink plenty of water, the RCOG says at least 2 litres a day, and eat vegetables, fruit, cereals and wholemeal bread.
- Put your feet on a low stool so that your knees are higher than your hips, rest your elbows on your knees and take your time.
- Instead of straining, breathe deeply into your belly, pushing it outwards.
- Hold a clean pad against your perineum and press gently, the NHS says this eases pressure on the wound.
- If opening your bowels is very painful, ask your midwife, doctor or pharmacist about a stool softener. After a third- or fourth-degree tear such medicines are recommended as standard.
After a third- or fourth-degree tear, control of your bowels and wind may be weaker than before the birth for the first few days. If it lasts longer, or wind or stool comes out through the vagina, see a doctor urgently.
Which symptoms after an episiotomy or tear need help?
An infected perineal wound usually shows itself when the signs of healing get stronger instead of fading. The key question is: is it better or worse from one day to the next? If you are not sure which group your symptom belongs to, choose the more urgent one.
| What to do | Symptoms |
|---|---|
| Call 112 | Sudden, very heavy vaginal bleeding, especially with dizziness, weakness or fainting. Sudden shortness of breath or chest pain. |
| Go straight to the emergency department (SOR) or the admissions unit of a hospital with a maternity ward | Fever or shivering with pain in the perineum, lower abdomen or pelvis. Bad-smelling vaginal discharge with fever. A wound that has opened. Wind or stool coming out through the vagina. A painful swelling of one calf. |
| Call your midwife or doctor the same day | Redness and swelling of the perineum that are getting worse. Pus or other discharge from the wound. An unpleasant smell. Pain that does not go away or gets worse, and a growing need for painkillers. Bleeding from the wound. Trouble holding in wind or stool. |
| Ask at your next midwife visit | Irritation around the stitches, threads from the stitches on your pad, soreness when sitting that eases day by day, stinging when passing urine without fever. |
The NICE guideline recommends that a woman whose perineal wound has broken down is seen in hospital the same day. In the evening, at night and at weekends, do not wait for the midwife. Night and holiday healthcare (nocna i świąteczna opieka zdrowotna) runs Monday to Friday from 18:00 to 8:00 and around the clock on public holidays, and you can go to the SOR without a referral. We write more about warning signs after birth in our article on when to call the midwife and when to go to hospital.
When to do pelvic floor exercises and have sex again after an episiotomy?
The RCOG recommends starting pelvic floor exercises as soon as you can after the birth, because they strengthen the muscles around the vagina and anus and help healing. At first you may barely feel these muscles, but sensation should improve over time.
- How: according to the NHS, squeeze and draw in your bottom as if holding in wind, then the muscles around your vagina and urethra as if stopping the flow of urine.
- Long squeezes: hold for no longer than 10 seconds, then relax.
- Short squeezes: squeeze quickly and release straight away, until the muscles tire.
- How much: the NHS suggests building up to 10 repeats of each exercise at least 3 times a day. Breathe normally and do not pull in your stomach.
- After a third- or fourth-degree tear, the RCOG advises avoiding strenuous activity and heavy lifting for 4-6 weeks, then gradually increasing activity.
Tell your midwife or doctor about any leaking of urine, wind or stool. The perinatal care standard requires the POZ midwife to advise on preventing pelvic floor problems and, when a problem goes beyond her competence, to tell you about rehabilitation funded by the NFZ, which needs a referral from a doctor.
There is no set date for having sex again. The RCOG writes that you can when your stitches have healed, the bleeding has stopped and you feel ready. The NHS notes that pain during sex is very common in the first months after a tear or episiotomy and suggests a water-based lubricant, as the vagina can be drier while breastfeeding. If the pain continues, talk to a doctor or midwife. Remember contraception: according to the NHS you can get pregnant as early as 3 weeks after the birth, even while breastfeeding.
What does the POZ midwife check during home visits?
After discharge you are entitled to free home visits (wizyty patronażowe) from your POZ midwife (the primary care midwife funded by the public health fund, NFZ). The perinatal care standard provides for at least four visits, with the first within 48 hours (excluding Saturdays, Sundays and public holidays) of the birth being reported or of your discharge from hospital. Among other things, the midwife checks:
- how the perineal wound is healing,
- how the uterus is contracting and the postpartum bleeding,
- passing urine and stool,
- your breasts, nipples and feeding,
- your wellbeing and mood.
If needed, the midwife removes stitches from the perineum, teaches you postnatal exercises and advises you on caring for your pelvic floor. The NICE guideline recommends asking at every visit about pain that does not ease or gets worse, a growing need for painkillers, bad-smelling discharge, swelling and the wound opening, and if you have concerns you can ask for your perineum to be examined. Do not be shy about asking.
If you want more time or an extra visit, you can book a private postnatal home visit from a midwife. When the postpartum period ends, see an obstetrician for a check-up, and after a third- or fourth-degree tear also attend the follow-up appointment that the RCOG recommends 6-12 weeks after the birth.
Does perineal massage in pregnancy lower the risk of a tear?
Yes, though not equally for every woman. A Cochrane review covering almost 2,500 women found that perineal massage in the last weeks of pregnancy, done by the woman or her partner as little as once or twice a week from 35 weeks, reduces the risk of perineal trauma needing stitches and the risk of an episiotomy. The effect was seen in women who had not given birth vaginally before. The massage did not, however, reduce the rate of third- and fourth-degree tears.
The RCOG also suggests considering perineal massage from 35 weeks of pregnancy, especially before a first birth. You can ask a midwife about the technique, for example at antenatal classes. If you had a third- or fourth-degree tear, discuss the plan for your next birth with a doctor: according to the RCOG, the chance of a similar tear at the next vaginal birth is about 7-10 in 100.
