Caring for Your Perineum after You Give Birth


After you give birth, your perineum (the area between your vaginal opening and your anus) can feel sore and tender for a couple of weeks. This is especially true if you had stitches. Even without stitches, your perineum may be swollen and sore. Most women feel much better about 3 weeks after birth. Here are some tips to help you feel better sooner and prevent any problems or complications.

How can I help my perineum heal?

  • Sitz Baths — Fill your tub with about 6 inches of warm water and sit in the tub for 10 to 15 minutes at least 2 to 3 times each day. The warm water increases the flow of blood to the perineum, which helps the area heal.
  • Rosemary Tea — Make a tea with dried rosemary leaves by pouring very hot water over about 3 tablespoons of the leaves. You can buy these leaves in bulk at many grocery stores. Add the strained tea to the water when you take your sitz bath. Rosemary may help women heal faster, and it smells very nice.
  • Kegels — Do Kegel exercises (tightening the muscles of your perineum as if you were trying to stop urinating) often during the day. Kegel exercises also increase the flow of blood to the perineum.
  • Numbing Spray — You may have been given a small can of numbing spray for your perineum. You can spray it on your perineum to help with the pain. If you did not get the spray, call your provider and ask for a prescription for numbing spray (lidocaine).
  • Arnica — Arnica is a homeopathic treatment. It may help with swelling and bruising. You can buy Arnica pills at most health food stores. Place 2 to 3 of the tiny pills under your tongue 3 to 4 times a day and let them dissolve. They are safe to use when breastfeeding.
  • Fresh Air — When you are lying down to rest or breastfeed, take your underwear off so the perineum is exposed to fresh air. The area will heal faster if it is dry and warm, which is hard to do when wearing a pad to collect any vaginal bleeding or discharge.

I am constipated. What should I do?

  • Water — You need to drink at least 6 big glasses of water a day to keep from getting constipated. This is especially true if you are breastfeeding.
  • High-fiber diet — Eating lots of fruits and vegetables, salads, brown rice, dried fruits (like prunes and figs), and yogurt will help you avoid constipation.
  • Stool softener — You may be given a stool softener medication by your provider. You can buy more in any pharmacy without a prescription. Look for docusate (Colace), and take 1 to 2 each day until your stools are soft.
  • The first bowel movement — The first bowel movement is not going to hurt as much as you think it will. Don't wait or avoid it, because holding the stool in will make it harder and more difficult to push out. When you feel like you can have a bowel movement, go into the bathroom and make a big ball of toilet paper. While you bear down to have a bowel movement, push up against your perineum in front of the anus with the toilet paper. This will support the area that hurts and any stitches so they don't pull. You might urinate on your hand, but you will have a bowel movement without putting painful pressure on your perineum!

It really stings when I urinate. Is that normal?

If you have stitches or even small tears, you can have burning and stinging when you urinate. Get a plastic bottle with a spray top and fill it with warm water before you urinate. Spray the warm water on your perineum while you urinate. This will dilute your urine and make urinating more comfortable. If you feel pain inside your body or need to urinate more often or can only urinate small amounts, be sure to call your provider. You might have an infection.

I think I have hemorrhoids. What can I do?

  • Avoid constipation.
  • Use over-the-counter ointments such as Preparation H or Anusol.
  • Use witch hazel (Tucks) pads. Witch hazel pads can be found in the drugstore. They are great to wipe with after you have a bowel movement. You can make your own pads by soaking cotton balls in regular witch hazel (very cheap and available in all drugstores). Witch hazel helps swollen tissue get back to normal.
  • Your hemorrhoids will shrink and stop being painful, but they will not ever go away completely.

When should I call my health care provider?

  • Fever — If you get a fever of more than 100°F, call your provider.
  • Increasing pain — You should be feeling a little better every day. If you have a big increase in the pain in your vagina or perineum or rectum, call your provider.
  • Bleeding — You can expect your bleeding to be bright red for 3 to 4 days after giving birth. You may pass a few clots in the first 3 to 4 days, especially when getting up or after breastfeeding. Then the bleeding will become more yellowish and light red and may be very strong smelling for about 10 days. Then it will become light red or pink spotting for several weeks. You may have a burst of bright red bleeding 10 to 14 days after giving birth when the placenta site heals. As long as it lasts for less than a day and tapers off, that is okay. If you have bright red blood that soaks more than 2 pads an hour and continues for more than 2 hours or if you pass several clots, call your provider.
  • Odor — Your discharge will smell pretty strong for several weeks. This is normal. If the smell gets stronger rather than less strong or starts to smell like fish, call your provider.

Remember, this is going to get better!

This page may be reproduced for noncommercial use by health care professionals to share with clients. Any other reproduction is subject to the Journal of Midwifery & Women's Health's approval. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, the Journal of Midwifery & Women's Health suggests that you consult your health care provider.

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