Coping with perineal pain and discomfort following childbirth
Is it normal to feel like this?
Having a baby is rather like running a marathon… joy and elation at crossing the finishing line… culminating in the safe arrival of your gorgeous new baby as well as, feelings of utter physical and emotional exhaustion including aches and pains in places you’d never believed possible!
In the hours immediately following the birth, everything ‘down there’ can feel very different. This is perfectly normal because your muscles and soft tissues have had to stretch significantly to allow your baby’s passage down through the birth canal. If your baby was born using forceps or the ventouse (suction apparatus), you may have had an episiotomy (a cut made at the opening of the vagina during childbirth to help you give birth), or you’ve torn and needed to have stitches (also called sutures), then your perineum (the area of skin between your vagina (birth canal) and your anus (back passage)), is likely to feel very strained, tender, bruised and swollen.
If you had an epidural or spinal for labour and/or your baby’s birth (also called regional anaesthetic), you would have had painkilling drugs passed into the small of your back through a fine catheter (tube)to block the pain; these anaesthetic drugs leave you feeling ‘numb’ for a few hours after the birth. However, if you were given local anaesthetic for an episiotomy or stitches, this is shorter-acting and sensation returns much sooner.
Don’t worry, these aches and pains will subside and in the days and weeks following your baby’s birth things should return to pretty much how they were. There is actually a very rich blood supply to this part of your body, which means that any bruising, swelling or tears usually heal very quickly. There are however, some simple measures that you can also take to help aid the healing process:
Coping with a swollen perineum
Most perineal swelling after childbirth tends to resolve within 24-48 hours. The area around the birth canal (vulva and perineum) can look very bruised and swollen soon after childbirth, but this swelling should be soft when gently touched. If on rare occasions, the swelling is causing you severe pain and is hard and shiny, it might be a rarer condition called a vulval haematoma – this is a large collection of blood, rather like a massive bruise. It is very important that you tell your midwife or doctor if you have any worries about the extent of the pain you are feeling; they can check you over and organise treatment and adequate pain relief.
It is best to try and relieve any pressure on your swollen perineum, by avoiding sitting for long periods at a time. You may find it more comfortable to lie down or to lie on your side; this might include when you are breastfeeding your baby. There are also specialist cushions available from maternity shops and websites. These products have been designed to support your buttocks (bottom) while ensuring there is no pressure against your perineum or stitches. However, you can easily make your own DIY cushion by rolling a large bath towel or sheet into a cigar-shape and then positioning it on the surface of a chair in the shape of a horseshoe with the gap at the front. When you sit down the towel will act as a support in keeping pressure away from your perineum.
You might also consider applying cooling gel pads, which can be stored in the fridge and then applied for short periods to the area of swelling. However, the use of ice packs should be avoided as research has shown that these can actually delay the healing process. This is because the blood vessels that are needed for healing become narrower reducing the flow of blood when they are exposed to cold temperatures; subsequently, there isn’t such a healthy blood supply to the area.
Your perineal stitches (sutures) are dissolvable, which means you don’t have to have them taken out. They dissolve under the skin, but sometimes, you might find that a small piece of suture material comes away and you might notice it in your pants. You may also notice around the 5th day postnatal that the area around your stitches feels tighter. This is a normal sensation and is part of the healing process; it should ease off again. However, if you are at all concerned, speak with your midwife or GP who can check that all is as it should be.
Feeling sore and uncomfortable in such an intimate area isn’t pleasant and can make walking, sitting or changing position rather a challenge. However, as previously mentioned, everything heals quickly and within 24-48 hours, you should start to feel more comfortable. In the interim taking a couple of Paracetamol 4-6 hourly (to a maximum of 8 tablets in 24 hours) can help to ease discomfort. It can be helpful to take these at regular intervals to stay on top of any pain and discomfort. If you are breastfeeding your baby, Paracetamol is perfectly safe to use, but there are be some pain killers that should be avoided as they are excreted through your breast milk and are unsuitable for babies. Your midwife, GP or local pharmacist will be able to advise you about pain relief options.
A warm soak in the bath can also be very soothing and you may wish to consider adding a few drops of Tea Tree oil and a few drops of Lavender oil to the bath water to help relieve discomfort and promote healing. However, it is always advisable to speak with your local pharmacist or a trained homoeopathist to ensure their suitability before using them. Initially, it is also advisable to avoid using strongly scented bath products, feminine deodorants, perfumes, powders or lotions, as these might cause irritation to the area around your stitches. If you feel that you need stronger pain relief, it is important that you don’t suffer in silence and contact your midwife or GP; they can check that your perineum is healing as it should be. They can also review your medication and organise stronger pain relief for you; some pain relieving drugs also contain anti-inflammatories which have the added benefit of reducing inflammation/swelling as well as easing pain and discomfort.
Keeping the area clean and dry
Maintaining good standards of hygiene is an important part of the healing process. You should be looking to replace your maternity/sanitary pads every 3-4 hours or sooner if your postnatal blood loss (‘lochia’) is heavier. NB. Never use tampons or douche (unless medically directed) as these could easily introduce infection into your vagina and uterus (womb)! Keeping the area clean and dry will promote healing, so a bath or shower in the morning and another in the evening is always a good idea. Be careful with the temperature of the water though; your perineum is a sensitive area and if you have stitches, water that is warm to the hand can feel a lot hotter. When drying your perineum always make sure that you gently pat the area dry and don’t rub or pull the area around your stitches, as this could cause pain and irritation. Start at the front where you pass urine and work your way backward towards your anus, as this prevents germs being introduced from your back passage into your vagina. Wearing underwear made from natural fibres, ie cotton, are always ideal because they help keep the area cool and allow the skin to breathe; whereas manmade fibres tend to have the opposite effect.
NB. Should you notice that your lochia has an offensive odour (has become smelly), is heavier or has turned ‘red’ again, you have abdominal discomfort/pain or you are feeling unwell, please tell your midwife or GP so that they can check you over and make sure you haven’t developed an infection.
Urine is acidic, so when it comes into contact with broken skin eg from a graze perineal tear, laceration or episiotomy, it will inevitably cause ‘stinging’. For many mums their first ‘wee’ after giving birth is viewed with trepidation; however, there are some simple steps that can help to ease any discomfort.
Firstly, drink plenty of water… we should all be drinking around 2 L of fluid daily, as this helps to flush out our kidneys and clear the toxins from our body. If you drink plenty of fluids, your urine will be more diluted and less acidic. The midwife may also suggest that you do your first ‘wee’ in the bath; this is because warm water is very soothing, helps you to relax better and as the urine leaves your body it is immediately diluted, so… very little, if any stinging. You just need to make sure that somebody is on hand to give the bath a clean afterwards! Alternatively, you may prefer to pour water over your genitals and perineum while passing urine? This follows the same principle but on a much smaller scale; a plastic jug or a shower attachment are both suitable for the job! Similarly, if you lean forwards when sitting on the toilet, this can help you to empty your bladder properly and can also help with the direction and flow of urine. This can be particularly useful in the early hours immediately following the birth when everything can feel very numb and unfamiliar.
Having your bowels open
Many new mums are often worried that their stitches might burst when they have their bowels open for the first time. Pleased be reassured this is extremely unlikely! In 25 years of midwifery we have never seen a single case. Sometimes, trauma to the perineum caused by the birth can make it difficult for women to control their bowels and ‘wind’ (flatus). This usually resolves pretty quickly as things heal and your muscle tone returns. However, if this isn’t the case and the problem persists, it is very important that you let your health care professional know. Your GP, midwife or health visitor will understand, be sensitive and discreet; they can advise and support you, and ensure that you are referred for specialist follow-up care if this is indicated.
Constipation during pregnancy and in the postnatal period is very common, especially if you are taking iron tablets (called Ferrous Sulphate); however, drinking plenty of fluids and having a high fibre diet can all help to get things moving again! The skin and muscles of your perineum are strong and flexible, which is why women are able to give birth; however, the muscles around your back passage are very different to those around the vagina, so passing a stool (having a poo) is not the same as having a baby. If you are feeling uncomfortable and remain constipated, see your midwife, GP or Health Visitor for advice. They can organise medications that are designed to soften stools and encourage you to have your bowels open, for example, Lactulose, Fybogel, suppositories or an enema.
Haemorrhoids (also called ‘piles’) are basically, varicose veins in your rectum (back passage). They are very common in pregnancy and caused by the action of the pregnancy hormones and the pressure of your pregnant uterus on the blood vessels in your pelvis. Sometimes they are visible as small lumps during later pregnancy; at other times they can occur directly following childbirth as a result of all the pushing needed to birth your baby. Alternatively, they can develop at a later time because of poor muscle tone and women having to push more to have their bowels open post birth. In the majority of cases, haemorrhoids will shrink and disappear as your body returns to its pre-pregnancy state. However, if you are finding your haemorrhoids painful or itchy, your midwife, GP or health visitor can organise treatment with an ointment or cream that is specifically designed to reduce the swelling and relieve discomfort.
Pelvic floor exercises
When you’re feeling exhausted from your baby’s birth, postnatal exercises are probably the last thing on your mind. However, we can’t stress strongly enough how very important pelvic floor exercises are in promoting healing and regaining tone in the muscles that have been weakened by childbirth. Your pelvic floor extends like a sling from the pubic bone at the front to the base of your spine at the back; they support your pelvic organs, including your bladder and urethra (the small opening where your urine comes out). Looking after your muscle tone now and working to regain muscle strength is very important in helping you to avoid stress incontinence – this is when you leak urine if you cough, laugh or sneeze. Pelvic floor exercises are also important in helping you to control wind and bowel motions; strong pelvic muscles can also increase your sensitivity during sexual intercourse and enhance orgasms.
They are very simple to do… they don’t require a gym membership or expensive sports equipment either. In fact, people won’t even know that you are doing them!
How to do pelvic floor exercises
a). Sit comfortably
b). Squeeze the muscles that you use to stop yourself passing urine; this action pulls the vagina and rectum upwards and backwards
c). Hold for up to 10 seconds and then release
d). You may feel that you want to instinctively hold your breath while tightening your muscles; however, it is important that you breathe regularly throughout
e). Aim to do around 50 pelvic floor exercises a day; perhaps five sets of 10 pelvic floor exercises ensuring that you rest in between each set. You can do these whilst feeding your baby or watching the TV.
f). You should not contract any other muscles at the same time eg your stomach, thighs, or the muscles of your buttocks
After a few months you should start to notice an improvement in your muscle tone; you should carry on doing pelvic floor exercises even when things have improved.
Because of the changes to the way postnatal care is now provided, you are less likely to have regular home visits from your midwife and will be asked to attend postnatal clinics instead. These are a good opportunity to check that you and your baby are recovering well from the birth and that feeding, whether breast or formula, is going well. You are the one person who knows your body better than anyone else, so should something not feel right, always speak to your health care professional and get yourself checked out. Similarly, if after a few weeks, you find that not all your stitches have dissolved and are causing irritation, you can always arrange to see your midwife and get them removed.