Stitches, pain and bruising after birth (2023)

Perineal stitches after a tear or episiotomy (where your doctor or midwife makes a cut) are common if you have a vaginal birth, as are grazes and bruises. Most women heal quickly and there are lots of things you can do at home to ease the pain and help your recovery. Stitches and grazes can be incredibly uncomfortable and you might be worried about everyday activities like going to the toilet. Find out what easy tips you can try to soothe swelling and bruising, how to care for stitches and what signs of infection to look out for.

How common are perineal tears, cuts and bruises during birth?

Very common. The area between the opening to your vagina and your anus (perineum) has to stretch a lot when you give birth vaginally (NHS 2018c).

It’s quite likely to tear or graze a little as you push your baby out, especially if you’re a first-time mum. Sometimes your midwife needs to make a small cut to the perineum (an episiotomy), to help your baby out.

You may be more prone to having a severe tear if:

• it's the first baby you've had vaginally (RCOG 2020). Nine out of 10 first-time mums who have a vaginal birth have a tear, graze or cut, so it's very common (CUH/NHS 2017, NHS 2020)
• the pushing stage of your labour goes on for longer than expected (RCOG 2020)
• one of your baby’s shoulders becomes stuck behind your pubic bone (shoulder dystocia) during birth (RCOG 2020)
• your baby weighs more than 4kg (8lb 13oz) (RCOG 2020)
• you have an assisted birth, where your baby is born with the help of forceps or ventouse (RCOG 2020)
• you've had a third-degree or fourth-degree tear before (RCOG 2020)
• your baby is born in a back-to-back position (Smith et al 2013)

Having an epidural is unlikely to influence whether or not you tear (Zhou et al 2017).

Find out more about why perineal tears and episiotomy cuts happen during childbirth, different types of tears and the stitching you might get after a tear.

How long will my perineal bruises and stitches take to heal after birth?

Healing time and recovery from pain depends on the severity of the tear (OUH/NHS 2017). Most tears or episiotomies heal well, although it’s normal to feel pain for two to three weeks. Your stitches will dissolve, and you should heal within a month of your baby's birth (NHS 2018a, NHS 2020).

As well as having a tear, or needing a cut, you're likely to have bruising and swelling in and around your vagina (NHS 2018c). If you had an assisted birth, the forceps or ventouse may leave you with big bruises (Hayman 2014). Bruising usually gets better within a few days.

What things can I do at home to ease perineal pain from tears, stitches and bruises?

There are lots of things you can do to feel more comfortable during the healing process. Most importantly, take it easy. If you’ve had stitches, you will need lots of rest for the first 24 hours after they are put in. Lie down on your side rather than sit, as sitting puts pressure on your stitches (NHS 2018c) .

And try these tips at home:

Keep your wound cool

Put something cool such as a cold gel pad, a frozen pack of peas or ice cubes wrapped in a towel, on your perineum (NHS 2020). This may help to reduce the swelling in the first two or three days (NHS 2020, OUH/NHS 2017) and soothe itchy stitches. Try lying on your side with the pack between your legs. Wrap the pad or pack in a clean flannel to protect your skin, and don't leave it on for longer than half an hour. Wait an hour before re-applying it.

Sit more comfortably

If it's uncomfortable to sit, use a doughnut-shaped cushion (NHS 2020) or a Valley Cushion. This is a specially designed cushion that has two airbags that inflate to support your buttocks and relieve pressure on your wound. Valley cushions and other pressure support cushions are available to hire or buy.

Have a warm bath

As things ease, you can have a warm bath, perhaps adding a few drops of lavender oil, chamomile or tea tree oil to the water (OUH/NHS 2017).

There's little evidence that warm baths or essential oils help with healing, but they can be soothing. Sit in the water for about 20 minutes, twice a day. Pat your stitches dry with a clean, soft towel (OUH/NHS 2017).

Take painkillers

Try paracetamol first as it may help with the pain (NICE 2015, NHS 2020, OUH/NHS 2017). If it doesn’t work for you, ibuprofen can be useful for reducing inflammation, but don’t use it if you have a stomach ulcer or asthma that gets worse with ibuprofen (NHS 2018b).

Your doctor may prescribe more powerful painkillers if paracetamol or ibuprofen aren't enough for you (NHS 2020).

There's no evidence that witch hazel helps with irritation or swelling (OUH/NHS 2017), but it won’t do any harm and some mums swear by it.

If you want to try it, make a witch hazel compress by sprinkling witch hazel onto a maternity pad and putting it in the freezer. When you take it out, give it a minute, then press it onto your perineum to get relief. Or you could dab witch hazel straight onto your stitches with a cotton pad. Make sure you wash your hands thoroughly, before and after. Or you could add it to your bath (OUH/NHS 2017).

How can I make going to the toilet less painful after childbirth if I have stitches?

Use warm water to dilute your wee

Pour warm water over the area while you wee (NHS 2020). Use a clean jug, or a thoroughly washed plastic squeezy bottle. The warm water will dilute your wee, reduce the sting, and keep your perineal area clean (NHS 2020). Gently dab your stitches dry with toilet paper, from front to back.

Don't use a hairdryer to dry yourself off. Using a hairdryer can delay healing (OUH/NHS 2017).

Prevent constipation

Drink plenty of water every day (two litres if you can), and eat fibre-rich foods, such as wholemeal bread, brown rice, and fruit and vegetables, to help prevent constipation (RCOG 2020). Your midwife may also give you stool softeners to make it easier for you to poo without straining your stitches (RCOG 2015).

Prop your feet up

When you are pooing, it can help to put your feet on a footstool and to press a clean pad against the cut to relieve the pressure (NHS 2020, RCOG 2020).

How can I help the stitches in my perineum to heal after I’ve given birth?

Making sure your stitches are clean will help them to heal as well as reduce the risk of infection (RCOG 2020). Try these self-care tips:

• Have a shower or bath at least once a day (NHS 2018a, RCOG 2020).
• Change your maternity pad regularly, and wash your hands before and after you do it (RCOG 2020).
• Keep an eye on your wound. You can check your perineum with a hand mirror to see how well it's healing (QG 2012).
• Keep doing your pelvic floor exercises, as this will help with healing, improve circulation to the area, and prevent leaking from your bowel or bladder (QG 2012, RCOG 2020).
• Expose your stitches to the air. Take off your pants and lie down for 10 minutes, twice a day. Put a clean towel underneath you to protect your bed linen or sofa (NHS 2020).
• Wear loose clothes so the air can circulate round your wound (OUH/NHS 2017).

If you had a severe tear, your obstetrician will advise you to take a course of antibiotics to guard against infection (RCOG 2020) and your tear will also be checked at around six weeks after birth to make sure it’s healing as it should.

What are the signs I might have infected stitches and when should I see a doctor?

You'll see your GP or practice nurse for your postnatal check about six to eight weeks after the birth. By then, you should be recovering well (NHS 2020).

However, make an appointment with your doctor sooner than your postnatal check-up if:

• Your stitches become more painful or smelly, as you may have an infection (RCOG 2020).
• You had a first or second degree tear but you have to rush to the toilet to poo (RCOG 2020).
• You leak a little poo when you pass wind (RCOG 2020).
• Weeing gives you a burning or intense stinging pain, and you need to go more often (RCOG 2020).
• You have a high temperature. A high temperature is 38.5 degrees C or more in the first 24 hours after you've given birth, or 38 degrees C or more for at least four hours (Dalton and Castillo 2014).
• You have a severe pain in your lower tummy, or around your perineum (NICE 2015).
• You have any other worries or concerns (NICE 2015).

It's natural to worry about sex if you've had stitches and bruising (RCOG 2020). If the thought of having sex again makes you feel anxious, talk to your doctor or health visitor. Share your feelings with your partner, too.

Will my perineal stitches cause problems in the future?

Most women have no long-term problems, even if they’ve had a severe tear. A very small number of women may continue to have perineal pain or problems controlling when they poo. Physiotherapy or surgery can help with this (RCOG 2020).

These problems are not a natural consequence of giving birth, or just part of being a mum, so you don't have to put up with them.

If you have longer-term problems with controlling wee or poo, or sex remains painful, ask your doctor for help. You may need to be referred to a women's health physiotherapist for pelvic floor rehabilitation, or a specialist continence unit. With the right treatment, most problems caused by a tear or episiotomy can be helped or cured (RCOG 2020).

Can I avoid having stitches next time I give birth?

It's hard to say, because every labour is different, and there's no clear answer about the best way to avoid the most serious tears (Aasheim et al 2017).

However, massaging your perineum daily in the weeks before your due date may help it to stretch better during the birth (Aasheim et al 2017, Beckmann and Stock 2013, NHS 2020, QG 2012). Often, this involves inserting one or two fingers into your vagina and applying downward pressure towards the perineum (NHS 2020).

It's also possible that using a warm compress on your perineum during labour may mean you're less likely to need stitches (Aasheim et al 2017).

Worried about having sex with stitches after an episiotomy or tear? Read our advice about sex after the birth.

Learn more about your pelvic floor after the birth, or watch our video to discover how other mums relieved the discomfort of tearing.