How to Take Care of Your Perineum After Giving Birth

Proper care of the perineum after childbirth is very important in order to avoid infection and to speed healing of the rectal and pelvic muscles. This area can be very sore, and cleaning and care can help relieve pain as well. Learn what to expect and how to treat common symptoms.

Pain and Swelling

You may notice some uncomfortable swelling and pain in this area due to the stretching required to deliver your baby. You may also have stitches; if so, your healthcare provider will give you instructions on caring for them.

Ice

To reduce swelling, you can use ice packs. Be sure to wrap the ice pack with a washcloth or other soft, absorbent material. Direct application of ice can damage tender tissue in this area if prolonged.

Sitz Baths

You can also take sitz baths. Your health care provider may have sent you home with a special tub made for this. If not, you can simulate this bath by sitting in a tub with two to three inches of warm water for about 15 minutes. If you notice a lot of pain while sitting in the bath, it may be helpful to sit on a doughnut pillow or towels rolled into a doughnut shape.

Pain Medication

Your health care provider may have prescribed pain medication. It's advisable to take this as directed. You can avoid the pain if you stay on top of your dosing (for example every 4 hours) rather than waiting until the pain starts again before taking another dose.

Some providers prescribe ibuprofen, which helps not only with pain relief but helps manage swelling. Continue taking this for as long as your provider has recommended, even if you aren't in pain.

Other Options

Other pain relief measures may include sprays like Dermoplast that you can apply after using the bathroom or changing a pad. Some providers also use a foam such as Epifoam to reduce swelling and itching if you've had stitches in the area.

Hemorrhoids

Hemorrhoids may occur directly after childbirth as a result of pushing or sometime afterward if your muscles have relaxed and you are having to push more when having a bowel movement. You can use cotton balls or pads soaked in witch hazel or use Tucks pads to help soothe burning or itching. Use these after you have thoroughly cleansed the area after a bowel movement.

If you are having trouble with constipation, try to make changes in your diet to include more grains and vegetables and be sure to drink plenty of water. Sometimes, a stool softener may be needed. Colace (or any stool softener containing docusate) is very gentle and recommended by many healthcare providers.

Discharge and Bleeding

You will have discharge and bleeding (also called lochia) for 4 to 6 weeks after giving birth. The changes in this discharge indicate the speed of your healing. Initially, the flow will be heavy and a dark red with some clotting. This should last three days.

After this, you will notice the flow slowing down and becoming lighter in color. By about the second week, the discharge turns from pink to a brown or yellowish color and the flow is very slight.

If you notice bright red bleeding, an increase in abdominal pain or if you have a fever, contact your healthcare provider immediately. If you are not breastfeeding, your period will return somewhere around 4 to 10 weeks and will likely be heavier than a normal period. This is not unusual.

Proper Perineal Cleansing

Make sure to follow any instructions given to you by your healthcare provider. It's important to clean your perineum carefully.

1. Always wash your hands before using the bathroom or changing pads.
2. Remove your old pad and dispose of it properly.
3. After using the toilet, spray or pour warm water over the entire vaginal area. Your health care provider may have provided you with a squirt bottle for this and may have also given you an antiseptic soap or solution to add to the water. If not, consider purchasing your own.
4. Gently pat the area dry with toilet paper, making sure to start at the front and end at the back to avoid spreading germs from the rectum to the vagina.
5. After drying the area, use any wipes, sprays or foams required to relieve pain and apply ice if necessary.
6. Place a clean pad in place securely and stand before flushing to avoid any of the water from the toilet from contacting your perineum.
7. Always wash your hands after caring for your perineum.

Tips and Warnings

• Do not use powders, perfumes, or lotions on your perineum unless directed.
• If you feel your stitches have not dissolved within 3 weeks or if the area of your stitches seems to be raw or irritated, contact your healthcare provider.
• If you notice prolonged itching or a very foul smell, contact your health care provider immediately.
• Perform Kegel exercises often to help strengthen the muscles in the pelvic floor.
• Take care of the temperature of water applied to your perineum. This area is tender and water that seems warm to your hand could be very painful to your perineum.
• Unless your doctor has advised you to do so, never use a douche or tampon. Most providers advise that nothing is placed inside the vagina until after your postpartum checkup.