Pain and Swelling
You may notice some uncomfortable swelling and pain in this area due to the stretching required to deliver your baby. 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. 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 2-3 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.
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, so you should take continue taking this as long as your provider has recommended, even if you aren't in pain.
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 may occur directly after childbirth as a result of pushing or some time afterward if your muscles have relaxed and you are having to push more during elimination. 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 health care providers.
Discharge and Bleeding
You will have discharge and bleeding (also called lochia) for about 4 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 about 3-6 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 a large increase in discharge, chances are you should decrease your activity level. Try to get some rest, nurse your baby or massage your abdomen to decrease the flow. If you notice bright red bleeding, an increase in abdominal pain or if you have a fever, contact your health care 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.
Make sure to follow any instructions given to you by your health care provider. Here are some steps to proper perineal cleansing:
- Always wash your hands before using the bathroom or changing pads.
- Remove your old pad and dispose of it properly.
- After using the bathroom, spray or pour warm water over the entire vaginal area. Your health care provider may have provided you with a spray bottle for this and may have also given you an antiseptic soap or solution to add to the water.
- 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 your vagina.
- After drying the area, use any wipes, sprays or foams required to relieve pain and apply ice pack if necessary.
- Place a clean pad in place securely and stand before flushing to avoid any of the water from the toilet from contacting your perineum.
- Always wash your hands after caring for your perineum.
Tips and Warnings
- Take care with 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 be placed inside the vagina until after your postpartum checkup.
- If you notice prolonged itching or a very foul smell, contact your health care provider immediately.
- 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 health care provider.
- Perform Kegel Exercises often to help strengthen the muscles in the pelvic floor.