While delivering a baby vaginally, women often get a tear in the area between the vaginal opening and the back passage(perineum). The perineum is the area between the vagina and the anus. Women who are having their first child through a vaginal delivery are more prone to tears. Almost nine out of ten mothers suffer from vaginal tears. This appears to be alarming but the best thing is that theses tears are minor, and some of them may not even need stitches. Coming to the degrees of tears, a third or a fourth degree tear is quite rare, but pretty painful. You may also experience bruising when your baby passes through the vaginal opening.
Why Are Perineal Stitches Required After Vaginal Birth?
When the baby passes through the vaginal passage he requires more space and can thus cause stretching of the perineum and tear of the same. Immediately after the delivery the perineal area is examined for tears and is taken care of. The doctor will ask you to put your legs in stirrups in the lithotomy position so as to enable him to see effectively. You might need a local anesthesia if your epidural is not effective anymore. Even at the slightest hint of pain, tell your doctor.
The torn area is stitched to keep infection at a bay. Stitches are also required if a cut is deliberately made on the perineum to facilitate delivery and to avoid irregular tears. This surgical deliberate cut is called episiotomy. One in seven mothers has an episiotomy while delivering normally.
Will I Need A Episiotomy?
As a procedure, episiotomy is only performed if there is a need for it, and your doctor is the best judge for it. Though not very common, about 1 in 7 women end up having an episiotomy during birth. When delivering vaginally, sometimes use of assisted birth instruments are required, like forceps or a ventouse. In such a scenario, your doctor will cut your perineum and facilitate the birth. The cut, by far, will take time to heal and is usually not offered unless:
- this is your first baby
- the baby needs to be born quickly and is in distress
- the baby is in a back to back position
- the baby weighs more than 4 kgs, macrosomia
- you need assisted birth tools for delivery
Recovering from an episiotomy can be quite painful, so you will be given pain relief options.
Degrees Of Perineal Tear After Childbirth
The doctor examines the tear area and assesses the degree of tear. Usually there are four degrees of ‘tear’ which are explained as follows:
- First-degree tear
This type of tear is small, skin-deep and generally heals without any stitches. They usually cause little or no discomfort, and are superficial. Because they involve the skin or the tissue of the vaginal outermost layer and the perineum, and no muscle they generally heal quickly
- Second-degree tear
This type of tear is deep and reaches up to the muscles. These tears are stitched, layer by layer, and closed. They will cause you some degree of discomfort and will heal in a few weeks. The stitches get dissolved in the process
- Third-degree tear
It is a deep and serious tear and involves skin and muscles of the perineal region. Sometimes, it can reach up to the muscles surrounding the anal or the rectum region. About 4% of women end up having a third degree tear and this will cause you considerable pain for many months and stitches are always required
- Fourth-degree tear
This type of tear is the most severe type and extends beyond the muscles of anus, going as far as your bowel. Stitches are always required in this case. Third and fourth degree tears put you at a risk of anal continence as well
Stitching the Perineal Tears
The doctor gives local anesthetic to the adjacent area and then very cautiously stitches the tear with running stitch in the same room if the tear is a small one. Strict asepsis is maintained. If your epidural is no longer effective, you will be given a local anesthetic to facilitate stitches.
Majority of the doctors are of the opinion that a tear should be sewn in continuous manner instead of interrupted way. These stitches are less painful and less uncomfortable afterwards. The stitches are self-soluble and do not require any removal afterwards.
In case of a severe third or fourth degree tear, the stitching is done in an operation theater. Spinal or epidural anesthetic is required as the pain is severe.
Catheter of fine tube is passed in the urinary bladder for collecting urine this is helpful in avoiding soiling of the perineum and keeps the area dry. Intravenous infusion is given to maintain the fluid balance. Antibiotics are given to speed up recovery and avoid super-added infection. Painkillers are given to ease off the pain. A lot of rest is advised to expedite the natural healing process. You must avoid sitting up for long periods for the next 24 hours.
Tips To Speed Up Healing Of Perineal Stitches
Perineal stitches can be painful, hence you need to be careful with them and make every effort to facilitate the healing process. Here are some tips to help in speedy healing of stitches:
- Keep the stitched area clean to avoid the threat of invading infection
- Take a daily bath and maintain good personal hygiene
- Wash your hands with a good antiseptic soap both before and after using the washroom
- Change sanitary pads regularly, preferably every time you use the loo
- Do pelvic exercises daily. This improves the blood circulation and expedites the process of healing
- Rest on bed and expose the stitched area to air for 10 minutes at least two or three times a day
- You should wear loose cotton knickers and do not wear tight skin-fitting trousers. Loose knickers facilitate the circulation of air
- Drink plenty of fluids every day; around 3 to 4 liters, fiber-rich foods e.g. brown rice, whole meal bread, vegetables and fruits. This will avoid constipation and will keep you healthy
- Antibiotics are administered for five days to keep you protected against infection. Laxatives are given to avoid constipation and straining of tender stitches
- Always pat yourself dry running from the front to the back and never the other way round. This will ensure that anal germs do not get into the vagina
- A sitz bath is can be taken after 24 hours post delivery
- Be very, very religious with Kegels, these will speed up healing, encourage stimulation and help get the muscles back in shape
Perineal Stitches Infection
After the perineal stitches, you might be advised a 5-day course of antibiotics to ward off any infection. Your doctor may also prescribe you some laxatives to make it easier for you to pass bowels. In case of severe tear, you will be advised not to strain the stitches, and you can ask your doctor for painkillers. Though paracetamol seems like a safe option, it is suggested that you get your painkillers prescribed by the doctor. Following signs indicate infection in the perineal stitches, so reach out your doctor immediately if:
- you are running a high fever
- you feel pain or redness at the site of incision
- the stitches have a foul smell, or a discharge
- you notice bleeding from the incision
- you leak your bowels when passing air
Tips For Soothing The Tender Perineum Region
Painful stitches can be very distressing. Here are some easy tips that you should follow to soothe the painful area:
- Apply a frozen pack or cold gel pad on the perineum. Wrap the pack in clean flannel to safeguard. Do not keep if for too long. Apply the pack twice a day
- Whenever you pee, pour a jug of lukewarm water over the perineal region. This is helpful in diluting wee, mitigating the sting and will keep the perineal region clean
- Never use tampons till your stitches have healed
- Consult your doctor if pain or swelling persists
- Use cushions to sit on as sitting and be painful for you
- Take painkillers such as paracetamol to ease perineal pain. You can also have ibuprofen if pain is severe. Remember to consult your doctor before taking any painkillers
- Keep the perineum clean and dry
Dire Emergency Conditions Of Perineal Stitches
Following are some emergency situations that might require active interventions:
- If the stitches become smelly and painful-this is indicative of infection
- Difficulty in controlling stools
- Pain in passing wind
- Pain in passing urine
- Smelly discharge coming out of the stitches
- If you experience a stinging and intense pain
- Passing urine again and again
- Pain in lower abdomen and around the perineum region
- If you are having high temperature with chills
- If you are passing clots or lochia from the vagina
When Will Perineal Stitches Dissolve?
Perineal stitches healing will depend on the kind of tears you have had. Simply put, the deeper the cut, the longer it takes to heal. First degree perineal stitches dissolve by 2-3 weeks, whereas more severe stitches take around 6 weeks, though some discomfort may prevail for weeks and even months together. Normally with the healing of stitches the pain subsides. But some women experience long term pain in the perineal region. They often complaint of pain around perineum, while passing stools or having sex. This can be prevented by practicing pelvic floor exercises. If you still have pain and discomfort immediately consult your doctor for further treatment.