Written by Pradeep
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.
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.
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:
Recovering from an episiotomy can be quite painful, so you will be given pain relief options.
The doctor examines the tear area and assesses the degree of tear. Usually there are four degrees of ‘tear’ which are explained as follows:
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.
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:
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:
Painful stitches can be very distressing. Here are some easy tips that you should follow to soothe the painful area:
Following are some emergency situations that might require active interventions:
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.
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