How to Care for a Perineal Incision

A perineal incision is a small cut made at the base of the pelvis, in the area between the anus and the genital region. This procedure is performed on pregnant women to make childbirth easier by facilitating the delivery of the baby. The pelvic floor is often damp and enclosed, which can lead to infections or slow healing of the wound. However, there are simple steps you can take to minimize infection risk, reduce discomfort, and manage pain.

Consult your doctor about the appropriate pain medications you can take. Many medications may not be suitable for breastfeeding women because they can pass into breast milk, so it's essential to seek your doctor's advice on safe pain relief options after this procedure.

• Paracetamol is often recommended for breastfeeding mothers who need pain relief after a perineal incision surgery.

Place an ice pack on the bottom of the basin while you are resting. Applying cold compresses after surgery helps reduce swelling and pain. Wrap the ice pack in a towel before positioning it between your legs while lying flat on the bed or reclining on a chair.

• Avoid applying the cold for more than 15 minutes at a time, and occasionally take a break to prevent your skin from getting too cold.

Squeeze your glutes while sitting. Tightening your glutes helps gather the tissue around the pelvic floor, preventing the stitches from stretching or becoming strained.

• Sitting on a cushion or pillow can also relieve pressure and reduce pain in the pelvic area.

Consult your doctor about a sitz bath. Depending on your condition, your doctor will advise whether a sitz bath should be used daily. A sitz bath can help alleviate pain, swelling, and bruising around the incision site.

• Fill the basin with warm or cool water. Warm water promotes blood circulation, providing comfort, while cool water offers quicker pain relief.
• Sit in the bath for about 20 minutes.

Spray water on the stitches while urinating to avoid discomfort from the incision. Urine can irritate the surgical site, increasing the risk of infection.

• To minimize discomfort and keep the area clean, use a sprayer to rinse the stitches while urinating. After you finish, continue spraying for a while to thoroughly cleanse the wound.

Apply pressure to the wound while having a bowel movement. After childbirth surgery, having a bowel movement can be difficult. To ease this process, press a clean sanitary pad against the pelvic floor while straining, which can reduce pain and discomfort.

• Discard the used pad after each session and use a fresh one for every bowel movement.

Reduce the risk of constipation. Constipation puts extra pressure on the pelvic floor during bowel movements, which can cause the incision to stretch and result in pain. To lower the risk of constipation, drink plenty of water, consume fiber-rich foods, and engage in light exercise throughout the day.

• Drink at least 8 cups (250ml) of water daily if you're formula feeding, and more if breastfeeding. Don’t force yourself to drink too much, as excessive water intake may decrease breast milk supply. Simply avoid feeling thirsty.
• Eat foods high in fiber. Fiber-rich foods soften stool and make bowel movements easier. Examples include fruits and vegetables.
• Engage in light exercise daily. Exercise promotes intestinal movement, helping to push food down through the digestive system. Aim for 15–30 minutes of light activity every day during the postpartum period.
• Inform your doctor if you experience constipation. If the above strategies don’t improve constipation within a few days, ask your doctor for advice. They may prescribe a stool softener until your body returns to normal function. Do not self-medicate with laxatives before consulting your doctor.

Keep the incision area dry and clean to promote healing. Since the incision is located between the vagina and anus, extra care is needed to keep the area dry and as clean as possible.

• Always rinse the wound after urinating and clean from front to back after bowel movements. This cleaning method keeps the pelvic area clean and reduces the risk of bacterial infection from feces.

Perform Kegel exercises. Start doing Kegel exercises as soon as possible after childbirth, if permitted by your doctor. Kegels help improve blood circulation and speed up healing, while also assisting in the recovery of tissue damage after delivery.

• Kegel exercises strengthen the pelvic floor muscles, which support the bladder, uterus, and rectum. In addition to aiding the recovery of the perineal incision, Kegels can reduce urinary incontinence in women and enhance muscle contractions during orgasm.
• It’s best to perform them after urination. Imagine trying to stop the flow of urine and passing gas at the same time—this means tightening and lifting the muscles that control urination. Remember not to use any other muscles during the contraction. Avoid tightening your abdomen, squeezing your legs together, clenching your glutes, or holding your breath. The focus should solely be on your pelvic floor muscles during the exercise.

Allow the wound to breathe. Since the perineal incision doesn’t often get exposed to air during daily activities, you should occasionally let the wound breathe. Aim to expose the wound to fresh air for a few hours each day.

• While napping or at night, you may choose not to wear underwear to allow more air circulation around the incision.

Change your sanitary pad every 2-4 hours. You will need to wear a sanitary pad while waiting for your incision to heal. The pad keeps the stitches dry and prevents blood from staining your underwear. Additionally, a dry and clean environment helps the wound heal faster.

• Remember to change the pad every 2-4 hours, even if it still looks clean.

Consult your doctor about sexual activity and using a tampon-like sanitary pad. A perineal incision typically heals within 10 days, but the internal structures have stretched, and tiny tears may remain. Most doctors advise waiting 6-7 weeks postpartum before resuming sexual intercourse.

• Seek your doctor’s advice before starting sexual activity to ensure it is safe.

Prevent infection in the incision. Infection can delay healing and increase pain. If an infection occurs, it must be treated promptly to avoid more serious complications. In the first 7-10 days post-surgery, check the stitches and surrounding area daily. Contact your doctor if you notice any of the following symptoms:

• Increased pain
• The wound appears to be opening
• Foul-smelling discharge
• A hard or painful lump in the area
• Redness around the vaginal-anal area
• Swelling in the vaginal-anal area
• Pus coming from the stitches

Understand the purpose of an episiotomy during childbirth. In natural childbirth, the baby’s head must pass through the vaginal canal, exerting pressure on the pelvic floor until the tissue there stretches enough to allow the head to pass. An episiotomy is performed if:

• The baby is large and requires more space to emerge
• The baby’s shoulders are stuck during delivery
• The labor progresses too quickly, and the pelvic floor does not have time to stretch before birth
• The baby’s heart rate indicates that urgent delivery is necessary
• The baby is in an abnormal position

Learn about different types of episiotomy surgery. Doctors typically perform one of two types of episiotomy, and both require the same care after delivery and discharge. The choice of incision depends on your body’s structure, the amount of space needed for the baby to pass through, and the speed of labor.

• One type involves making a cut from the bottom of the vagina to the midpoint between the anus and vagina. This is the easiest cut for the doctor to stitch up afterward, but there is a risk of tearing toward the anus during childbirth.
• The second type involves cutting at an angle away from the anus, which reduces the risk of tearing toward the anus but may cause more pain after birth. Additionally, this incision can be harder for the doctor to stitch later.

Communicate your concerns with your doctor. Be sure to express your desire for the pelvic floor to have enough time to stretch during childbirth and ask for guidance on how to avoid needing an episiotomy.

• Ensure that your wishes are documented in your birth plan so that hospital staff can follow your preferences. You should discuss this plan with your doctor at a prenatal visit or when you’re admitted to the hospital.
• During labor, apply a warm compress to the pelvic floor to help the tissue stretch more easily as you deliver.
• Ask your doctor if you can stand or squat to push, as this position applies more pressure and helps the pelvic floor stretch more easily.
• In the early stages of labor, try pushing gently for 5-7 seconds while breathing steadily to slow down the process and allow more time for the baby’s head to press on the pelvic floor, encouraging it to stretch.
• Ask your doctor to apply gentle pressure on the pelvic floor to help prevent tearing.

Do Kegel exercises to reduce the likelihood of needing an episiotomy. You can lower your risk of needing an episiotomy by practicing Kegel exercises throughout your pregnancy, which will help strengthen the pelvic floor muscles and prepare your body for delivery.

• Spend 5-10 minutes daily doing Kegel exercises.

Massage your perineum. About 6-8 weeks before your due date, you should start massaging your perineum once a day to reduce the chances of tearing or needing an episiotomy. You can do this yourself or ask your partner for help.

• Lie on your back with your head supported by a few pillows, and bend your knees.
• Apply a small amount of essential oil to the perineal area, using plant-based or coconut oil to soften the tissue for better stretching.
• Insert a finger about 5 cm into your vagina and press down toward the anus. Move your finger in a U-shape to stretch the skin between the vagina and anus. You may feel warmth or slight pain.
• Hold the stretch for 30-60 seconds, then release. Repeat the stretch 2-3 times during each massage.

• Keep in mind that the healing time for an episiotomy is approximately 10 days, although it may take up to a month in some cases. Be patient during the wound care process.
• Proper care is essential to keep the incision clean and dry, reducing the risk of infection and promoting faster healing.
• Consult your doctor about the reasons for needing an episiotomy and whether they frequently perform this procedure. While an episiotomy may sometimes be necessary, it is certainly not a routine procedure.

• Contact your doctor immediately if you notice pus draining from the wound, if the stitches tear, or if you develop a fever.