What to do after a perineal tear.
What is a perineal tear?
During a vaginal delivery, there may be some injury to the skin, fascia and muscles due to speed of delivery and increased stretch of the tissues. This can range from a superficial skin tear to an injury involving the perineal muscles and extending into the anal sphincters and rectum.
What to do early postpartum?
To help promote early perineal recovery it is important to avoid activities that put excess pressure on the healing tissue which includes straining, heavy lifting, and dependent positioning that may increase swelling particularly during the first 48 hours after birth. It’s important to focus on two items for good tissue healing:
Constipation Management:
To help improve colon transit and reduce hard stools it is important to have:
Good intake of high fiber foods (such as whole grains, blueberries, avocado & broccoli)
Adequate water intake. Experts recommend about 128 oz of water daily if breastfeeding.
Proper voiding position with knees elevated and hips flexed to lengthen the pelvic floor muscles and improve relaxation without pushing during a bowel movement. You can use a squatty potty, step stool, yoga blocks, or bathroom trashcan to help achieve the position.
Digital support at the perineum using toilet paper if there is increased pressure during a bowel movement.
Proper Cleaning:
Recommended to perform 2 sitz baths daily with warm water only (no essential oils or bath salts needed) to help speed up healing by boosting blood flow to the area and soothing irritation.
Clean the perineal area with a peri bottle every time you go to the bathroom
Pat with toilet paper versus rubbing to dry
Use of items such as witch hazel/dermoplast or lidocaine to help with discomfort the first two weeks after birth.
What can happen if not addressed?
Poor healing of perineal tears can lead to residual scar tissue that may be painful to touch, or painful in response to pressure or stretch with vaginal insertion. This can greatly impacting comfort with tampons/menstrual cups, gynecological examinations, and result in pain with penetration.
What’s the worst that can happen?
Research has shown that women with deeper perineal trauma, grade 3 or 4 tears that involve anal sphincter musculature and potentially the rectum itself, demonstrated greater perineal pain at 6 months post-birth, were more likely to have weaker pelvic floor muscle strength and were more likely to experience anal and/or fecal incontinence at some point in the future (whether initially postpartum or later in life). Fecal incontinence is the inability to control the leakage of solid or liquid stool (or feces) from the rectum while anal incontinence is the inability to control the leakage of gas, liquid or solid stool from the rectum.
Here to help you:
If you have experienced a perineal tear during childbirth and experience pain with intercourse, leakage or uncontrolled gas there is a high chance that you may need some help improving perineal mobility and reducing residual scar tissue formation. We highly recommend seeing a pelvic PT for an evaluation and specific treatment to improve perineal mobility, pelvic floor muscular resistance and reduce pain with your daily activities.
Want to learn more?
If you are currently pregnant and want to be proactive about reducing the risk of perineal tears check out our pregnancy prep class! We cover all the ways you can reduce orthopedic, pelvic floor and perineal injuries
If you are postpartum and have sustained a perineal injury we offer in person and virtual one on one sessions as well as a 12 week postpartum class to support your postpartum journey.