Perineal tears and stitches: healing

A first-degree tear affects the skin; deeper tears can involve muscle. The degree tells you which tissues were injured during birth. Ask your midwife or doctor to explain what was repaired and what follow-up is planned.

What the different degrees mean

The perineum is the area between the vaginal opening and the anus. A tear happens as the baby stretches this area during birth. An episiotomy is a cut made by a healthcare professional through the vaginal wall and perineum; it can sometimes extend into a deeper tear.

Tear	Tissue affected
First-degree	Skin; these tears usually heal naturally.
Second-degree	Skin and the muscle of the perineum; stitches are usually needed.
Third-degree	Extends into the muscle controlling the anus, called the anal sphincter.
Fourth-degree	Extends further into the lining of the anus or rectum.

Third- and fourth-degree tears are also called obstetric anal sphincter injuries, or OASI. They are usually repaired in an operating theatre. Afterwards, care includes pain relief, antibiotics to reduce infection risk, laxatives to make pooing easier and an offer of physiotherapy. Your prescriber or pharmacist can explain any medicines in your discharge plan.

Keeping stitches comfortable

Wash the area daily with water, change sanitary pads regularly and wash your hands before and after using the toilet. RCOG advises avoiding products on the perineum while it heals.

For discomfort after an episiotomy, the NHS suggests a cold pack wrapped in a towel. Keep ice off bare skin. Ask your midwife, doctor or pharmacist which pain relief is suitable, especially if you are breastfeeding.

Stitches used to repair tears usually dissolve. RCOG notes that you may see small threads on a pad or in the bath after an OASI repair. Increasing pain, new bleeding, pus or a visible gap needs assessment, even if you also notice loose threads.

Peeing, pooing and pelvic floor care

Pouring water over the area while you pee can ease stinging. Opening your bowels is unlikely to damage the stitches. Eat fibre-containing foods such as fruit, vegetables and wholemeal bread, drink water and avoid straining. A footstool that raises your knees above your hips may help with your toilet position.

RCOG advises starting pelvic floor exercises as soon as you can after birth. A physiotherapist can help you learn the correct squeeze and support bladder or bowel control. Ask for a demonstration if the movement is difficult to feel.

After an OASI, difficulty holding in wind, sudden urges to poo or leaking poo are reasons to speak to your care team. Specialist treatment can include physiotherapy and, for some people, surgery. Tell the clinician what happens in everyday words, including any effect on leaving the house or getting to a toilet.

After a third- or fourth-degree tear, RCOG advises avoiding strenuous activity and heavy lifting for 4-6 weeks, then gradually increasing general activity. Ask your care team how this applies to work, exercise and caring responsibilities. If help is available at home, explain the restrictions when discussing which tasks someone else can take on.

Arrange a review if healing worries you

Call 999 now (UK), 911 (US), or your local emergency number for confusion, very fast breathing or blue, pale or blotchy skin.

Contact your maternity unit (UK), obstetric clinician (US), or local urgent service now for fever or feeling increasingly unwell while the wound heals, even without pus or an opening wound.

Contact your maternity unit or GP today in the UK, your obstetric clinician in the US, or your local doctor or midwife for an opening wound, worsening pain, pus or an unpleasant smell. A clinician can examine the stitches and may take a swab. An infected wound is not always re-stitched immediately; the team will explain the options after examining it.

RCOG describes hospital follow-up at 6-12 weeks after an OASI to check healing and bowel control. Raise persistent pain, discomfort during sex or distress about the birth as well. Ask who will arrange the appointment and how to contact the team before then.