It’s scary how few women know about how to care for their perineal tear or episiotomy after childbirth. Caring for your perineal tear or episiotomy is something every single woman should know heading into labour.
In case these terms are new to you, let me explain exactly what they mean. During a vaginal birth, your vagina and pelvic floor need to stretch to accommodate your baby’s head. In some cases, the perineum can’t stretch enough, so it naturally tears to create more space for your baby. This perineal tear is graded between 1-4 depending on its severity. Alternatively, an episiotomy is when your Obstetrician cuts the perineum to enlarge your vagina opening. A tear (greater than grade 1) and episiotomy involves both skin and muscle tissue, so will be stitched together after your baby is born.
Not all vaginal births will end in a perineal tear or episiotomy, and it’s important to do what you can in the lead up to birth to help prevent this from occurring. Read how to best prepare for childbirth here.
How to Care for a Perineal Tear or Episiotomy:
1. Know the Details of Your Labour.
Often there is so much going on during the birth of your baby, combined with a lack of education around the topic, that women don’t know to ask the details of their birth. So make sure you find out:
- If you had a tear and if so, where is it and what grade is it.
- If you had an episiotomy.
- If they used forceps or suction.
2. Personal Hygiene
- Make sure you keep the area clean and dry.
- Wash your perineal area with water (no soap) and gently pat yourself dry after a shower.
- After voiding pat the area from front to back with toilet paper.
- Avoid rubbing the area.
- Wash the area with water after you use your bowels.
- Change your sanitary pad every 4-6 hours.
3. Ice and Compression
The area is likely to be inflamed and swollen after childbirth so ice and compression will help to reduce this and provide pain relief. A good idea is asking the nursing staff to put some of your maternity pads in the freezer. Put the pad inside a supportive pair of underpants to provide some comfortable compression.
Ice is in particularly important intermittently in the first 48 hours after birth, but you can continue to use it when you go home if it helps you.
Once you are able, you can also wear a compression garment, such as SRC recovery shorts to provide your pelvic floor and abdominal muscles support.
4. Pain Relief
Your doctor will prescribe you with pain relief when you leave hospital. Make sure you take it if the area is painful.
Often pelvic floor injury can be accompanied by a feeling of vaginal heaviness or discomfort. Resting in the first week after birth is really important to alleviate gravity from adding extra downward pressure on your pelvic floor. Making sure you are spend time lying flat, resting and sleeping will encourage healing of the area. Move about as you feel comfortable, but always ensure you are lying down for 20-30 minutes each hour. You can try to feed your baby lying down to allow maximum rest. It’s also a good idea to limit hospital visitors so you can rest.
6. Mindful Movement
Be mindful of the way you move to avoid putting pressure through your stomach and pelvic floor. Examples are:
- Roll to one side to get out bed instead of sitting straight up
- Avoid lifting your suitcase or other children
7. Start Gentle Pelvic Floor Contractions
It is safe to start gently contracting your pelvic floor the day after you have given birth. This encourages blood flow to the area to help with healing and helps to reduce swelling. Focus on gently lifting the pelvic floor and then releasing the muscle completely. It’s important not to overdo it, but instead do about 4-5 pelvic floor contractions throughout the day. A good time to do this is when you are breastfeeding your baby.
Don’t worry if initially you can’t feel much (if any) lift of your pelvic floor, as this will likely come back in time. The important thing is that you are starting to fire up the neural pathways to the muscle, and your sensation of this area should improve over days and weeks.
8. Avoid Constipation/Straining
In order to promote healing of your pelvic floor, we need to make sure you do not strain when you use your bowels. Ensure you keep your diet high in wholefoods, especially fruit and veggies, and drink 2-3L of water. This may involve your partner or family bringing healthy meals into hospital to ensure you are getting adequate nutrients and fibre, as we all know that hospital food can be less than desirable!
It’s a good idea to use a laxative in these early days after childbirth, to soften your bowel motion and prevent straining. Your nurse should provide you with a laxative, or otherwise ask. If you are prone to constipation, continue using the laxative when you get home.
The way you sit on the loo will also help you to avoid straining. Click here to see how.
You should only be discharged home after you have comfortably emptied your bowels.
9. Support your Perineum.
You may find manually supporting your perineal muscles (vaginal area) when you are using your bowels helps you to feel more comfortable. To do so, fold some toilet paper over and place this on your vagina/perineal, supporting it with your hand.
You may also want to support the area with your hand when you sneeze, cough or laugh.
10. Reconnect to your Vagina.
It is common for women to disconnect from their vaginal area after pelvic floor injury or a traumatic birth, as the area feels different/strange/uncomfortable and they don’t feel themselves. It’s really important to recognise that your body had just achieved the amazing feat of giving birth, and you vagina not meant to bounce back and feel “normal” straight away. Disassociating or ignoring your downstairs area will only contribute to dysfunction down the track. So instead, be aware that your vagina is likely to feel or look different, and this is OKAY! Know that your pelvic floor is currently healing, just like any other muscle needs to heal after an injury. The ability of your pelvic floor to heal and recover will be heightened by the amount of TLC you give it.
A way to reconnect with your vagina is to lie down in a relaxing environment (ie. when your baby is sleeping), close your eyes and breathe into your belly, allowing your whole body to let go. Imagine the breath moving down into your pelvis, to your pelvic floor, bringing healing energy to it. Do this exercise daily.
I also advise eventually getting a small mirror and looking at your vagina. It’s important to accept what you see. This might sound daunting to many of you, but your vagina is an incredibly primitive part of your body, and should be treated with the same respect as any other area.
Self-massage is a game changer once your scar has healed. Scar tissue is formed as the tissue heals and is a completely normal process. However, scar tissue can lead to the tension in the pelvic floor muscle and therefore it may not working optimally or may cause pain.
After your 6-week check up with your Doctor, I recommend regularly massaging your scar with your thumb/fingers and a natural lubricant like olive oil. You can do this in supported sitting on your bed with your legs spread. Make sure your hands are clean, and use gentle pressure on your scar and around the opening of your vagina. When you feel tension or pain, hold your thumb on this area and breathe into the area, until the pain dissipates. Overtime self-massage will soften the scar tissue and help to alleviate any accompanying pelvic floor issues.
It is common to be hesitant to do self-massage, but once you do it once it gets easier and the benefits are 100% worth it. To reassure you, you will not do any damage to the area, in fact you are helping it. Your women’s health Physio can teach you how to do self-massage in one of your sessions.
12. Breathing and Relaxation
Pelvic floor injury and scar tissue can lead to pelvic floor tension or overactivity and potentially pain with intercourse if it is not well looked after. Often pelvic floor tension and overactivity occurs subconsciously, as a protective response to the injury/trauma it has been through. To prevent this from occurring, it is really important for you to focus on consciously relaxing the area and breathing. Diaphragmatic Breathing is a perfect technique to achieve this, which you can learn here. http://www.thewholemother.com/reduce-stress-heal-your-body-with-diaphragmatic-breathing/
During the day, it is also a good idea to bring your awareness to your pelvic floor. Are you sucking it in without even realising? If so, breathe into your belly and soften through your stomach and pelvic floor muscles. Remember the aim of pelvic floor recovery is not to suck in our pelvic floor (even if that area feels heavy). Instead you need to prioritise rest, taking pressure off the area, and do pelvic floor exercises that involve both a lift and a release.
13. Obstetrician/GP Check Up
At your 6-week check up with your obstetrician, GP or midwife, make sure they do an internal examination to check your scar. It astounds me how many 6-week check ups don’t include this, and the woman is left unsure about the state of her vagina.
14. Women’s Health Physiotherapist Assessment
At 6-weeks postpartum you should have an appointment with a women’s health Physio. It’s important to know that Women’s Health Physio’s specialise in the recovery of the pelvic floor, and can do a thorough internal assessment of your muscles (something your doctor is not trained to do). Your Physio will ensure your muscles are healing well, can assess for pelvic floor tension or activity, prolapse, check your pelvic floor strength, endurance and motor control, set you up with an exercise program, and provide manual therapy for scar tissue treatment.
15. Returning to Sex
At your 6-week check up your doctor should check the injury has healed, and give you the all clear to have intercourse. However, every woman and pelvic floor is different so you may not feel ready at this point. For some women this can take 3 months or more. Make sure you feel ready to have sex again, and openly discuss how you are feeling with your partner, as men may need this explained to them! Implementing all the above steps will help increase your body confidence.
It’s important for both you and your partner to recognise that sex may feel different for you initially, and this is okay. In saying this, it should NOT feel painful, and you should stop if you feel any pain. My advice is to create a relaxing, romantic environment and start with foreplay. All going well, you can progress into intercourse. I also recommend using a natural lubricant like sylk or olive oil, as vaginal dryness is common when you are breastfeeding, and this may contribute to some discomfort.
If you do experience pain, then continue self-massage and breathing, and book in to see your Women’s Health Physio again.
Being aware of the above strategies before having your baby and then adopting them post-birth is a game changer for your pelvic floor recovery!
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