What a perineal repair is and why it is done
A perineal repair closes tissue that tore during birth or was deliberately opened. The aim is to stop bleeding, support healing and restore anatomy so that function and load-bearing capacity return.
This can follow a perineal tear, an episiotomy, or other small birth-related injuries around the vaginal opening. Many sutures are done with absorbable stitches that break down over time.
A clear overview of perineal tears and episiotomy is provided by the RCOG, including the information that healing takes time and that symptoms should be taken seriously. RCOG: Perineal tears during childbirth
How healing can typically feel
Healing is not linear. In the first days the main issues are wound pain, swelling and a feeling of marked sensitivity. After that many people gradually improve, but individual days can be worse again, for example after prolonged sitting, lack of sleep or a difficult bowel movement.
Common, plausible sensations
- Burning or tugging when standing up, sitting down or urinating
- A feeling of pressure, especially after sitting for a long time
- Short sharp twinges at single points when a stitch end rubs
- A hard scar sensation or small lumps in the tissue during the remodelling phase
If symptoms improve week by week overall, that is often a good sign. If things worsen, it is a signal to take a closer look.
Stitches that poke: what might be behind it
Poking stitches are common. Often a stitch end protrudes slightly or the mucosa is so sensitive that any contact feels like a prick. Dry mucous membranes can also increase friction, particularly if you are breastfeeding.
It is important to distinguish: an occasional poke is different from persistent, increasing pain or a sensation that something is tearing. If you are unsure, a quick check at your clinic is often the fastest reassurance.
What you can usually sensibly do for poking stitches
- Reduce friction, for example with soft underwear and loose clothing
- Relieve pressure when sitting, using a cushion or side-lying position
- Keep the wound clean and dry, without aggressive scrubbing
- Have strong symptoms checked rather than pulling at the stitch yourself
Everyday care: less is often more
The best care is usually simple. The body heals when the environment remains calm. Many products feel active but can irritate, dry out or disturb the skin barrier.
Practical care that is often well tolerated
- Clean gently, ideally with water, then pat dry rather than rub
- Change pads regularly so the area does not stay constantly damp
- Brief cooling for swelling, but not directly on bare skin and not for too long
- Allow air to the area when possible in daily life
If you want to use something additional, the key question is: does it actually soothe or does it make the area more noticeable. If in doubt, ask your midwife, clinic or pharmacist.
Pain when sitting: why this can take a long time
Sitting places pressure directly on the area that is remodelling. Many people also unconsciously tense during the first weeks because they expect pain. The pelvic floor and buttock muscles then hold tight, which creates more pressure again.
It helps to dose load rather than avoid it entirely. Short sitting periods, frequent position changes and a soft cushion are often more effective than hours of protective behaviour that put you into constant tension.
Everyday strategies that relieve many people
- Get up by rolling to your side instead of pushing straight up
- Sit with a slight forward tilt or shift weight to one side
- Lie down briefly several times a day so pressure is relieved
- Do not strain during toileting, as this greatly stresses the perineal area
Bowel movements and the perineal repair: an underestimated factor
Hard stool and straining are the moment when things often feel worse again for many people. This is not because you did something wrong, but because pressure and friction can irritate the wound.
In this phase it can make sense to actively aim for soft stools, for example through adequate fluids, fibre and a relaxed routine that is not rushed. Fear of bowel movements is common in the postpartum period, but it can become a cycle of tension and constipation.
Warning signs of infection or impaired healing
Many concerns centre on whether the suture is infected. The key signals are not a single twinge but a clear deterioration or a combination of several signs.
Seek assessment if
- pain increases noticeably instead of gradually decreasing
- a strong new odour or purulent discharge develops
- the area appears markedly red, hot or swollen
- fever, chills or a pronounced feeling of being unwell occur
- the suture visibly opens or you feel tissue is separating
If you have severe headache, visual disturbances or shortness of breath, these are not typical of a local suture infection but in the postpartum period are still reasons for prompt assessment.
Later scar sensations: when everything is healed but it still feels unpleasant
Sometimes the wound is technically closed, but the tissue feels hard, numb or oversensitive. This can be related to nerve healing, scar tethering or pelvic floor tension. Many notice it when sitting, when starting exercise or during sex.
In those cases simple care often no longer helps and targeted support is useful. Pelvic floor physiotherapy can assess whether the problem is tension, scar mobility or coordination. If breastfeeding is a factor, dryness can additionally irritate.
ACOG describes that the time after childbirth is a longer adjustment process and that symptoms should be taken seriously, even if they are not immediately dangerous. ACOG: After Pregnancy
Hygiene, tests and safety
The area is sensitive in the postpartum period. That does not mean you must live in sterility. It does mean avoiding anything that causes additional irritation.
What is usually sensible in this phase
- No aggressive intimate washes and no fragranced products
- Use tampons only after bleeding has stopped and when medically advised
- If you use a bidet or shower, a gentle water stream rather than high pressure
- With concerning symptoms, have things checked one time too often rather than too late
For general guidance on the time after birth and physical recovery, the NHS provides a good overview. NHS: Your body after the birth
When seeking medical advice is particularly sensible
If something does not get better, it is not automatically normal. It is a sign that you need support. Many problems can be quickly resolved if they are looked at early, for example stitch irritation, a small wound opening or early infection.
Good reasons to have a check-up
- pain becomes markedly worse after an initial improvement
- stitches poke so much that sitting and walking are barely possible
- odour, discharge, fever or a strong feeling of illness develop
- you continue to have strong scar tugging or burning after several weeks
- sex or attempting a tampon remains clearly painful even though you waited
If you want to read more about perineal injuries and postpartum follow-up, RCOG is one of the clearer sources. RCOG: Perineal tears during childbirth
Conclusion
A perineal repair can poke, burn and be bothersome when sitting in the postpartum period without necessarily indicating something is wrong. Sensible care is usually simple: clean gently, keep the area dry, reduce pressure and avoid straining. Key warning signs are a clear deterioration, fever, foul odour, marked redness or a suture that is opening. If you are unsure or recovery does not improve, an early check is often the quickest path back to reassurance.
