What a perineal repair is and why it is done
A perineal repair closes tissue that tore during labour or that was deliberately opened. The aim is to stop bleeding, support healing and restore anatomy so that function and strength return.
This can happen after a perineal tear, after an episiotomy or after other small birth-related injuries around the entrance to the vagina. Many sutures are made with dissolvable threads that break down over time.
A good overview of perineal tears and episiotomy is provided by RCOG, including the point that healing takes time and symptoms should be taken seriously. RCOG: Perineal tears during childbirth
How healing typically feels
Healing is not linear. In the first days the main issues are wound pain, swelling and the sense that everything is very sensitive. After that many people gradually improve, but individual bad days can occur, for example after long periods of sitting, lack of sleep or a difficult bowel movement.
Common, plausible sensations
- Burning or pulling when standing up, sitting down or passing urine
- A feeling of pressure, especially after prolonged sitting
- Short sharp twinges in specific spots when a stitch end rubs
- A hard scar feeling or small lumps in the tissue during the remodelling phase
If symptoms generally improve week by week, that is often a good sign. If things suddenly worsen, that is a signal to take a closer look.
Stitches that prick: what might be behind it
Pricking stitches are a classic problem. Often a stitch end protrudes slightly or the mucosa is so sensitive that any contact feels like a sharp stab. Dry mucous membranes can also increase friction, especially if you are breastfeeding.
It is important to distinguish: an occasional prick is different from persistent, increasing pain or a sensation that something is tearing. If you are unsure, a quick check at a clinic is often the fastest reassurance.
What you can usually do about pricking stitches
- Reduce friction, for example with soft underwear and loose clothing
- Relieve pressure when sitting, using a cushion or lying on your side
- Keep the wound clean and dry, without aggressive scrubbing
- Have strong symptoms checked rather than pulling at the stitch yourself
Daily care: less is often more
The best care is usually simple. The body heals when the environment is calm. Many products feel active but can irritate, dry out or disturb the skin barrier.
Practical care that is often well tolerated
- Clean gently, preferably with water, then pat dry rather than rubbing
- Change pads regularly so the area is not kept damp
- Apply a cool compress briefly for swelling, but not directly on bare skin and not for too long
- Give the area some air when possible in everyday life
If you want to use something extra, the key question is: does it really soothe or does it make the area more noticeable. If in doubt, ask your midwife, clinic or pharmacist.
Pain when sitting: why it can last so long
Sitting places pressure directly on the area that is being remodelled. In addition, many people unconsciously tense up in the first weeks because they expect pain. The pelvic floor and buttock muscles then hold tight, which creates more pressure.
It is helpful to dose activity rather than avoid it. Short sitting periods, frequent position changes and a soft cushion are often more effective than hours of protective behaviour that keep you in constant tension.
Everyday strategies that relieve many people
- Get up by rolling onto your side rather than pushing straight up
- When sitting, lean slightly forward or shift weight to one side to reduce pressure
- Lie down briefly several times a day so pressure is taken off downward
- Avoid straining on the toilet, as this heavily stresses the perineal area
Bowel movements and the perineal repair: an underestimated factor
Hard stools and straining are, for many, the moment when everything feels worse again. This is not because you did something wrong, but because pressure and friction can irritate the wound.
At this stage it can be sensible to aim for soft stools, for example by staying well hydrated, eating fibre and keeping a relaxed routine without rushing. If you are fearful of bowel movements, that is common in the postnatal period, but it can develop into a cycle of tension and constipation.
Warning signs for infection or impaired healing
Many worries focus on whether the stitch is infected. The most important signals are not a single twinge but a clear deterioration or a combination of several signs.
Have it checked if
- Pain increases markedly instead of slowly decreasing
- a strong, new smell or purulent discharge appears
- the area looks noticeably red, hot or very swollen
- fever, chills or a pronounced feeling of being unwell occur
- the stitch visibly opens or you feel the tissue is breaking down
If you have severe headache, visual disturbance or breathlessness, these are not typical signs of a local stitch infection, but in the postnatal period they are still reasons to seek prompt assessment.
Scar sensation later: when everything is healed but it still feels wrong
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 returning to exercise or during sex.
At that point, simple care often no longer helps; targeted support can. Pelvic floor physiotherapy can assess whether the issue is tension, scar mobility or coordination. If breastfeeding plays a role, dryness can add to irritation.
ACOG notes that the period after childbirth is a longer process of adjustment 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 postnatal period. That does not mean you must live in a sterile way. It does mean you should avoid anything that adds extra irritation.
What is usually sensible in this phase
- No harsh intimate washes and no fragrances
- Use tampons only once bleeding has stopped and you have medical clearance
- If you use a bidet or handheld shower, use a gentle stream rather than pressure
- With noticeable symptoms, have it checked one time too many rather than too few
For a general orientation on the postnatal period and physical recovery, the NHS provides a good overview. NHS: Your body after the birth
When medical advice is particularly sensible
If something is not improving, that is not automatically normal. It is a sign that you need support. Many problems can be solved quickly if they are checked early, for example stitch irritation, a small wound opening or early infection.
Good reasons to get checked
- Pain becomes significantly worse after an initial improvement
- Stitches prick so much that sitting and walking are hardly possible
- Smell, discharge, fever or a marked feeling of being unwell develop
- You still have severe scar pulling or burning after several weeks
- Sex or trying a tampon is clearly painful later on, even though you waited
If you want to delve deeper into what perineal injuries are and what follow-up care can look like, RCOG is one of the clearest sources. RCOG: Perineal tears during childbirth
Conclusion
A perineal repair can prick, sting and cause discomfort when sitting in the postnatal period without anything necessarily being 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 smell, marked redness or a stitch that opens. If you are uncertain or the course does not improve, an early check is often the quickest route back to reassurance.
