What a perineal suture is and why it is done
A perineal suture closes tissue that tore during birth or was deliberately opened. The goal is to stop bleeding, support healing, and restore anatomy so that function and load-bearing return.
This can follow a spontaneous 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 reliable overview on perineal tears and episiotomy is available from RCOG, including the information 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 it’s mainly about wound pain, swelling, and the feeling that everything is very sensitive. After that many people slowly improve, but individual days can be worse again—for example after long periods of sitting, too little sleep, or difficult bowel movements.
Common, plausible sensations
- Burning or pulling when standing up, sitting down, or when urinating
- A feeling of pressure, especially after prolonged sitting
- Brief sharp twinges at certain points when a suture end rubs
- Firm scar feeling or small lumps in the tissue during the remodeling phase
If symptoms overall improve week by week, that is often a good sign. If things worsen, that’s a signal to take a closer look.
Sutures poking: what might be behind it
Poking sutures are common. Often a stitch end sticks out a bit or the mucosa is so sensitive that any contact feels like a prick. Dry mucous membranes can also increase friction, especially if you are breastfeeding.
It’s important to distinguish: an occasional poke is different from persistent, increasing pain or a feeling that something is tearing open. If you are unsure, a quick check at the clinic is often the fastest reassurance.
What you can usually do for poking sutures
- Reduce friction, for example with soft underwear and loose clothing
- Relieve sitting pressure with a pillow or by lying on your side
- Keep the wound clean and dry without aggressive scrubbing
- Have strong symptoms checked rather than pulling on the suture yourself
Everyday 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 instead of rubbing
- Change sanitary pads regularly so the area does not stay continuously moist
- Apply short-term cooling for swelling, but not directly on bare skin and not for too long
- Let the area breathe when possible during daily life
If you want to use something additional, the key question is: does it actually soothe or does it make the area feel more noticeable. When in doubt, consult your midwife, doctor’s office, or pharmacist.
Pain when sitting: why it can last so long
Sitting places pressure exactly on the area that is remodeling. In addition, many people unconsciously tense up in the first weeks because they expect pain. The pelvic floor and gluteal muscles then hold tight, which creates more pressure.
It helps to dose activity rather than avoid it. Short sitting periods, frequent position changes, and a soft pillow are often more effective than prolonged protective behavior that keeps you in constant tension.
Everyday strategies that relieve many people
- Stand up by rolling to the side instead of pushing straight up
- Slightly lean forward or shift weight to the side while sitting
- Lie down briefly several times a day so pressure is taken off
- Do not strain during bowel movements, as that heavily stresses the perineal area
Bowel movements and the perineal suture: an underestimated factor
Hard stool and straining are the moments when everything often feels worse. It’s not because you did something wrong, but because pressure and friction can irritate the wound.
In this phase it can be helpful to actively aim for soft stools, for example through adequate fluids, fiber, and a relaxed routine without rushing. If you are fearful of bowel movements, that is common in the postpartum period, but it can turn into a cycle of tension and constipation.
Warning signs for infection or impaired healing
Many worries center on whether the suture is infected. The main signals are not a single twinge but a clear worsening or a combination of several signs.
Have it checked if
- Pain clearly increases instead of gradually decreasing
- A strong, new odor or purulent discharge appears
- The area looks clearly red, hot, or markedly swollen
- Fever, chills, or a strong general feeling of being unwell occur
- The suture visibly opens or you feel tissue softening or separating
If you have severe headache, visual changes, or shortness of breath, these are not typical for a local suture infection but are still reasons for prompt evaluation in the postpartum period.
Scar sensations later: when everything is healed but it doesn’t feel right
Sometimes the wound is formally closed, but the tissue feels hard, numb, or oversensitive. This can be related to nerve recovery, scar adhesion, or pelvic floor tension. Many notice it when sitting, when starting exercise, or during sex.
At that point, routine care often no longer helps and targeted support is useful. Pelvic floor physical therapy can assess whether tension, scar mobility, or coordination are the issue. If breastfeeding is a factor, dryness can additionally irritate.
ACOG describes that the time after childbirth is a longer period of adjustment and that symptoms should be taken seriously even if they are not acutely dangerous. ACOG: After Pregnancy
Hygiene, tests, and safety
The area is sensitive in the postpartum period. That does not mean you need to live sterile. It means you should avoid anything that causes additional irritation.
What is usually sensible in this phase
- No aggressive intimate wash products and no fragrances
- Only use tampons once bleeding has stopped and you have been cleared medically
- If you use a bidet or shower, use a gentle stream rather than pressure
- With noticeable symptoms, it’s better to have something checked one time too early
For a general orientation about the time after birth and physical recovery, the NHS provides a useful overview. NHS: Your body after the birth
When medical advice is particularly sensible
If something does not get better, that is not automatically normal. It is a sign that you need support. Many problems can be solved quickly when they are checked early, for example with suture irritation, a small wound opening, or early infection.
Good reasons to get checked
- Pain returns markedly worse after an initial improvement
- Sutures poke so much that sitting and walking are almost impossible
- Odor, discharge, fever, or a strong general feeling of illness occur
- After several weeks you still have strong scar pulling or burning
- Sex or trying a tampon is clearly painful later on, even though you gave it time
If you want to go deeper into what perineal injuries are and what follow-up care can look like, RCOG is one of the clearer sources. RCOG: Perineal tears during childbirth
Conclusion
A perineal suture in the postpartum period can poke, burn, and be bothersome when sitting without anything necessarily being wrong. Sensible care is usually simple: clean gently, keep dry, reduce pressure, and avoid straining. Warning signs are mainly a clear worsening, fever, foul odor, strong redness, or a suture that opens. If you are unsure or the course does not improve, an early check is often the quickest route back to calm.
