Talk to your midwife or obstetrician about your options for dealing with any pain you have.
It is normal to feel pain after an episiotomy. But it is unusual for this to last for more than 2 weeks.
Painkillers
Paracetamol tablets are safe to take and can help with the pain. The usual recommended dose is to take two 500 mg tablets every 6 hours. This is safe to take when you are breastfeeding.
Diclofenac tablets or suppositories also work well for pain. You put the suppository in your bottom. The dose is usually 1 suppository every 18 hours. Your midwife can show you how to use the suppository.
Aspirin is not recommended as it can be passed on to your baby through your breast milk.
Your obstetrician may prescribe pain relief for you while you recover on the post-natal ward.
When you get home, talk to your midwife or GP if paracetamol and diclofenac are not helping your pain. They may need to check you in case the area has become infected.
Infection
Signs of infection include:
- very sore or tender
- yellow or green discharge
- a lot of redness on skin - it may be harder to see on black or brown skin
Make sure to tell them if you are breastfeeding. Some medicines are not suitable to take when breastfeeding.
Taking medicine while breastfeeding
Other tips to ease pain
To help ease the pain:
- rest and lie on your side as much as you can
- use an icepack a few times a day for 20 to 30 minutes at a time
- use a donut-shaped cushion to help you feel more comfortable
- squeeze your bum cheeks together when you sit down
- have a warm bath
Some women take Arnica. This herbal remedy is thought to help the wound heal and reduce bruising. But there is no strong evidence to prove that it works.
Non-urgent advice: Contact your GP, maternity unit or public health nurse if:
- pain gets worse and does not improve despite taking medicine
Bleeding
It is normal to bleed for up to 6 weeks after the birth. Never use tampons. Tampons can introduce infection into the area.
Use sanitary pads instead. Change your pads often.
Keeping the wound and your perineum clean
Use plain warm water to clean your perineum. Clean it gently and avoid rubbing it. Witch hazel or salt do not speed up wound healing. But if you find them soothing to use, there is no harm in using them.
Wear underwear that is made from a breathable material like cotton. Wear loose comfortable clothes. Tight clothes can be uncomfortable while you are healing.
Wash your hands:
- before and after going to the toilet
- before and after cleaning your wound
- when you change your pad
This is especially important if there are young children in your home. They might have an infection, such as Group A strep, that you can pass to your wound. This can be serious if it gets into the bloodstream.
Going to the toilet
Wash your perineum after every time you go to the toilet. Do this until the wound heals.
Pour warm water over your vaginal area after going to the toilet. Pouring warm water over your outer vagina as you pee can also help reduce stinging.
When you are on the toilet for a pee, lean forward towards your knees. This helps direct the pee away from your wound.
Your first poo
Your bottom and back passage can feel a little bruised after the birth of your baby.
It is normal to feel worried about your stitches when you poo. But pooing does not cause your stitches to fall out or your wound to open.
To make pooing more comfortable:
- put a clean pad at the side of your wound and press gently as you poo - this can take some of the pressure off the wound
- gently wipe your bottom from front to back - this helps to prevent germs infecting the wound
- drink lots of water and eat foods that are rich in fibre, such as vegetables, fruit, wholegrain oats, wholegrain bread and pasta
Non-urgent advice: Talk to your midwife, GP or pharmacist if:
- you find it very painful to poo
Taking a laxative might help. Laxatives are medicines used to treat constipation. Laxatives can soften the poo, making it easier to pass.
Sex after an episiotomy
There are no strict guidelines about when to start having sex again after giving birth. Some experts feel it is a good idea to wait until your bleeding has stopped. This is to reduce the risk of infection.
Take things at your own pace. It is normal for sex to feel different after childbirth.
Most women find that the first time they have sex after an episiotomy is uncomfortable.
If you try to have sex before the episiotomy or any other tears heal, it can be very painful.
After the wound heals, the pain improves with time.
Tell your partner if:
- you are worried about pain or sex
- sex is painful or uncomfortable
- you do not want to have sex
When you are ready and you want to have sex, you could try:
- using lubrication - if you are breastfeeding you may have vaginal dryness
- different positions to reduce pressure on the area
- oral sex or mutual masturbation if penetration is too uncomfortable
Remember, it is possible to become pregnant again soon after giving birth. If this is not what you want, talk to your GP about contraception.
Pelvic floor exercises
Doing pelvic floor exercises can:
- strengthen the muscles around your vagina and bottom
- reduce your risk of having problems controlling your bowel and bladder
- improve the blood flow to this area
- help the wound to heal
- reduce the pressure on your wound and on the skin around your wound
