Perineum and Birth

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Perineum and Birth
Most women will experience some damage to the perineum or pelvic floor with their first vaginal birth.

Usually this is dealt with immediately after delivery by careful repair of the vagina and deeper tissues by your midwife or obstetrician. This is usually done using either a local anaesthetic or an epidural and is normally performed in the delivery room. In most cases, the stitches heal quickly, especially when aided by pelvic floor exercises and some other simple measures.

Care of the perineum area after delivery requires regular pain relief, good hygiene, and making sure that the bowels are kept regular. It can be scary going for your first poo, but it is never as bad as you expect. It can help to eat a couple of kiwi fruit a day, as they are very good natural laxatives. At this stage, a Midwife should be calling round on a regular basis, at least up until 10th day, and will give you advice on general care and any issues you may have regarding healing or discomfort.

If you experience increasing pain, soreness and redness over the perineum, and even a fever, this could indicate early signs of infection. If untreated this may lead to severe pain followed by a discharge of blood and pus giving rise to great relief. Infection in the perineum is more common after assisted deliveries especially if there have been lots of internal examinations and extra bleeding. Sometimes infection can be related to a collection of blood under skin, called a haematoma. If there are any concerns about infected perineum you must consult your midwife or doctor.

The stitches used during perineum repair are normally dissolvable and therefore do not need removing. They usually fall out sometime between the 2nd and 6th week depending on their thickness. Sometimes a stitch may be uncomfortable and irritating and this can usually be removed without any local anaesthetic. You should see your doctor or midwife about this. The tissues in this area are very well served with a good blood supply so normally the perineum heals well by about 6 weeks. There should be continued improvement of any tenderness and or swelling for the next 6-12 weeks.

Occasionally there can be a complete breakdown of the stitches. This may require further surgery in theatre either at the time or at a later date. Please do speak to your doctor or midwife if you are worried that the area is not healing as it should.
Sometimes some scar tissue can persists and can cause bleeding and pain on touching or when attempting intercourse. This fleshy bit of scar tissue which is usually bright red is called Granulation Tissue. It is easily treated in a clinic, by removing it and touching the base with a little stick of silver nitrate. This stick looks like a little matchstick and it cauterises the area and encourages quick healing.

Occasionally you may require a small operation under a short general anaesthetic. The procedure will get rid of any scar tissue and restore tissues to a normal size and shape.

If you have any issues regarding your perineum then please do speak to your midwife or doctor and he or she will give you the best advice.

Advice provided by The Doctor and Daughter's Guide to Pregnancy

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