Perineal Care: Tears and stitches after birth

Perineal tears and stitches after birth are more common than many women realise. Around 85 percent of women who have a vaginal birth experience some degree of tearing, and most of these require stitches. Knowing how to care for them properly makes a real difference to how quickly and comfortably you heal.

This guide covers what to expect, what to do, and the clear signs that something needs medical attention.

What happens to your perineum during and after birth?

During birth, the perineum stretches significantly as the baby moves through the birth canal. Tears can happen spontaneously, or your midwife may perform an episiotomy (a deliberate cut) to allow more room. Tears are graded from first degree (small, surface-level) to fourth degree (deep, involving the anal sphincter). First and second-degree tears are the most common and typically heal well with good home care.

Dissolvable stitches are used in most cases. These do not need to be removed, they absorb into the body over two to six weeks. The stitches often feel uncomfortable and scratchy in the first week, and the surrounding area will be bruised, swollen, and sore. This is entirely normal and expected.

How to care for perineal tears and stitches after birth

The perineum is the area between the vagina and anus. It can stretch, graze or tear during birth, and some tears need stitches. Even when healing is normal, the area can feel bruised, swollen, stingy or tender during toilet trips.

Soothing support for perineal healing

A no-touch comfort step

If wiping over stitches feels uncomfortable, an external perineal spray can be used after rinsing so you can avoid rubbing the area.

Shop Perineal Spray

Daily care checklist

• Wash your hands before and after changing pads.
• Use a peri bottle or warm water rinse when you wee.
• Pat dry gently with a clean towel or soft tissue. Do not rub.
• Change maternity pads regularly and monitor bleeding.
• Use cold therapy or witch hazel externally if it feels soothing.
• Take pain relief only as advised by your midwife, GP or pharmacist.
• Avoid constipation and ask about stool softeners if you are worried about your first poo.

What to prepare before coming home from hospital

1. Have your peri bottle ready in the bathroom: Put it by the toilet before you leave so it is there the moment you need it.
2. Put pads within easy reach: You should not need to search for pads while sore. Have them on the back of the toilet or in an open basket.
3. Keep pain relief accessible: Paracetamol on the bathroom shelf or bedside means you take it before you need it, not after pain escalates.

Signs that your stitches are not healing normally

• Pain that is getting worse, not better, after three to five days
• A strong or unpleasant smell from the perineal area
• Spreading redness or warmth around the wound site
• Fever above 38°C
• The wound appears to be opening or gaps are visible between the stitches

Any of these signs warrant contacting your community midwife, GP, or calling 111. Do not wait until a scheduled appointment if symptoms feel urgent.