Stitches and Perineal Care After Birth: What Actually Helps

Tearing during a vaginal birth is common rather than exceptional. The RCOG puts it at up to 9 in 10 first-time mothers experiencing some kind of tear, graze or episiotomy. Knowing that does not make it hurt less, but it does mean what you are dealing with is ordinary and well understood, and that there is a fairly clear set of things that help.

What kind of stitches you have, and why it matters

Tears are graded by how deep they go, and the grade changes both the healing time and the follow-up you should expect. If you are not sure what you had, your midwife or maternity notes will say — it is a reasonable thing to ask.

• First-degree — skin only. Often heals without stitches at all, usually within a couple of weeks.
• Second-degree — skin and the perineal muscle. This is the most common tear needing stitches, and the one most of this article describes.
• Episiotomy — a deliberate cut, usually angled away from the anus. It is repaired like a second-degree tear and cared for the same way.
• Third- and fourth-degree — extending into the muscle around the anus, and in fourth-degree into the bowel lining. These are repaired in an operating theatre and come with specialist follow-up, physiotherapy and, usually, laxatives.

Third- and fourth-degree tears together are what clinicians call OASI. The RCOG puts them at about 3 in 100 vaginal births overall — more common in a first vaginal birth, around 6 in 100, and less common afterwards. If you had one, follow the plan your team gave you rather than general advice like this page, and go back to them with any new bowel or wind control symptoms.

The first 48 hours: cold, clean, supported

• After each visit to the toilet, pour warm clean water over the area as you pass urine — a jug or peri-bottle makes this easy — then pat dry from front to back rather than wiping.
• Use maternity pads rather than tampons, and change them often. Moisture and friction are what make stitches sore.
• A cold pack wrapped in a clean cloth, held on for 10 to 15 minutes at a time, is the single most useful thing in the first two days. Never put ice directly against the skin.
• Lie down when you can. Time off your feet takes pressure off the repair in a way nothing else does.

What actually helps stitches heal

This is the question behind most searches, and the honest answer is that healing is mostly about removing the things that interfere with it rather than doing anything clever.

• Keep the area clean and dry. Wet, warm, unchanged pads are the most common reason stitches stay sore longer than they need to.
• Take pain relief properly rather than heroically. Pain that stops you moving, sitting normally or emptying your bowels comfortably actively slows recovery.
• Avoid constipation and straining. This matters more than almost anything else on this list, and it is the main reason laxatives are offered routinely after a deeper tear.
• Move gently and often, but stop short of standing for long stretches. Circulation helps; gravity and hours on your feet do not.
• Let air reach the area when you are lying down at home, with a towel underneath and the pad off for a while.
• Do not scrub, and do not pull at anything you can feel. Dissolvable stitches are meant to break down and come away on their own.

Home remedies: what is worth trying, and what is not

A lot is suggested for stitches, and it is worth separating what has some basis from what is simply comforting — and from the few things best avoided.

• Cold packs — worth doing. Genuinely reduce swelling and pain in the first days, and recommended by the NHS.
• Warm shallow baths — worth doing. Soothing and keep the area clean. Warm rather than hot, and pat dry afterwards.
• Salt in the bathwater — harmless but not a healer. It has been studied and has not been shown to speed healing or reduce infection, so use it if it feels nice, not because it is doing work.
• Witch hazel, essential oils, tea tree, herbal pastes — leave them alone. Evidence is thin and broken skin is the wrong place to experiment. Nothing goes on stitches unless your midwife has said so.
• Antiseptic creams and powders — not unless prescribed. They can irritate healing tissue and trap moisture.
• Douching or anything inserted — no. Not while anything is healing internally.

Pain relief while you are feeding

Paracetamol and ibuprofen are both routinely used after birth and are considered compatible with breastfeeding by the NHS. Aspirin is the one to avoid while feeding. Taking pain relief regularly for the first few days, rather than waiting until it is bad, is what lets you sit, walk and feed without bracing.

If you were given a codeine-based painkiller, watch for constipation — it is common, and straining is exactly what you do not want. Ask about a stool softener alongside it rather than choosing between pain and constipation.

Swelling, and how to bring it down

Swelling usually peaks in the first day or two and can make the area feel tight and unfamiliar, sometimes more than the stitches themselves do. Cold packs, lying on your side, and time off your feet are what shift it. Swelling that keeps increasing after the first couple of days, becomes hot or hard, or comes with a fever, is a reason to be seen rather than to wait it out.

Sitting, lying and sleeping without making it worse

Position is one of the few things entirely within your control, and it makes a real difference to how the first fortnight feels.

• Lying on your side takes pressure off the perineum completely. It is usually the most comfortable way to sleep and to feed in the early days.
• Sitting back on your bottom rather than perched forward keeps weight off the repair. A cushion with a gap in the middle, or a rolled towel under each thigh, does the same job.
• Sit down and stand up in one controlled movement, squeezing your pelvic floor gently as you rise, rather than lowering yourself gingerly.
• Long car journeys are worth postponing in the first weeks — sustained sitting on a vibrating seat is uncomfortable for exactly the tissue that is healing.

Going to the toilet comfortably

Perineal pain often peaks on the toilet, and the fear of that first bowel movement is close to universal. Drink plenty of water, and if straining is uncomfortable, press a clean pad gently against the stitches to support them and let things happen without pushing. A stool softener helps if your midwife or doctor recommends one. Pat rather than wipe, front to back, every time.

How long until it stops hurting

Dissolvable stitches usually break down over two to four weeks, and it is normal to feel them, or to find small pieces on a pad as they come away. The tissue underneath keeps repairing for about six weeks. Most people notice a clear turn for the better somewhere in the second or third week.

What matters is the direction of travel rather than any particular day. Comfort that slowly improves is healing. Pain that plateaus at a high level, starts increasing, or is still significant at your six-week check is worth raising — including pain during sex later on, which is common, treatable, and very often not mentioned.

When to call your midwife or doctor

• Pain that is increasing rather than easing after the first day or two.
• Fever, chills, or simply feeling unwell in a way you cannot place.
• Discharge that becomes heavy, unusual, or foul-smelling.
• Skin around the stitches that is hot, bright red, spreading, or blistered.
• A feeling that the wound has opened, or stitches giving way early.
• Any new difficulty controlling wind or bowel movements — report this the same day, particularly after a third- or fourth-degree tear.
• Being unable to pass urine, or a sudden inability to feel when you need to.

Asking to be looked at is not a fuss. Most problems here are straightforward when caught early and considerably less so when left for a fortnight.

When you can start pelvic floor work again

Gentle pelvic floor squeezes can usually begin early, often within the first days, once they feel comfortable — the NHS encourages starting soon after birth. They are not the same thing as exercise, and they help rather than hinder the repair. If you had a deeper tear, your team may want you to wait or may refer you to a pelvic health physiotherapist.

Anything more demanding waits for your postnatal check and your provider's clearance. If you are wondering when running, core work or the gym become reasonable again, the timeline is covered in our answers to the questions mothers actually ask about postpartum exercise.

For most people this is a fortnight of being careful followed by a steady return to normal. Clean, dry, cool early on, well managed for pain, and unhurried — that is genuinely most of it.

Frequently asked questions

A recovery plan that flows

Note which positions and routines feel best each day, so you walk into your postnatal check with a clear picture — track it all in MatraBloom's simple daily check-in.

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