First off, I’m sorry you’re reading this because it probably means you did a google search in the middle of the night trying to come to terms with what has happened to your body. I first want to send you a virtual hug and let you know that you are not alone. Caring for a newborn is a lot of hard work and recovering from a perineal tear makes it harder. You are also stronger than you know and you've got this.
Recovering from a perineal tear can vary from person to person and changes through time but there are a few things that most everyone can benefit from whether you just tore or are well on your way to recovery.
Recovering from Perineal Tear in Early Postpartum
In the immediate postpartum, mamas normally notice pain. Pain with walking, sitting, getting up out of bed, peeing (oh the sting or burn), and while holding their child. The visible portion of the perineum usually heals within the first few weeks and after that the pain and soreness tends to improve within 2-3 weeks. Meanwhile, in those first few weeks there are things you can do to help ease recovery.
Good hygiene: Keep the perineum clean by using warm water, washing your hands before and after using the restroom and changing your sanitary pad or depends regularly.
Side note on pads: I highly recommend you invest in either cloth pads or organic pads in those early days. Many find the plastic portion of the pads actually causes additional swelling, redness and irritation or causes chafing so go ahead and buy the good stuff like Sustain, Seventh Generation, or L brand.
Side note on water: your vagina is a self-cleaning oven and does not require special sprays or disinfectants to clean it postpartum. Unless you have an infection, warm water is all you need or want to put on the vagina.
Perineal bottle: The upside down perineal spray bottle is nothing short of amazing and may be your best friend in those early. Keeping the spray bottle by the toilet and using warm water on your perineum while you use the restroom (both pee or poop) can help ease the stinging or burning sensation many women feel.
Hydration: This is one of those win-lose situations we all “love”. Yes, staying hydrated will make you need to pee more frequently (use the perineal body) but tissues that are hydrated also heal faster so it is important to make sure you are staying hydrated after a perineal tear.
Diet/Bowel Health: These go hand-and-hand because one of the best things to do is avoid constipation and this is done by eating high-fiber foods. Additionally, try to sit up tall on the toilet, use a squatty potty or something to prop up your legs, don’t rush and breathe your bowel movement out rather than push. T
As far as foods go the following is a list of fiber packed foods that may help you limit or avoid constipation as long as you are well hydrated: black beans, apples, pears, spinach, lentils, almonds, broccoli, chia seeds, bananas, Brussels sprouts, berries (blackberries, strawberries, blueberries), avocado...mostly eat fruits and vegetables with the peel on alongside good fats and healthy protein.
SITZ bath: Double check with your provider to make sure there are no contraindications, but a sitz bath is when you fill the tub with a small amount of water and soak in it with epsom salt and herbs. It’s generally recommended to soak for 10-15 minutes to soothe postpartum discomfort (and relieve good ole hemorrhoids as well).
Rest/Ask for Help: Oh Mama, I know it’s hard to ask for help. In a world full of go-go-go it’s hard to slow down. Trust me, I get it (oh, do I understand all too well). Trust me when I saw, one of the best things you can do for both you and your sweet babe is to get quality rest. Ask friends or family to help cook meals, do a load of laundry, load the dishwasher, change the babe, rock the babe so you can sleep. Whatever you feel comfortable asking, ask. Our bodies need sleep in order to heal so taking the time to rest now will help your body heal faster.
Ice?: Yeah, I included a question mark. There is a ton of mixed research on this one. I believe in informed consent and like everything there are risks and benefits to ice and only you can decide what is best for you at this time. The benefit is that using ice on the perineum (with a towel in between, not directly on it) is a good way to reduce pain in the early days when it hurts to function. The risk is that some studies have shown that ice may make the tissues take longer to heal. If you decide to use ice, you can make a homemade padsicle by using the cotton pads you bought and adding witch hazel to the pad and putting it in the freezer to use when needed.
Roll: Now is not the time to get on the floor and practice rolling, but it is a perfect time to focus on rolling out of bed instead of doing a modified sit-up to get out of bed. This will decrease the tension and pressure on your pelvic floor so it is ideally not as painful to get in and out of bed.
What to Look Out for with Perineal Tears
If you have ANY concerns about what is happening to your body or your pelvic floor, please contact your provider now. You hired them and they are there to help you. Here are a few things to look out for that are also important to contact your provider if you experience:
Painful stitches
Odor
Redness or swollen skin
Discharge or pus
Increase in pain or tenderness
Stitches that are taking longer to heal than you expected
Fever
Difficulty controlling urine or bowels (you are leaking gas, stool or pee)
Recovering from Perineal Tearing Long Term
There are two things I recommend for long-term perineal tear healing: pelvic floor rehab and to nourish the body through nutrition.
The number one thing I recommend for recovering long-term from a perineal tear is to see a pelvic floor rehab specialist. Depending on the circumstances, it can take time to heal but a pelvic floor provider can assess your specific needs. Your perineal tear may result in a hypertonic pelvic floor or muscles that are constantly tight while someone else and you need stretching and lengthening while someone else needs strengthening and tightening of the pelvic floor or balance and coordination. There are too many variables to say that all perineal tears require xyz treatment to improve so you deserve to know what your body needs.
Postpartum can be a chaotic time with a ton of moving parts, but it is equally important to nourish mama postpartum as it was while pregnant. A few little things you can add is daily bone broth or collagen to help support the tissue repair. Many women also notice a benefit with short-term use of 1,000-3,000mg of Vitamin C with bioflavanoids (but if you have loose stools it is too much). Vitamin C is a key co-factor for collagen and helps with tissue healing.
Mama, I just want to remind you that you’ve got this. That’s not to say that it is easy, but I hope you are able to ask for help, find support and are on the road to recovery so you can enjoy your little one without pain.
References
Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstet Gynecol Scand. 2010;89:1511–1522. doi: 10.3109/00016349.2010.526188.