How should my stitches feel after the birth?

Should my stitches feel uncomfortable after the birth or during intercourse?

If you have stitches after the birth of your baby, it is not unusual for them to feel uncomfortable initially, but this pain or discomfort should not continue long term.

Initially stitches may mean that your perineum area may also be swollen or bruised. Using ice pads or packs in the first 24 to 48 hours and sometimes longer can help to reduce the swelling and can make you feel more comfortable. As charming as it sounds putting ice over your perineum area, it really does make a difference to how you feel. Ice pads or packs can be used regularly while in hospital in those initial few days. They can be easily made at home if you do continue to need them. Simply dampen a sanitary pad with a little bit of water, and place it in the freezer until you need it. These can only be used once, for hygiene reasons, as you are usually still bleeding at this stage.

Starting your pelvic floor muscle exercises will actually help your stitches to heal. Make sure that you are doing your exercises properly. Refer to How NOT to do your Pelvic Floor Exercises or get your Midwife or Physiotherapist to check for you if you are unsure. The exercises will help to improve the circulation in the perineal area, which can help to reduce the swelling. Providing you are doing your exercises correctly, they will not place any strain on your stitches, as doing your exercises lifts your perineum upwards. Often women think that it will hurt to do the exercises, but it actually helps and usually feels quite comfortable to do. Just start gently and it will also help your pelvic floor muscles to recover more quickly after the birth. Doing your exercises 'little and often' at this stage can be more helpful than doing a lot in one session.

While in hospital or in those early weeks at home, ultrasound treatment by a Physiotherapist can help to reduce the swelling and tenderness around the stitches. This usually makes a difference to how you feel quite quickly, so if you do have ultrasound available, make the most of the opportunity to have this done. It does not hurt during the treatment either, and is actually quite soothing because of the cold gel that is used.

Everyone heals and scars differently. As you can imagine having a scar at your vaginal opening means it is in quite a sensitive area. Normally your vaginal opening is quite supple and stretches easily. Sometimes a scar can mean that it doesn't stretch so easily, so when you start to try and make love again, it can be sensitive and sometimes uncomfortable. Some couples are unable to actually start intercourse because of the discomfort from the scar site, whereas others may be able to continue, but it is not comfortable for the woman during intercourse. Sometimes discomfort can be felt over the scar tissue from the stitches after intercourse. If any of this happens, it is NOT normal, although it is common, and you should not continue to put up with the pain.

Sometimes there is a little bit of discomfort initially and then it gets less with each time you try making love. If this occurs, it is likely that it will get better by itself. But if the pain continues, or intercourse is 'no go' because of the pain, you should seek further advice and treatment.

Something you can try yourself at home is perineal massage, which you may have heard about in Antenatal Classes or read about in pregnancy books. You can try massaging over the scar, starting gently and pressing as hard as you can tolerate, using some sort of lubrication gel or natural oil to massage with. If you cannot tolerate the massage, or it does not get better after a few weeks, you should seek advice from a Physiotherapist working in the area of Women's Health.

A Physiotherapist can use ultrasound which can be applied directly over the scar at the opening of the vagina, and over any tender area of the scar. Again, it sounds charming and also embarrassing thinking about this, but it is a treatment that works really well. The ultrasound softens and breaks down the scar tissue, and over a course of treatments, the scar tissue becomes less painful and stretches more easily. Perineal massage is sometimes easier to do after the ultrasound, so that you can do this at home between treatments to help speed the recovery process along. It is better to have treatment which will sort out the problem, rather than to be put off intercourse because you know it is going to hurt. There are enough other factors like having a new baby in the house, and being more tired, that make intercourse a challenge for new parents.

Sometimes the scar tissue from stitches can hurt with just sitting down, or with going to the toilet, particularly to use your bowels. The scar rubbing against your underwear may also be uncomfortable at times. If this occurs, ultrasound in those first few weeks or months can help to reduce the sensitivity and discomfort.

If you think that your scar might hurt when you try intercourse, you can have some ultrasound treatment before you even try. Then you will know that you are going to be comfortable, and there is more chance of relaxing when you do try.

Don't continue to put up with this problem long term. It is not good for you or your relationship. Cary (not her real name/story used with permission) started trying intercourse when her baby was a few months old, but was unable to due to the pain at the vaginal opening and just inside, which she thought was from her stitches. She left it 6 months before seeking advice and treatment from a Physiotherapist. Within a few weeks of treatment, the problem had resolved and they were able to successfully make love with no pain.

Continuing with your pelvic floor exercises at this stage is still important. They will help to improve the circulation in the area, and will also help to keep on strengthening your muscles after the birth.

To learn more about your pelvic floor get our NEW e-booklet The Pregnancy and Postnatal Pelvic Floor Connection PregnancyPelvicFloor-Border.jpg

Physiotherapist's Note:

Women have sometimes put up with pain for longer, even up to a year or more, because:
• They didn't know that intercourse shouldn't be painful after having a baby.
• They didn't realize that it wasn't normal or were told that the pain would go away.
• They were too embarrassed to come in for treatment and just hoped that the problem would go away by itself.
• They just didn't know that treatment was available.

It is hoped that this article will encourage you to seek help early if you need it, rather than continue to put up with pain and discomfort, like women have in the past. Also, please advise any friends who have had a baby and mention that treatment is available, as they may not know that they can do something about this problem.


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