Perineal Tear or Episiotomy After Birth: Healing and Warning Signs
A tear or episiotomy can cause soreness while the perineum heals. Learn how to care for stitches, what different tear degrees mean, when bowel or bladder symptoms need review, and which wound changes deserve prompt medical advice.
In this guide
What a tear or episiotomy means after birth
The perineum is the area between the vaginal opening and anus. A tear can range from a small skin injury to a deeper injury involving muscle; an episiotomy is a cut made by a clinician during birth. Ask your birth team which type you had and whether it was repaired, especially if you have pain or bowel-control changes.
Ask for the tear degree and repair details
First-degree tears affect skin; second-degree tears extend into perineal muscle. Third-degree tears involve the muscle around the anus, and fourth-degree tears extend into the lining of the anus or rectum. These deeper injuries are also called obstetric anal sphincter injuries (OASI) and need a specific follow-up plan. Ask for the birth or discharge note if you are unsure which description applies.
Know that soreness can happen while tissue heals
Tenderness, swelling and discomfort with sitting or moving can follow a vaginal birth, with or without stitches. Recovery varies. A trend toward improvement is reassuring, but severe pain or pain that is increasing deserves assessment. You do not need to tolerate pain silently to prove you are recovering well.
Understand why an episiotomy may have been done
An episiotomy is not automatically required for every vaginal birth. It may be considered when an assisted birth is needed or the baby needs to be born quickly. You can ask what happened, why a cut was recommended in your case and what was repaired; those questions remain valid after birth.
| Birth / repair date | Tear degree or episiotomy | Pain trend | Wound changes | Bowel / bladder symptoms | Follow-up plan |
|---|---|---|---|---|---|
Gentle wound care and everyday comfort
Use the discharge instructions from your maternity team, because the right plan depends on the injury and repair. Keep the area clean and dry, change pads regularly and ask before using creams, antiseptics or pain medicines, especially if you are breastfeeding.
Clean gently and follow the stitch instructions
A warm shower or bath with plain water and careful patting dry is a common NHS recommendation for stitches. Wash your hands before and after changing a pad. Stitches often dissolve as the wound heals, but your own clinician can explain what to expect and whether a check is needed.
Ask which pain relief and local care are suitable
Tell the clinician if you are breastfeeding, have allergies or take other medicines before using an over-the-counter painkiller, cream or ointment. Avoid inserting products or applying home remedies to the wound unless your care team recommends them. Ask whether a wrapped cold pack or another comfort measure is suitable for your repair.
Protect bowel and bladder comfort
Drink fluids and try not to strain when passing stool. A clean pad held gently against stitches may feel supportive. If you cannot urinate, have severe stinging, ongoing constipation, stool leakage or loss of control of wind, contact your clinician rather than assuming it is part of normal healing.
When to call about the wound or a deeper tear
Get clinical advice for signs of infection, a wound that may be opening, pain that is getting worse, or new bowel-control problems. A third- or fourth-degree tear should come with a planned review and instructions about who to contact if symptoms change.
Call promptly for worsening pain or infection signs
Increasing stitch pain, red or swollen skin, pus or other fluid from the wound, an unusual smell or persistent pain can signal a problem. Contact your maternity unit, doctor or midwife as soon as possible. Fever or feeling seriously unwell needs urgent assessment.
Seek urgent advice for stool or wind passing through the vagina
If stool or wind appears to come through the vagina after birth, seek urgent medical care. This is not an expected effect of stitches and needs prompt assessment. Also report new trouble holding stool or wind after a deep tear, even if it feels embarrassing; specialist support is available.
Keep the follow-up appointment after a severe tear
After OASI, follow-up can review healing, pain, bowel or bladder control, emotional wellbeing and options for a future birth. Ask whom to contact if the appointment is delayed and whether a pelvic-health physiotherapist or specialist clinic is available locally.
Perineal tears and episiotomy: frequently asked questions
Will opening my bowels break the stitches?
NHS guidance says it is very unlikely that passing stool will break stitches or reopen the cut. Try not to strain and ask your midwife or doctor about constipation that does not improve or if you have a severe tear.
How long do stitches take to heal?
Healing time varies by the depth of the injury and your health. Some NHS patient information says many episiotomy stitches heal within about a month, but a deeper tear may need longer follow-up. Ask your own team what timeline applies to your repair.
Is pain with sex after a tear common?
Pain can happen while tissue heals, but you do not have to continue penetration through pain. Wait until you feel ready, and ask for an assessment if pain persists, worsens or affects your wellbeing.
Can a severe tear affect a future birth?
Many people have a later vaginal birth after a severe tear, while ongoing bowel symptoms or other circumstances may change the discussion. Ask for an individual review with an obstetrician and include your preferences in future birth planning.
Words you can use
Ask for a wound and tear review
You are unsure what repair you had or symptoms are not improving
“I gave birth on [date] and had [stitches / a cut / a tear, if known]. The pain is [improving / unchanged / worse], and I have noticed [wound, bowel or bladder symptom]. Can you check the repair, tell me the tear degree and explain whether I need an appointment today?”
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Sources and publication record
Clinical sources checked 28 September 2026; medical and human Hindi editorial review pending · Sources checked .
- Episiotomy and Perineal TearsNational Health Service, United Kingdom
- Care of a Third- or Fourth-Degree Tear after Childbirth (OASI)Royal College of Obstetricians and Gynaecologists, United Kingdom
- Your Post-Pregnancy BodyNational Health Service, United Kingdom