After you had your baby, your perineum may have been stitched to repair a tear or cut. The perineum is the area between your vagina and anus (back passage).
Occasionally these stiches come loose, leaving an opening or gap in your wound. This is called perineal wound breakdown. Usually this is due to an infection or pressure on the stitches caused by bleeding underneath the wound.
Symptoms of perineal wound breakdown
Symptoms of perineal wound breakdown include one or more of the following:
increase in perineal pain (difficulty walking or sitting)
yellow or green vaginal discharge
stitches which are loose or separated
feeling unwell, or flu like symptoms such as a high temperature
burning sensation or pain around the wound site when passing urine
presence of redness, hardness, or swelling around the wound.
Your Community Midwife will check your stitches for signs of infection. If they suspect an infection, they may swab your wound and send the swab to the laboratory to check this and to find out if any specific bugs are causing an infection.
What is the treatment?
Most women with perineal wound breakdown will be given a short course of antibiotics by your GP or obstetrician and advised to take painkillers such as paracetamol. It may also help to take anti-inflammatory pain relief such as ibuprofen which is safe to take whilst breastfeeding your baby.
If the infection is making you unwell, you may be referred to hospital for a course of intravenous antibiotics (via a drip). After this treatment, we will offer you an appointment in the hospital’s Perineal Health Clinic for ongoing support until your wound has fully healed.
Will the wound be re-stitched?
It is unlikely that we will re-stich your wound, especially if there is an infection, as this can trap the infection inside. Also, the infected tissue may not stitch back together well. Your midwife or GP will advise what is best for you.
What can I expect as the wound heals?
Perineal wounds that have broken down usually heal well with time. During the healing process, new tissue gradually forms in the gap where the stitches were. The healing timeframe varies from person to person and depends on the extent of the wound.
What can I do at home to help my wound to heal?
Try to keep the wound as clean and dry as possible.
Shower rather than soaking in a bath. Avoid using shower gel or soap on the wound. Only apply water to the wound.
After washing, let the wound dry naturally, do not rub it with a towel.
Change your sanitary pad regularly (2 hourly).
In the privacy of your own home, try to leave your underwear off at night and let the wound ‘air dry’.
Avoid constipation by drinking plenty of water and maintaining a healthy balanced diet including fruit and vegetables.
Regular pelvic floor exercises help healing by increasing blood flow to the wound.
Download the NHS Squeezy app for guidance on how to do these exercises (see the link below).
Will the wound cause me problems in the future?
Most women who experience a perineal wound breakdown have no further problems once the wound has healed. The wound will not break down again during exercise or sexual intercourse.
A perineal wound can ‘over heal’ leading to red patches of tissue called granulation tissue. Occasionally, this becomes uncomfortable and bleeds. It usually gets better with time and does not need treating.
However, if it does not improve or you are in significant discomfort, a perineal specialist midwife, consultant obstetrician or urogynecologist at the Perineal Health Clinic can treat it painlessly using silver nitrate. A midwife or doctor at the clinic will discuss whether this treatment is suitable for you.
What can I expect with future births?
If you experience a perineal wound breakdown once, it doesn’t mean you will experience this again with a future birth.
If you are worried about this during future pregnancies, tell your midwife or obstetrician and they can refer you to the Perineal Health Clinic. At the clinic, you can discuss your previous birth(s) and we will give you advice on ways to reduce the risk of perineal damage during childbirth.
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