Throughout your pregnancy, you’ll probably hear your perineum being mentioned a lot.
Whether it’s around mastering the art of perineal massage in preparation for labour, or contemplating the (slightly scary but not uncommon) thought of perineal tearing, this tiny part of your body becomes quite a big deal ahead of, and during birth.
Sometimes, lumps can appear either right on or just near the perineum — particularly during pregnancy or postpartum. In some cases, these lumps aren’t cause for concern, but in others, they may be painful and need attention.
Here’s what you need to know about perineum lumps before and after birth, as well as how to treat them.
First things first, what is the perineum?
The perineum is a small area between your vagina and anus. You can probably locate it pretty easily, and once you do, the patch often feels a little sensitive.
The perineum might seem like it doesn’t play much of a role, but it really does. Underneath the skin and flesh over your perineum is a network of nerves, tissue, and blood vessels that support and strengthen your pelvic floor [1].
The perineum also helps control bladder and bowel movements, as well as your reproductive system.
Understanding perineum lumps after birth
Childbirth is no mean feat. It’s a huge thing for your body to go through, not least your perineum.
Because this area undergoes so much stress during vaginal birth, it’s no surprise that it can come out the other side looking and feeling a little worse for wear.
You’ll likely feel very sore down there in the weeks following birth, partly thanks to the incredible force placed on your pelvic floor and perineum.
This kind of strain can cause some rather unpleasant side effects like pain, swelling, bruising, or even bleeding.
It can also lead to lumps on or around your perineum if the blood pools under the skin, or if there's another kind of perineal trauma [2].
What are the symptoms of a perineal lump?
If you suspect you’ve got a lump on your perineum, the most obvious symptom is a small bump or swelling in your perineal area. It may be painful or itchy to the touch, or it may not be.
You might be able to see the lump, or only feel it when you press your fingers on your perineum [3]. The area on or around the lump can also be red.
Along with these symptoms, you may also notice the following:
- Discharge from the lump, or even from your vagina or anus
- Bleeding
- Bruising around the lump
- Abnormal growths in your perineal area or a bulge under the skin
- Difficulty urinating
- Pain when you go to the toilet
- Bloody stools
What causes perineum lumps postpartum?
There are a few reasons why a perineum lump can appear after childbirth, and even before it. Here are some of the most common ones.
Pregnancy
As your bub gets bigger and bigger, more and more pressure is placed on your perineum and pelvic floor muscles — which can be downright uncomfortable and a potential cause of perineal lumps.
Particularly during the third trimester, when your baby is at its biggest, you might experience swelling around your perineum.
Varicose veins are another common cause of perineum lumps, and it’s estimated that around 18-22% of pregnant women get them [4].
These are small, raised bumps that are blue or purple in colour, and they often appear around your vulva as blood pools in the area [5].
While varicose veins typically don’t come with any pain, they can make your vaginal area feel full, and they can be itchy or even bleed [5]. And even though they’re a common pregnancy symptom, varicose veins can last until after childbirth.
Haemorrhoids
Another common occurrence during the later stages of pregnancy is haemorrhoids, which affect up to 1 in 4 women [6]. These are similar to varicose veins in that they’re caused by the pressure of your growing baby, but instead, they affect the veins around your anus [6].
Constipation — which is also very normal in pregnancy — and the consequent strain it causes when going to the toilet can exacerbate haemorrhoids.
Haemorrhoids are technically internal, but they can sometimes prolapse — meaning they appear as external lumps around the anal area or close to your perineum [7].
It’s worth noting that haemorrhoids can appear after pregnancy, too, especially following a vaginal birth (thanks to all that pushing).
Hematomas
A hematoma is a bit like a haemorrhoid in that it’s a collection of blood that pools and can often swell. More specifically, a perineal hematoma happens when blood pools in the tissue around your anus, often if a vein bursts or bleeds [7].
Like haemorrhoids, perineal hematomas can appear as small lumps. The difference with perineal hematomas is that they’re always outside the anus, never inside.
You may spot haemorrhoids on the external parts of your anus or near your perineum, but this is usually because they have temporarily dropped from inside your body.
Perineal tearing
The process of childbirth is full-on (to say the least) and as we know, it puts a lot of strain on your perineum. This can lead to your perineum being injured, particularly if you experience tearing. Lumps can sometimes appear as a result of a perineal tear [8].
Know, though, that perineal tearing is incredibly common. More than 85% of women experience some degree of tearing, especially if it’s their first time giving birth [9][10].
There are different degrees of tearing, but quite often, the tear is pretty minor — only affecting the skin or muscles of your perineum and usually just requiring stitches.
Childbirth can also cause pelvic floor dysfunction, as the muscles around the area become strained and, as a result, difficult to relax. Instead, these muscles may tighten and/or contract involuntarily, which can cause lumps to appear.
Episiotomy
If your baby needs to come out quickly during the birth or if your health is at risk, you may undergo an episiotomy [11][12]. This is a small cut made in your perineum to give the baby more space.
While often a necessity to ensure both your and your baby’s well-being, recovering from an episiotomy can cause pain and come with all kinds of unpleasantries.
As the area heals, you can experience discomfort, pelvic pain, itchiness, swelling, and those aforementioned perineum lumps.
Should I see a doctor about perineum lumps?
If you’re ever worried about unusual perineal swelling, you can always chat with your doctor for advice.
They’ll perform a comprehensive diagnosis to get to the root of the issue, which may involve a complete physical exam, or even more extensive analysis like urine, blood, and imaging tests if the lump appears concerning.
Depending on the underlying cause, your doctor will advise on whether your lumps will require medical treatment, and if so, what the best treatment is for your circumstances.
If the lumps appear to be a relatively routine part of pregnancy or postpartum recovery, you might very well be able to apply at-home treatments (more on these below!).
Seeing immediate medical care is a good idea if you notice abnormal discharge, uncontrollable bleeding, difficulty or pain passing urine or a bowel movement, fever, nausea, or severe pain that's so bad that you can’t sit down [2].
Treating perineum lumps at home
We totally get it: perineum lumps can be downright frustrating.
The good news is that as long as your doctor has given you the all-clear, there are plenty of ways to treat them at home.
Stay cool
A cool compress, like Kin's Postpartum Soothing Padsicles, can do wonders for perineum pain and discomfort.
Not only does applying one to your perineum during postpartum feel bloody wonderful, but it can also relieve swelling and inflammation, and assist with recovery.
Remain elevated
When you’ve got pain down there, sitting can be a real chore.
If you’re back at work and perched at your desk all day, or at home dealing with breastfeed after breastfeed, a long stint of sitting can put a lot of pressure on your perineal area.
This is where a doughnut-shaped pillow, or one designed specifically for haemorrhoid relief, can really come in handy. It takes the strain off your perineum and makes sitting a heck of a lot more comfortable.
Sit in a sitz bath
Ever heard of a sitz bath? It’s a nifty little tub that sits snugly inside your toilet. You fill it with water and sit there for as long as you darn well want (you’ve just birthed a human, after all) to promote postpartum recovery.
You can also combine Kin's Sitz Tub with our specially formulated Sitz Bath Salts to boost its healing power. Together, these can relieve perineal swelling and itchiness, assist with constipation, and shrink haemorrhoids.
Read up about sitz baths in our helpful guide.
Keep your perineum clean
When your perineum is recovering from childbirth, you’ll want to keep the area very clean — especially if you’ve experienced tearing or if you’ve got an open wound.
A specially designed peri bottle filled with warm water and a postpartum healing solution will easily do the trick.
With Kin's ergonomically-designed Peri Bottle, you can gently spritz our Healing Foam over your perineum lumps to relieve swelling, itching, and pain, and to make sure the area stays clean.
Try a few lifestyle adjustments
On top of specific treatments for perineum lumps, you can make a few lifestyle tweaks to reduce the load on your perineal area, including:
- Adding more fibre to your diet and drinking plenty of water to minimise the risk of constipation
- Sticking to gentle exercise rather than going hard at the gym
- Wearing loose clothing — especially on your bottom half — to relieve pressure on your sore and tender perineum [6]
Can you take medication for perineal discomfort?
If the swelling and pain get too intense, taking over-the-counter medicine is an option, as long as it is safe and approved by your doctor. This is especially important if you're breastfeeding.
If you need something stronger, you may be given prescription pain medicine. For third and fourth-degree perineal tears, you may also have to take doctor-prescribed antibiotics.
How long does it take for a perineum lump to go away?
Depending on what’s caused the lumps on or around your perineum, they can take a few days to several weeks after birth to disappear [7][5].
In the meantime, try any or all of the above at-home treatments to relieve the unease associated with perineal lumps.
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