Women's Health

How to care for a sore and itchy perineum after birth

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You've waited nine months in anticipation for your little bundle of joy to arrive in the world, but you maybe weren't quite so prepared for the impacts birth had on your vagina (and all its surrounding areas).

As you sit up in discomfort, you may wonder why none of your friends with children ever discussed the challenging journey of postpartum recovery. The answer: because stories about sore perineums, itchy skin, swollen vaginas and haemorrhoids aren't really dinner table conversation.

They're also pretty personal, so, if what happens after giving birth has taken you by surprise, you're not alone.

For many women who've had a vaginal birth, one of the unpleasant after effects can be a sore and itchy perineum – known in the medical world as anogenital pruritus.

This can happen for a number of reasons (which we'll discuss below), but the good news – and yes there is good news! – is that it doesn't last forever, and if you know how to care for it, you'll likely have a much faster recovery.

Let's start with the basics - What is a perineum?

Remembering back to high school biology days might be a stretch, so here's a quick recap.

For women, the perineum is the area of skin between the vagina and the anus. It connects with the muscles in the lower pelvis (the pelvic floor) that hold the pelvic organs in place. The pelvic organs include the bladder, uterus and cervix, vagina, and rectum.

In the six weeks leading up to birth, perineal massage is often recommended to stretch the perineum and to help reduce the risk of the skin tearing during a vaginal birth.

However, the unpredictability of childbirth, and the fact that you're squeezing a head the size of a melon out of your vagina, means that not all tears can be avoided.

Perineal tearing

More than 85% of women who have a vaginal birth suffer some perineal trauma, so it's more common that you might have thought.

Perineal tears are more likely to happen if:

  • It's your first time giving birth
  • Your baby is "sunny side up" (face up) during delivery
  • Your baby weights more than 3.6kg
  • You had an assisted birth, for example, using forceps

There are also varying degrees of tearing, ranging from a first-degree tear (the least severe) to a fourth-degree tear (the most severe).

In the most severe case, the tear extends from the vagina through to the anus. Ouch! Thankfully the chance of the latter is only about 1%.

The episiotomy

To prevent perineal tearing, doctors used to routinely make a cut through the perineum to allow the baby to be pushed out more easily - a procedure known as an episiotomy.

It was thought that this type of 'straight' cut to the skin would heal better than a natural tear and better preserve the perineal muscles and ligaments of the pelvic floor.

Today, however, research suggests that routine episiotomies don't prevent these problems after all, and may even make a woman more likely to develop a third- or fourth-degree tear. So today, episiotomies are only used when absolutely necessary.

In stitches

If you've had a tear, whether a natural one or from an episiotomy, stitches are often needed to help with the healing process.

There may be a combination of stitches of the external skin as well as internal stitches, depending on how severe the tear is. Thankfully, they use dissolvable ones, so you won't have to return to hospital to have them removed.

Any external stitches are usually dissolved within two-to-four weeks, and any deeper stitches can take up to three months.

While the 'stitching-up' process is usually pretty quick and straight forward, the few weeks following a perineal tear can be quite uncomfortable.

What causes a sore and itchy perineum after birth

General soreness and swelling of the vagina - and its surrounds – after birth, are a standard part of postpartum recovery.

After all, the area saw a huge increase in blood flow and fluid, and you did just squeeze out a tiny human!

One of the most common complaints from women is a sore and itchy perineum.

While an itching sensation on the skin down there is not generally a part of pregnancy that your friends will ever tell you about, it's something that doctors and midwives deal with on the regular, so it's nothing to be ashamed of.

Now, let's dive into what might be causing all the pain and itching.

The healing process

The healing process and the action of stitches dissolving can make the perineal skin itchy. While this type of itching is unpleasant, it will go away as the healing progresses with time.

Dry skin

Having a baby causes big fluctuations with your hormones, especially oestrogen and progesterone. The levels of these two hormones soar while you're pregnant and decline dramatically after you give birth.

A lack of oestrogen is responsible for many of the postpartum symptoms women experience, including vaginal dryness.

Dryness can make the tissue of the vagina thinner, less elastic and more prone to injury. It can also make the area inflamed, which may cause itching and burning.

Itchy lochia (postnatal bleeding)

Vaginal bleeding after birth is called lochia, and it's completely normal and necessary. It's made up of all the excess tissue and blood that lined your uterus while pregnant.

Many women think of it as a long period after birth, which lasts for up to six weeks. If the lochia gets left on your skin, it can cause itching and irritation until washed away. Read on for our remedies!

Perineal infection

A torn perineum can become infected, with or without stitches. You'll know if the area is infected if you experience red, swollen skin, pus or liquid oozing from the wound, persistent pain and an unusual smell.

The surrounding areas can become infected as well, including the uterus, which is known as a puerperal infection. With this type of bacterial infection, you may also experience fever, headache and pain in the lower abdomen.

If you have any of these symptoms, it's important to tell your doctor as soon as possible so you can treat it immediately.

More serious damage  

After a tear or an episiotomy, many women also experience nerve damage, pelvic disorders (such as urinary incontinence) and problems passing a stool. All of these issues can affect the perineum, leading to itching or burning.

If you have any of these more serious issues, it's important to see a doctor for proper diagnosis and specific treatment of your symptoms.

Haemorrhoids

Even if you managed to avoid haemorrhoids while pregnant, all that pushing during birth can cause them to occur.

Essentially, haemorrhoids are a painful swelling of the veins the anus (your back passage). They can range in size from a small raisin to a large grape and can occur inside the anus or protrude outside the anal opening. They can cause pain, itching and bleeding after a bowel movement.

They're pretty unpleasant and can make sitting down a difficult task. But for the most part, they're not serious and they tend to go away with attentive home treatments.

If they're persisting past six weeks, however, it's advisable to consult your doctor. Read up on our guide to treating postpartum haemorrhoids here.

Yeast infection

Also known as thrush or vaginal candidiasis, it's common to experience this within a few weeks after giving birth. It may be associated with antibiotics (often taken to prevent an infection after an episiotomy) or due to hormonal changes, of which there are many postpartum!

If you have a yeast infection, common symptoms include vaginal itching and soreness and a white vaginal discharge that resembles cottage cheese.

Like many women, you may have previously treated a bout of thrush with over-the-counter antifungal medications.

But if you're in the postpartum phase, it's best to check with your doctor first about the most appropriate treatment for you.

Best at-home treatments for a sore and itchy perineum

All that pain and itching will have you in need of some soothing, cooling and calming solutions.

Thankfully, there are plenty of home remedies to help you relieve itching and feel more comfortable down there.

Keep the area clean with a Peri Bottle

As soon as you get home, the most important thing is to keep your perineum clean to avoid infection.

The best way to do this is with a squirt bottle filled with warm water every time you use the bathroom.

Kin's Peri Bottle is made just for this. It's ergonomically designed to delicately clean your vagina without painful pressure. It'll also relieve any stinging caused when urine touches the wound. Once you're done, gently pat the area with toilet paper or a baby wipe. Don't rub.

Kin's Peri Bottle
Avoid infection with Kin's Peri Bottle.

Take a sitz bath

Whether it’s itchy stretched skin, haemorrhoids or a torn perineum, using a shallow mini-tub called a Sitz Bath along with Sitz Salts can help you ease itching and heal at home.

Kin's Sits Tub fits neatly over the toilet seat and allows you to soak the perineal area for cleansing and pain relief. Its a mess-free set up and super easy to use.

Kin's Sitz Bath
Ease itching at home with a sitz bath.

Change pads regularly

Change your maternity pads every 2-4 hours and avoid using sanitary pads made for periods as they can cause friction and discomfort.

Also, remember to wash your hands before and after changing the pad to reduce any chances of infection.

Apply a cool compress

To soothe burning and pain in the perineal area, apply an ice or gel pack wrapped in a clean towel. Alternatively, try Kin's Soothing Padsicles.

They're a super handy 2-in-1 pad and ice pack, so you can soothe your most vulnerable bits while preventing leaks.

They're also approved by Australian OBGYNs, so you can rest easy knowing they're safe to use.

Kin's Soothing Padsicle
Kin's Soothing Padsicles come in a pack of 14.

Apply a soothing solution

Witch Hazel is a herbal remedy that's widely known for its ability to ease inflammation and soothe sensitive skin. For relief from a sore perineum and/or haemorrhoids, apply a maternity pad soaked in witch hazel between your legs.

You might also like to try Kin's Healing Foam. It uses Witch Hazel's healing properties, but in foam form, which is perfect for travelling with.

It can either be applied to the Soothing Padsicles or as gentle wash with the Peri Bottle.

Let the area breathe

Allow air to get to the affected area when possible to help with healing. When you can, lie on your bed without any trousers or underwear on, with a clean towel underneath you.

When you do wear underwear, make sure they're comfortable, breathable and washed in a non-irritating soap. Cotton is best.

Kin's Mesh Panties are perfect during this time. They're soft, stretchy and breathable, and they provide the ultimate comfort and support.

You can purchase them as part of our Postpartum Recovery Kit.

Make use of over-the-counter pain relievers and antihistamines

Over the counter pain relievers like ibuprofen can help alleviate perineal pain and discomfort.

An antihistamine can help with the itching, especially at night when itching tends to worsen.

Drink lots of water

Increasing your water intake and ensuring you're eating a healthy diet with plenty of fibre will help reduce constipation, which will help relieve pressure and pain in the perineal area.

The extra water will also help to dilute your urine so its less 'stingy' when you wee.

What to avoid

As with all injuries that need to heal, there are some things you should refrain from doing to help the healing process along. The following should be avoided:

  • Vigorous rubbing or cleansing of the anal area after a bowel movement
  • Using very hot water when taking a bath or shower
  • Using fragranced cleansers and perfumed soaps to clean the vaginal area  
  • Lots of physical activity, especially heavy lifting, pulling or pushing
  • Straining through your bowel movements
  • Tampon or menstrual cup use for the first six weeks after giving birth
  • Staying in sweaty clothing after exercise.

Know when to see a doctor

If at-home remedies haven't proven effective at minimising the discomfort of a painful and itchy perineum, or you've noticed signs of an infection – including swelling, more severe pain in the genital area, an unusual odour or any other symptoms that concern you – it's time to check in with your doctor for specific medical advice.

They'll be able to give you a physical examination of the area and provide an accurate diagnosis.

References

  1. Swamiappan, M. Anogenital Pruritus – An Overview, Journal of Clinical and Diagnostic Research, 2016.
  2. Nall, R. What Causes an Itchy Perineum and How to Treat It, Healthline, 2021.
  3. Pelvic organ prolapse, U.S. Department of Health & Human Services - Office on Women's Health, 2019.
  4. Anatomy of pregnancy and birth - perineum and pelvic floor, Health Direct - pregnancybirth&baby, 2020.
  5. Frohlich, J. Perineal care, BMJ Clinical Evidence, 2015.
  6. Vaginal Tears During Childbirth, Cleveland Clinic, 2020.
  7. Price, N. A third or fourth-degree tear during childbirth, Oxford University Hospitals - NHS, 2018.
  8. Galan, N. The Importance of the Perineum in Childbirth, verywell health, 2021.
  9. Episiotomy: When it's needed, when it's not, Mayo Clinic, 2020.
  10. Perineal Tear, Australian Birth Trauma Association, 2020.
  11. McIntire, F. et al., Meaningful Postpartum Advice Can Make a Difference, International Journal of Childbirth Education, 1995.
  12. Postpartum Vaginal Dryness, Healthline, 2020.
  13. What to expect, The Royal Women's Hospital, Victoria Australia.
  14. Episiotomy and perineal tears, NHS, 2020.
  15. Nicholls, E. Puerperal Infections, Healthline, 2016.
  16. What Causes an Itchy Perineum and How to Treat It, Healthline, 2019.
  17. Obstetrics & Gynecology: Obstetrics Division - Common Conditions: Constipation, University of Rochester Medical Center.
  18. Fletcher, J. What causes vulvar itching that is worse at night? MedicalNewsToday, 2019.