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Postpartum Perineal Care (cont.)

Care at Home

After delivering the baby, the perineum must be kept clean. Lochia may drain for up to four weeks, so pads should be changed frequently.

  • Do not use tampons after delivery. Tampons may cause an infection.
  • Take a bath or a shower once or twice daily. A sitz bath can be used after every bowel movement. A sitz bath involves sitting in shallow water, only deep enough to cover the hips and buttocks.
  • Urinating can be painful after delivery. Squirting warm water over the perineum during urination may ease the pain. When finished urinating, gently pat the perineum dry.
  • Cold sitz baths help reduce swelling and discomfort after delivery. Sit in a lukewarm or room temperature bath, and then gradually add ice cubes to the water. This prevents the uncomfortable, sudden sensation of ice water on the skin. Soak for 20 minutes at a time, up to three to four times a day. After the first two to three days, warm sitz baths will improve blood flow to the perineum. Check with your physician before adding medications such as epsom salts to the bath. An alternative may be ice placed in a sealed plastic bag.
  • Hemorrhoids are enlarged veins in the wall of the anus. They frequently occur during pregnancy and often go away without treatment after delivery. Hemorrhoids may bleed after bowel movements. If the hemorrhoids are painful, steroid suppositories may lessen the discomfort.
  • Stay well hydrated by drinking plenty of water. Straining with bowel movements will stretch the episiotomy scar and perineum and can cause pain. Avoid constipation by eating fiber-rich foods such as fresh fruits and vegetables. If you do get constipated, you can gently push up on your perineum as you bear down gently.
  • Using an inflatable “doughnut” cushion when sitting or lying down may help reduce pull on the episiotomy scar.
  • Kegel exercises strengthen and tone pelvic muscles and lessen perineal pain. Kegel exercises are small movements of the vaginal muscles similar to the movement you make if you are trying to stop urinating.
  • If you are not allergic to acetaminophen (Tylenol) or ibuprofen (Motrin), you can take them to help control your pain. Both drugs are safe for a mother who is breastfeeding. Ibuprofen in particular is very helpful for episiotomy pain and postpartum uterine pain.
  • Avoid sexual intercourse until you have no more perineal pain. Most health care providers recommend pelvic rest until four weeks after delivery, but there are no clear guidelines. If you need to use a lubricant for sex, make sure it is water-soluble.

Read What Your Physician is Reading on Medscape

Pregnancy, Postpartum Infections »

Emergency physicians are increasingly concerned about postpartum patients who come to the ED with a fever or evidence of infection.

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