Symptoms and Signs of Postpartum Perineal Care

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 9/10/2021

Doctor's Notes on Postpartum Perineal Care

The perineum is the area between the urethra and the anus. In women, this are includes the vaginal opening. The perineum undergoes stress and change during pregnancy and delivery, and it needs special care afterward. Some women have the perineum surgically cut (episiotomy) when they deliver a baby. Other women perform perineal massage during their pregnancy to prevent pain and other problems after delivery.

Symptoms of injury to the vagina and the perineum during delivery may include

  • pain,
  • swelling,
  • bruising, or
  • a collection of blood under the skin (hematoma).
  • Small hematomas may go away on their own.
  • Larger hematomas may need to be drained.
  • Tears in the tissues (lacerations) may heal on their own or need to be repaired by suturing.

The episiotomy will scar as it heals. After giving birth there will be some vaginal discharge called lochia that will be red at first and gradually become white, or clear like mucus.

What Is Postpartum Perineal Care?

After delivering a baby, the perineum must be kept clean. Episiotomy scars need to be kept clean and closely monitored for infection. Small amounts of bleeding may happen for several days from the perineum area. Also, lochia may drain for up to four weeks, so pads should be changed frequently. 

Things that can be done to help the perineum heal and decrease symptoms after delivery include:

  • Drink lots of fluids to avoid dehydration which can make bowel movements harder
  • Eat fiber rich foods to avoid constipation
  • Cold sitz baths help reduce swelling and discomfort after delivery
  • Take a bath or a shower once or twice daily, especially after a bowel movement (a sitz bath can help with this as well)
  • Ice packs or cool compresses to the area as tolerated
  • Cleanse hemorrhoids and apply topical steroid cream to soothe the area
  • Do not use tampons
  • Avoid heavy lifting or strenuous lifting for a few weeks (talk to your doctor about when to start exercising again)
  • Over-the-counter (OTC) pain medications such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil) may be used
  • Use Kegel exercises to restrengthen the muscles in the area of the vagina and perineum

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.