--- title: "Perineal tears and stitches: healing" description: "A plain guide to the degrees of tear, caring for stitches, signs of infection, and getting help with pain or bowel control." url: "https://myruva.co/learn/perineal-tears-and-stitches" language: "en-GB" topic: "After a birth" published: "2026-10-18" updated: "2026-10-19" author: "Ruva team" reading_minutes: 4 --- # Perineal tears and stitches: healing A plain guide to the degrees of tear, caring for stitches, signs of infection, and getting help with pain or bowel control. *Written and reviewed by the Ruva team · Updated 2026-10-19 · After a birth* ## Key points - The degree of a tear tells you which tissues are affected. - Wash the area with water and change pads often while the stitches heal. - Growing pain, new bleeding or pus can be signs the wound is opening up. - If you have trouble controlling your bowels after a deeper tear, specialist treatment can help. A first-degree tear affects the skin. Deeper tears can involve muscle. The degree tells you which tissues were hurt during the birth. Ask your midwife or doctor to explain what was repaired and what follow-up is planned. ## What the different degrees mean The perineum is the area between the opening of the vagina and the anus. It can tear as the baby stretches this area during birth. An episiotomy is a cut made by a healthcare professional through the wall of the vagina and the perineum. It can sometimes turn into a deeper tear. | Tear | Tissue affected | | --- | --- | | First-degree | Skin. These tears usually heal on their own. | | Second-degree | Skin and the muscle of the perineum. Stitches are usually needed. | | Third-degree | Reaches into the muscle that controls the anus, called the anal sphincter. | | Fourth-degree | Reaches further, into the lining of the anus or rectum. | Third- and fourth-degree tears are also called obstetric anal sphincter injuries (OASI). They are usually repaired in an operating theatre. Afterwards, care includes pain relief, antibiotics to lower the risk of infection, laxatives to make pooing easier and an offer of physiotherapy. Your prescriber or pharmacist can explain any medicines in your discharge plan. ## Keeping stitches comfortable Wash the area every day with water, change your pads often and wash your hands before and after using the toilet. RCOG advises not putting any products on the area while it heals. For discomfort after an episiotomy, the NHS suggests a cold pack wrapped in a towel. Don’t put ice straight onto your skin. Ask your midwife, doctor or pharmacist which pain relief suits you, especially if you’re breastfeeding. Stitches used to repair tears usually dissolve. RCOG notes that after an OASI repair, you may see small threads on a pad or in the bath. Pain that gets worse, new bleeding, pus or a gap you can see needs checking, even if you also notice loose threads. ## Peeing, pooing and pelvic floor care Pouring water over the area while you pee can ease stinging. Having a poo is unlikely to damage the stitches. Eat foods with fibre, such as fruit, vegetables and wholemeal bread, drink water and try not to strain. A footstool that lifts your knees above your hips may make it easier to go. RCOG advises starting pelvic floor exercises as soon as you can after birth. A physiotherapist can help you learn the right squeeze and help with bladder or bowel control. Ask them to show you if the movement is hard to feel. After an OASI, trouble holding in wind, sudden urges to poo or leaking poo are reasons to talk to your care team. Specialist treatment can include physiotherapy and, for some people, surgery. Tell the clinician what happens in everyday words. Include any effect on leaving the house or getting to a toilet. After a third- or fourth-degree tear, RCOG advises avoiding hard activity and heavy lifting for 4-6 weeks, then slowly doing more. Ask your care team how this applies to work, exercise and caring for others. If you have help at home, explain these limits when you talk about which jobs someone else can take on. ## Arrange a review if healing worries you Call 999 now (UK), 911 (US), or your local emergency number for confusion, very fast breathing, or skin that is blue, pale or blotchy. Contact your maternity unit (UK), obstetric clinician (US), or local urgent service now if you have a fever or feel more and more unwell while the wound heals, even if there’s no pus and the wound hasn’t opened. Contact your maternity unit or GP today in the UK, your obstetric clinician in the US, or your local doctor or midwife if the wound opens, the pain gets worse, or there is pus or a bad smell. A clinician can look at the stitches and may take a swab. An infected wound isn’t always stitched again straight away. The team will explain the options after examining it. RCOG describes a hospital follow-up 6-12 weeks after an OASI to check healing and bowel control. Bring up any pain that won’t go away, discomfort during sex or distress about the birth too. Ask who will arrange the appointment and how to contact the team before then. ## When to get help - **Emergency:** Call 999 now (UK), 911 (US), or your local emergency number for confusion, very fast breathing, or skin that is blue, pale or blotchy. - **Same day:** Contact your maternity unit (UK), obstetric clinician (US), or local urgent service now if you have a fever or feel more and more unwell while the wound heals, even if there’s no pus and the wound hasn’t opened. Contact your maternity unit or GP today (UK), your obstetric clinician (US), or your local doctor or midwife if the wound opens, the pain gets worse, or there is pus or a bad smell. - **Book an appointment:** Book a GP appointment (UK), see your doctor (US), or contact your local doctor or midwife for soreness that won’t go away, painful sex, or trouble controlling pee, wind or poo. ## Where you live Services and advice differ between countries. - **UK:** RCOG describes physiotherapy and hospital follow-up after a third- or fourth-degree tear. NHS England says you should be seen the same day if the wound opens up. - **US:** MedlinePlus advises contacting your clinician if pain around an episiotomy or tear gets worse, and asking about help with healing. - **Elsewhere:** Elsewhere, ask your doctor or midwife about having the wound checked and seeing a pelvic health physiotherapist. ## Sources 1. [Care of a third- or fourth-degree tear that occurred during childbirth (also known as obstetric anal sphincter injury OASI)](https://www.rcog.org.uk/for-the-public/browse-our-patient-information/care-of-a-third-or-fourth-degree-tear-that-occurred-during-childbirth-also-known-as-obstetric-anal-sphincter-injury-oasi/), Royal College of Obstetricians and Gynaecologists 2. [Episiotomy and perineal tears](https://www.nhs.uk/pregnancy/labour-and-birth/episiotomy-and-perineal-tears/), NHS 3. [Perineal wound breakdown](https://www.rcog.org.uk/for-the-public/perineal-tears-and-episiotomies-in-childbirth/perineal-wound-breakdown/), Royal College of Obstetricians and Gynaecologists 4. [Vaginal delivery - discharge](https://medlineplus.gov/ency/patientinstructions/000628.htm), MedlinePlus 5. [Your post-pregnancy body](https://www.nhs.uk/baby/support-and-services/your-post-pregnancy-body/), NHS 6. [Implementation guidance: Perinatal pelvic health services](https://www.england.nhs.uk/long-read/implementation-guidance-perinatal-pelvic-health-services/), NHS England 7. [Sepsis](https://www.nhs.uk/conditions/sepsis/), NHS 8. [When to use the emergency room - adult](https://medlineplus.gov/ency/patientinstructions/000593.htm), MedlinePlus --- This guide is general information to help you keep and use your own records. It isn’t medical advice. If you’re worried about a symptom, or something changes suddenly, talk to a doctor, nurse or pharmacist.