Dissolving stitches after birth
Episiotomy and perineal tears - NHS
Sometimes a doctor or midwife may need to make a cut in the area between the vagina and anus (perineum) during childbirth. This is called an episiotomy.
An episiotomy makes the opening of the vagina a bit wider, allowing the baby to come through it more easily.
Sometimes a woman's perineum may tear as their baby comes out. In some births, an episiotomy can help to prevent a severe tear or speed up delivery if the baby needs to be born quickly.
If your doctor or midwife feels you need an episiotomy when you're in labour, they will discuss this with you. In England, episiotomies are not done routinely.
Non-urgent advice: Call your midwife or GP if you've had an episiotomy or tear and:
- your stitches get more painful
- there's smelly discharge
- there's red, swollen skin around the cut (incision) or tear – you can use a mirror to have a look
Any of these may mean you have an infection.
Up to 9 in 10 first-time mothers who have a vaginal birth will have some sort of tear, graze or episiotomy.
The National Institute for Health and Care Excellence (NICE) recommends that an episiotomy might be done if:
- the baby is in distress and needs to be born quickly, or
- there is a need for forceps or vacuum (ventouse), or
- there is a risk of a tear to the anus
Around 1 in 7 deliveries in England involves an episiotomy.
If you have a tear or an episiotomy, you'll probably need stitches to repair it. Dissolvable stitches are used, so you will not need to return to hospital to have them removed.
Why you might need an episiotomy
An episiotomy may be recommended if your baby develops a condition known as foetal distress, where the baby's heart rate gets faster or slower before birth.
This means your baby may not be getting enough oxygen and has to be delivered quickly to avoid the risk of birth injuries or stillbirth.
Another reason for an episiotomy is because it's necessary to widen your vagina so instruments, such as forceps or ventouse suction, can be used to help with the birth.
This may be necessary if:
- you're having a breech birth, where the baby is being born with their bottom or feet first
- you have been trying to give birth for several hours and are now tired after pushing
- you have a serious health condition, such as heart disease and it's recommended that delivery should be as quick as possible to reduce further health risks
Research shows that in some births, particularly with forceps deliveries, an episiotomy may prevent tears that affect the anal muscle (third-degree tears).
How an episiotomy is done
An episiotomy is usually a simple procedure. A local anaesthetic is used to numb the area around the vagina so you do not feel any pain. If you have already had an epidural, the dose can be topped up before the cut is made.
Whenever possible, the doctor or midwife will make a small diagonal cut from the back of the vagina, directed down and out to one side. The cut is stitched together using dissolvable stitches after the birth.
Recovering from an episiotomy
Episiotomy cuts are usually repaired within an hour of your baby's birth. The cut may bleed quite a lot at first, but this should stop with pressure and stitches.
Stitches should heal within 1 month of the birth. Talk to your midwife or obstetrician about which activities you should avoid during the healing period.
Coping with pain
It's common to feel some pain after an episiotomy.
Painkillers such as paracetamol can help relieve pain and is safe to use if you're breastfeeding.
It's also thought to be safe to take ibuprofen while you're breastfeeding, but check with your doctor first.
Aspirin is not recommended as it can be passed on to your baby through your breast milk. Your midwife will advise you if you're not sure what painkillers to take.
It may be necessary to treat severe pain with stronger prescription-only painkillers, such as codeine.
However, prescription-only medicine may affect your ability to breastfeed safely. Your GP or midwife can advise you about this.
To ease the pain, try:
- placing an ice pack or ice cubes wrapped in a towel on the cut.
Avoid placing ice directly on your skin as this could cause damage
Exposing the stitches to fresh air can help the healing process. Taking off your underwear and lying on a towel on your bed for around 10 minutes once or twice a day may help.
It's unusual for pain after an episiotomy to last longer than 2 to 3 weeks. If the pain lasts longer than this, speak to a doctor, health visitor, or another health professional.
Going to the toilet
Keep the cut and the surrounding area clean to prevent infection. After going to the toilet, pour warm water over your vaginal area to rinse it.
Pouring warm water over the outer area of your vagina as you pee may also help ease the discomfort.
You may find squatting over the toilet, rather than sitting on it, reduces the stinging sensation when peeing.
When you're pooing, you may find it useful to place a clean pad on the cut and press gently.
This can help relieve pressure on the cut.
When wiping your bottom, make sure you wipe gently from front to back. This will help prevent bacteria in your anus infecting the cut and surrounding tissue.
If you find pooing is particularly painful, taking laxatives may help. This type of medicine is usually used to treat constipation and makes poo softer and easier to pass.
For more information, read about treating constipation.
Pain during sex
There are no rules about when to start having sex again after you've given birth.
In the weeks after giving birth, many women feel sore as well as tired, whether they've had an episiotomy or not. Do not rush into it. If sex hurts, it will not be pleasurable.
If you've had a tear or an episiotomy, pain during sex is very common in the first few months.
If penetration is painful, say so. If you pretend everything is OK when it is not, you may start to see sex as a nuisance rather than a pleasure, which will not help you or your partner.
You can still be close without having penetration – for example, through mutual masturbation.
Pain can sometimes be linked to vaginal dryness. You can try using a water-based lubricant available from pharmacies to help.
Do not use an oil-based lubricant, such as Vaseline or moisturising lotion, as this can irritate the vagina and damage latex condoms or diaphragms.
You can get pregnant just 3 weeks after the birth of a baby, even if you're breastfeeding and your periods have not started again.
Use some kind of contraception every time you have sex after giving birth, including the first time (unless you want to get pregnant again).
You'll usually have an opportunity to discuss your contraceptive options before you leave hospital (if you've had your baby in hospital) and at the postnatal check.
You can also talk to a GP, midwife or health visitor, or go to a contraception clinic at any time.
Find sexual health services near you.
Infection
Look out for any signs that the cut or surrounding tissue has become infected, such as:
- red, swollen skin
- discharge of pus or liquid from the cut
- persistent pain
- an unusual smell
Tell a GP, midwife or health visitor as soon as you can about any possible signs of infection so they can make sure you get the treatment you might need.
Exercises
Strengthening the muscles around the vagina and anus by doing pelvic floor exercises can help with healing and will reduce the pressure on the cut and surrounding tissue.
Pelvic floor exercises involve squeezing the muscles around your vagina and anus as though to stop yourself from going to the toilet or farting.
A midwife can explain how to do the exercises. You can also read more about pelvic floor exercises on our page about exercise in pregnancy.
Scar tissue
For a few women, excessive, raised or itchy scar tissue forms around the place where a tear happened or where an episiotomy was done. If your scar tissue is causing problems for you, tell your doctor.
Preventing a perineal tear
A midwife can help you avoid a tear during labour when the baby's head becomes visible.
The midwife will ask you to stop pushing and to pant or puff a couple of quick short breaths, blowing out through your mouth.
This is so your baby's head can emerge slowly and gently, giving the skin and muscles of the perineum time to stretch without tearing.
The skin of the perineum usually stretches well, but it may tear, especially in women who are giving birth for the first time.
Massaging the perineum in the last few weeks of pregnancy can reduce the chances of having an episiotomy during birth.
The type and frequency of massage varies across research studies. Most involve inserting 1 or 2 fingers into the vagina and applying downward or sweeping pressure towards the perineum.
The most benefit was in women who repeated this every day.
Episiotomies & Stitches After Birth | How To Heal & Care
Will I need stitches?
It’s perfectly natural to be a little nervous about requiring stitches after birth, try not to worry. Everyone’s different and not all women need them. If you need any extra advice or reassurance about stitches, don’t be afraid to speak to your midwife or GP.
Why might I need stitches after giving birth?
In order to give birth, your body needs to adapt by doing a fair amount of stretching.
The area between your vagina and back passage (known as your perineum) may over-stretch during delivery. This area is particularly vulnerable to possible tearing because it’s the part of your body that is placed under most stress as you push out your little one.
If your baby is in the breech position (which means their little head is not coming out first) or they require the use of forceps, they might be in distress and need to be delivered quickly, and this can also cause tearing. Or, you may need an episiotomy to help make room for your baby and prevent this from happening.
Your doctors might have had to make a small cut to your perineum (this procedure is called an episiotomy) to help make room for your baby.
You'll also need stitches if you have a Caesarean.
Regardless of why you may need stitches, the most important thing is that you understand how to care for them and help them heal.
What’s an episiotomy and why might I need one?
An episiotomy is when your midwife makes a small cut in your perineum to prevent you from tearing, or to speed things up if your baby needs to be delivered quickly.
A local anaesthetic is used to numb the area to stop you feeling any pain.
How long do stitches take to heal?
The length of time stitches take to heal will depend on the reason you need them. It tends to take between 2 and 4 weeks for stitches between the vagina and back passage (perineum) to heal, but everyone is different and you may find it takes longer.
Episiotomy stitches will usually heal in the first month or so after the birth of your little one, but be prepared for potential bruising and swelling, both of which are very natural.
If you’ve had stitches due to a Caesarean, you’ll generally heal in around 6 weeks, but again it’s not unusual in certain cases for this to take up to 12 weeks.
What makes a tear more likely during labour?
Every womans's body reacts differently to labour, and it is hard to determine if you're more likely to tear while giving birth. However, the following factors could make you more prone to tearing:
- If this is the first baby you've have had vaginally.
- If the pushing stage of your labour goes on for longer than expected.
- If your baby is born in the breech position.
- If your baby is born with the help of forceps or ventouse.
- If you've had tearing before.
- If your baby weighs more than 4kg.
How will the stitching be done?
For minor tears, you'll usually be stitched in the room where you gave birth. Your midwife will use a local anaesthetic to numb the area and will carefully stitch up the tear using a ‘running stitch’. Most maternity wards will use dissolvable stitches so there's no need to have them removed.
For more severe tears, you might be taken to an operating theatre, where you'll be given a local or general anaesthetic and a doctor will stitch the cut.
If you’re planning on having a home birth, then speak to your midwife about your options.
How long do stitches take to heal after giving birth?
The length of time stitches take to heal will depend on the reason you need them.
It tends to take between 2 and 4 weeks for stitches between the vagina and back passage (perineum) to heal, but everyone is different and you may find it takes longer.
Episiotomy stitches will usually heal in the first month or so after the birth of your little one, but be prepared for potential bruising and swelling, both of which are very natural.
If you’ve had stitches due to a Caesarean, you’ll generally heal in around 6 weeks, but again it’s not unusual in certain cases for this to take up to 12 weeks.
Episiotomy stitches care
The best way to care for your stitches is to keep them clean and dry. Try to wash your perineum using warm water every time you visit the loo and gently pat the area dry using toilet tissue. You should also aim to change your sanitary pad regularly to keep the area dry and comfortable.
How to soothe the pain caused by stitches after giving birth
Stitches after tearing during labour or an episiotomy can be quite sore at first, but there are some things you can do to help soothe the pain.
Cool temperatures will both ease the pain and help reduce swelling in the area. One way of doing this is to sit in a shallow bath of cold water – just make sure you pat your stitches dry with a clean towel afterwards. You can also use a cold gel pack wrapped in a clean flannel, but don’t leave it on for more than half an hour, and wait an hour between applications.
Painkillers will help to ease discomfort. It’s a good idea to talk to a doctor about the best painkillers for you, as some are not suitable for use when breastfeeding.
It can also be painful when you go for a poo, so try placing a clean pad over the cut and press gently as you pass the stool. And if urinating is painful, try going in the shower or pouring warm running water over the area to ease the stinging.
If you are finding it painful to sit, you could try using a Valley Cushion. These are specially designed inflatable cushions that make sitting down a little more comfortable.
Many new mums who’ve had stitches find sex painful for the first few months.
If this is the case, talk to your partner and take as long as you need to heal before having sex again. You shouldn’t feel any pressure in this department.
How to heal stitches faster after giving birth
It really helps to keep the area clean and dry. One way to do this is to give yourself a quick wash with a spray bottle full of water. Simply squirt a few times a day and dry yourself gently. It’s also a good idea to wipe your bottom gently from front to back to reduce the risk of infection.
If you do pelvic floor exercises as often as you can, you will increase blood flow to the area and encourage healing.
Eat plenty of fibre and stay hydrated with lots of water to avoid constipation, so you’re less likely to need to push when you go to the loo.
Lastly, change your sanitary pad regularly and make sure it doesn’t rub against your stitches.
What should I do if I feel there is a problem with my stitches?
Sometimes, regardless of how well you look after them, there can be complications with stitches.
If you experience pain, excessive discomfort or any of the symptoms below, it’s best to speak to your GP or midwife as soon as possible:
- Unusual pain or a bad smell in the area.
- High temperature.
- Severe lower abdominal pain.
- A burning or intense stinging pain when weeing.
- Having to rush to the toilet with the urge to poo.
- Being unable to control your bowels when passing wind.
- Bleeding more than you’d expect, or passing clots.
The most important thing is that you rest and heal, so try not to expect too much of yourself while you wait for the tear to get better. Remember to put your feet up, but still move around occasionally to ensure you’re getting blood to the area to help with healing.
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Last reviewed: 31st August 2020
Reviewed by Nutricia’s Medical and Scientific Affairs Team
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Absorbable sutures for recovery from episiotomies and ruptures during labor
Approximately 70% of women experience some degree of perineal injury during vaginal delivery, either as a result of rupture or incision (episiotomy), requiring subsequent suturing. These injuries can lead to pain in the perineum for up to two weeks after giving birth, and some women experience pain for an extended period and discomfort during intercourse. Perineal injuries have a negative impact on a new mother as she struggles to cope with hormonal changes and her baby's needs, and this can have a long-term impact on her sexual relationships. Most modern materials that are used for suturing the perineum are gradually absorbed and do not require removal. However, sometimes the stitches need to be removed by a doctor or midwife. A small number of perineal wounds separate (separation of sutures) or take a long time to heal, and for some of these wounds need to be re-sutured.
This review includes 18 randomized controlled trials involving 10,171 women and looks at catgut and synthetic materials used to close the perineum after childbirth. This review also includes a material that has recently been introduced and specifically designed to be more rapidly absorbed (resorbable). The main findings were that women who received synthetic sutures had less pain during the first three days postpartum and needed less pain medication for 10 days postpartum compared to women who received synthetic sutures.
catgut sutures. There was evidence that synthetic sutures did not always dissolve quickly and some women required their removal. When using standard absorbable synthetic materials, short-term and long-term pain in women was similar, and the sutures were faster to dissolve. However, in one clinical trial, fewer women who received fast-absorbing sutures reported using pain medication up to 10 days postpartum, and there was less need to remove these sutures. When comparing catgut and catgut impregnated with glycerol, the results were similar, however, the use of the latter was associated with shorter-term pain. One clinical trial looked at monofilament and standard synthetic sutures and there were small differences between the two materials in terms of pain and wound healing. As well as the type of material used, other factors such as the technique used in suturing (use of a continuous suture or a series of single stitches) and the experience and skill of the person performing the procedure can also influence the severity of pain and the healing of a perineal wound.
Translation notes:
Translation: Mamadzhanov Temur Shamsutdinovich. Editing: Yudina Ekaterina Viktorovna. Project coordination for translation into Russian: Cochrane Russia - Cochrane Russia (branch of the Northern Cochrane Center on the basis of Kazan Federal University). For questions related to this translation, please contact us at: [email protected]; [email protected]
how long internal and external sutures heal, how to process, why they hurt
Suturing is sometimes unavoidable during delivery. Doctors may perform surgery (caesarean section or episiotomy) or stitches for tears. "Komsomolskaya Pravda", together with the gynecologist, understands what complications are possible and what are the rules for caring for stitches after childbirth.
Type of sutures after childbirth
| Internal sutures | Placed on the cervix and vagina |
| External stitches | Placed directly on the perineum |
How long does it take stitches to heal after childbirth
Childbirth is a complex process.
And things don't always go smoothly. Tears, episiotomy, or even a full-fledged surgical intervention (caesarean section) are possible. All this requires suturing. Of course, only women who have given birth are interested in how long they will heal.
When performing a caesarean section, 2 types of sutures are applied (1):
- internal fix the cut edges on the wall of the uterus,
- external fix the skin of the abdominal wall.
- The process of suture healing during any intervention is directly related to the size of the wound surface, the correctness of care in the recovery period, the general condition of the woman's body, the methods and materials used for suturing, 一 says experienced obstetrician-gynecologist Alina Zhilich .
Internal sutures
For internal tears, the cervix is sutured and the vaginal walls are sutured. Pain during suturing is minimal because anesthesia is used. With a small intervention - local, with extensive gaps - general.
- When suturing the perineum, self-absorbable threads can be used - it will take about two weeks to heal, on average 7-10 days, says Alina Zhilina. - They do not require maintenance and are not removed after healing. They dissolve on their own, leaving a small scar.
External sutures
External tears in the perineum and labia are most often closed with non-absorbable sutures. They need proper care and must be removed after a while.
一 Non-absorbable sutures are removed at the maternity hospital before discharge (on the 5-7th day after delivery), - explains doctor Alina Zhilich.
Why stitches hurt after childbirth
Sore stitches are due to the fact that the integrity of tissues is disturbed. Their deep layers are damaged, as well as nerve endings. At first, the pain is felt during movement. The seams are stretched, creating discomfort. However, discomfort disappears after about a week, as the tissues are gradually restored. In this case, itching, tightness, a slight burning sensation appear.
Soreness of the sutures depends on the degree of intervention. For example, with a caesarean section, the incision is approximately 10 centimeters in length, and in the perineal region (with episiotomy) it does not exceed three. In case of breaks, the length may be different. It is important to consider the woman's susceptibility to pain. For some, the pain disappears after a few days, while others experience it for several months. If the pain is severe or does not go away for a long time, you should consult a doctor.
How long do sutures dissolve after childbirth
Suture absorption time directly depends on the material of which the threads are made.
- Catgut. Dissolves from 30 to 120 days, depending on the thickness and site of application.
- Lavsan. Resolves from 10 to 50 days.
- Vicryl. Resolves from 60 to 90 days.
一 Usually the incision heals without complications, leaving only a small scar on the skin, which becomes invisible over time.
But sometimes healing is delayed or complicated by inflammation (for example, inflammation in the vagina before childbirth, which they did not manage to treat in time). Then the pain and swelling intensify or the soreness in the suture area does not go away for a long time, a feeling of pulsation, fullness appears, sometimes purulent discharge may appear. That's when you need to immediately consult a doctor, he will look at the seam and prescribe treatment, 一 explains Alina Zhilich.
How to treat stitches after childbirth
Recommendations for care are given by a doctor. The most important thing is to be hygienic and wear suitable underwear (2). To avoid complications, gynecologist Alina Zhilich advises:
- carefully monitor intimate hygiene (change postpartum pads every 3-4 hours), arrange air baths 2-3 times a day,
- do not wear synthetic underwear,
- treat stitches with chamomile solutions , chlorhexidine, miramistin.
After a cesarean section, a sterile dressing is applied to the wound, which is changed every day.
To prevent the development of infections, the seam is treated with antiseptics. Initially, this is done in the maternity hospital, then 一 independently. After removing the sutures, subject to normal healing, the treatment can be stopped after 10-15 days.
Frequently Asked Questions
Can stitches come apart after childbirth?
The divergence of the external seams is possible for the following reasons:
- non-compliance with bed rest,
sitting down early,
lifting weights,
infection,
poor hygiene,
wearing wrong underwear,
early onset of sexual activity,
jerky movements.
- constipation.
Inner seams rarely come apart. This is possible with premature intercourse or similar interventions. If you have any suspicions or discomfort, you should contact a gynecologist. Depending on the situation, the doctor will re-suture or recommend treatment.
How to sit correctly if there are stitches?
The only restriction for a woman to be able to sit is an episiotomy.
- Sitting on both buttocks after an episiotomy is prohibited for two weeks. It is possible to sit on one of the buttocks or on special seat pads, they are sold in pharmacies. The child will also need to be fed lying down, explains obstetrician-gynecologist Alina Zhilich.
After discharge, you should go home in a reclining position. It is desirable to begin to fully sit down on hard chairs and only then - on comfortable and soft chairs. With other interventions, you can sit without restrictions.
How to go to the toilet if there are stitches?
The issue of going to the toilet after suturing worries many young mothers. Gynecologist Alina Zhilich advises to remember several important things.
After each visit to the toilet, you need to wash the external genitalia and gently blot the perineum (do not use terry towels, paper towels are better).
It is important that the stool is daily and not hard (especially the first stool after childbirth).
