Perineal Tear Recovery: What Healing Looks Like Week by Week

Most perineal tears and episiotomies heal well within about six weeks. The first week is usually the most tender, swelling settles over the following days, and stitches generally dissolve by themselves within two to four weeks. Gentle hygiene, rest lying down, pain relief your care team has recommended and soft bowel motions all help healing. Contact your midwife or GP if pain is getting worse rather than better, the area smells unpleasant, or you develop a fever.

Up to nine in ten women who have a vaginal birth for the first time experience some kind of tear or graze. It is one of the most common parts of birth, and also one of the least talked about. If you are feeling sore, worried or a little shocked, you are not alone, and your body is designed to heal.

Understanding the type of tear you had

Your midwife or doctor will usually tell you what kind of tear you had. If you are not sure, it is completely reasonable to ask at your postnatal check.

• Grazes and first-degree tears involve the skin only. They often heal without stitches and usually feel much better within one to two weeks.
• Second-degree tears and episiotomies involve skin and muscle and are usually stitched. Most feel comfortable for everyday activity by four to six weeks.
• Third- and fourth-degree tears extend to the muscles around the back passage. These are repaired in theatre and need specialist follow-up, often including a women's health physiotherapist.

Days 1 to 3: swelling and tenderness

The first few days are often the hardest. Swelling, stinging when you pass urine and a bruised feeling when sitting are all common.

• Use a cold pack wrapped in a cloth or a chilled maternity pad for 10 to 20 minutes at a time in the first 24 to 72 hours.
• Pour lukewarm water over the area while you wee, or wee in the shower, to reduce stinging.
• Lie down to rest when you can. Lying on your side takes pressure off the stitches.
• Take the pain relief your hospital recommended, regularly rather than waiting for pain to build. Check with your pharmacist if you are breastfeeding.

Days 4 to 14: settling and first bowel motions

Many mothers feel anxious about their first bowel motion after birth. It will not undo your stitches. Drink plenty of water, eat fibre-rich foods and ask your care team about a gentle stool softener. Holding a clean pad against your perineum while you push can make you feel more supported.

Change your pad at least every four hours, wash your hands before and after, and pat the area dry from front to back. Stitches may start to feel tight or itchy as they dissolve, which is usually a sign of healing.

Weeks 2 to 6: returning to everyday life

By the second or third week most women notice sitting and walking become more comfortable. Gentle pelvic floor exercises can begin when they feel comfortable, as they improve blood flow and support healing. Short, slow walks are helpful; heavy lifting and high-impact exercise are best left until after your six-week check.

There is no correct time to resume sex. Wait until bleeding has stopped, you feel healed and you feel ready. Discomfort is common the first few times; a water-based lubricant can help, especially while breastfeeding.

When to seek help

Contact your midwife, GP or maternity unit promptly if you notice:

• Pain that is getting worse instead of gradually improving
• A foul smell, pus or increasing redness and heat around the stitches
• A fever of 38°C or above, or feeling shivery and unwell
• Stitches that seem to have come apart, or a wound that looks open
• Difficulty controlling wind or bowel motions, or leaking that is not improving
• A painful, tense swelling that keeps growing

Call 000 if you feel very unwell, faint or have heavy bleeding. For non-urgent advice at any hour, Pregnancy, Birth and Baby is available on 1800 882 436.

The emotional side of healing

A difficult birth or a more serious tear can leave lasting emotions, including fear about future births or feeling disconnected from your body. These feelings are valid. Talking with your midwife, a women's health physiotherapist or your GP can help, and a debrief of your birth experience is something you can request.

A gentle reminder

Healing is not a race. Accepting help, resting while your baby sleeps and letting others take over household jobs is not a weakness; it is part of recovery. Your Maternal Health Nurse can check on how you are healing at your early visits, so mention anything that worries you, however small it seems.

This article is general information and does not replace individual advice from your midwife, GP or Maternal Health Nurse.