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Perineal Pain

Updated: Apr 8

There can be varying degrees of tearing during a vaginal birth and sometimes even episiotomies become necessary. An episiotomy is when the doctor or midwife has to cut your perineum to create more space. Episiotomies are generally performed when a forceps or vacuum suction has to be used to deliver the baby or room needs to be made to allow the babies shoulders to pass through the birth canal. 


Even before birth, the perineum can become swollen and sore. Once you get into the third trimester, the baby starts to drop lower, putting more pressure on your pelvic floor, including your perineum. Uncomfortable seated positions and even tight clothes can irritate the area causing unwanted pain. 


Thankfully, both during pregnancy, before delivery, and then postpartum as well, there are strategies that can be employed to relieve pain, increase elasticity and recover from any tearing or cutting. 


During Pregnancy


1. Avoid wearing pants that are too tight or put pressure on your perineum, especially when seated.

2. Work on strengthening your pelvic floor muscles to give you the most support possible.

3. Use lube with sex when necessary to avoid aggravating the perineum. 

Before Delivery


1. Continue to work on strengthening your pelvic floor muscles.

2. Begin performing a perineal massage.

a. Perineal massages are great for relaxing the muscles and tissues of the perineum to prepare the area for birth. 

b. The more relaxed and elastic the muscles are, the less likely it is that you will tear when giving birth.

c. Perineal massages can be performed yourself or with the help of your partner.

3. Practice breathing techniques that allow your pelvic floor muscles to relax and lengthen.


Postpartum


1. Get plenty of rest to allow the perineal area (and your whole body!) to recover.

2. Whether you had a vaginal birth or a C-section, odds are, your perineum will be swollen after delivery, so icing it can help bring that swelling down.

3. Padsicle – these are essentially cold packs that you can make at home yourself, using maxi pads and other supplies that can be bought at the store, which can be kept in the freezer and pulled out whenever you want some relief. There are many DIY instructions with varying ingredients that you can find online. Choose the one that works best for you and keep some padsicles on hand!

4. Heat – if swelling has decreased, but pain persists, a heating pad can provide some soothing relief.

5. Stay comfortable – wear comfortable clothes, keep a stool or pillows handy by the couch or your favorite chair to prop your feet up and try to choose a sleeping position that doesn’t aggravate your symptoms.

Perineal pain can often get overlooked during pregnancy and in preparing for the baby to come – you’ve got a lot to think about! But taking a few minutes every day the last few weeks of your pregnancy to perform perineal massages, and then taking steps postpartum to help manage your pain and discomfort can go a long way in helping your feel better faster! 


And as a final note, it your perineal pain persists without relief, schedule a visit to a Pelvic Floor Physical Therapist for an evaluation to see if there are other factors contributing to your symptoms. There is hope and help and I don’t want you living with pain. Be your own best advocate and search till you find the answers you need!

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