The area of tissue and muscle between your vaginal opening and anus is called the perineum. As your baby stretches your vagina and perineum during birth, it can tear spontaneously. When you hear women talking about tearing during childbirth, this is what they are referring to.

In some instances, you may need an episiotomy to help your little one make an exit, which involves making a surgical incision in the perineal tissue to widen the vaginal opening. Episiotomies are no longer routine, but are sometimes necessary.

Postpartum perineal pain is common after childbirth and it takes time to heal. The length of time required for your perineum to heal usually depends on the degree of tearing. In a 2008 study most women reported that their pain had resolved by two months postpartum, however, if you’re experiencing perineal pain long past this time frame, you’re not alone.

A 2020 review by the British Journal of Anesthesia reported that persistent vaginal and perineal pain appears to be associated with operative vaginal delivery (versus spontaneous vaginal delivery) and the degree of perineal trauma. In 2019 Åhlund et al investigated the prevalence of perineal pain relating to perineal injury within the first year after childbirth. They found that the majority of women with moderate and severe injuries suffered from perineal pain three months postpartum, and of these women a significant number still had perineal pain six months after birth.

Step one is being prepared as best as you can.

You can’t control your labour and how it will proceed, but you can support your perineum during pregnancy and childbirth.

Perineal massage during pregnancy

Have you been wondering what this is exactly, or how to do it? From 35 weeks of pregnancy onwards, you or your partner can use daily perineal massage until your baby is born which may reduce your risk of tearing. Get all the details in our blog on Perineal Massage.

2. Warm compress and massage during labour

There are never any guarantees of delivering your baby without tearing, and some risk factors are uncontrollable, but read our blog Tips to prevent tearing to learn what you can do to reduce the change you will tear.

3. Effective pushing

Your midwife or OB will usually guide you on how to push effectively, but we believe that nothing is as powerful as being prepared. Our blog Pushing during labour can be a game changer for your perineum so take a read.

Despite preparations, most first time mums will experience some perineal tearing or grazing during childbirth.

Step two is knowing how to manage & reduce perineal pain after childbirth.

1. Pelvic floor physiotherapy

First on our list is to see a pelvic floor physiotherapist. Pelvic floor physiotherapy is an extremely effective way to treat perineal pain following childbirth. During your initial appointment your pelvic floor physiotherapist will conduct an assessment and personalised treatment plan for you, helping you manage any symptoms.

Both episiotomies and perineal tearing leave scar tissue behind, which is stiffer and less elastic than normal tissue. If you are experiencing scar pain then your physio can help to release that scar tissue, really helping reduce your discomfort.

2. Belly breathing (AKA Diaphragmatic breathing)

Birth trauma, pain and scar tissue can cause the pelvic floor muscles to tighten protectively, and one-sided pelvic floor tears can cause the opposite side of the pelvic floor to tighten to compensate for weakness. This tightening of the pelvic floor muscles is a common contributor to pain following perineal trauma and diaphragmatic breathing is one of the simplest tools you can use to help relax a tight pelvic floor.

Belly breathing is all about breathing into your rib cage, allowing your abdomen to expand, and feeling your pelvic floor relax as you inhale.

To use this simple tool, try the following:

Place one hand on your chest and another hand on your belly, just below your rib cage. Take a deep breath in to the count of three, and then exhale to the count of four. When you inhale, your pelvic floor relaxes, and as you exhale, your pelvic floor returns to its resting state.

To help your pelvic floor relax you can try to imagine the following:

Feel your vaginal and anal openings soften and relax as you inhale
Imagine your sit bones spreading apart as you inhale

We have a whale blog on the ‘Overactive pelvic Floor’ with a heap more information and other exercises you can use to help relax these muscles.

3. Keep moving

It’s common that you’ll want to move less if you are in pain, either due to the pain or the fear if hurting yourself more. But movement is medicine. Movement will help increase blood flow to your healing tissue. Movement also releases endorphins, which reduces pain, and offers a helpful distraction.

If you’re wondering how to start moving again following childbirth, then please have a read out our blog Returning to Exercise Postnatally.

Consider joining our online postnatal program which is designed to guide you safely back to strength after baby.

Learn more

5. Use a spikey ball on your glutes

Perineal pain may start as a result of a tight scar, but as a result of this pain the surrounding muscles tend to tighten in an attempt to protect. This clenching of the muscles can cause pain to remain, even once our tissue has healed.

Use a spikey ball to release your glutes. You can do this on the ground or by leaning against the wall (with the ball between wall and buttocks). If you have a foam roller then also roll out all the muscles and connective tissue that connect to your pelvis, namely your ITBs (side of your thighs), quads, adductors and hamstrings,

6. Use lube

Perineal scar pain is often worse with penetration. If you are experiencing this then lube is so important. Few things feel worse for a painful scar than friction from dryness. Using lube is especially important in the early postpartum period and ongoing if you are breastfeeding, as your body has less oestrogen at the vaginal opening during this time, leading to dryness.

However, using lube generously can make a huge difference!

We hope that this information helps you.

As always, reach out if you have any questions!

Managing Perineal Pain After Childbirth