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Perineum pain: The WORST part

Ouch! I've got perineal bruising, bigtime. And it's my job as the resident "TMI" blogger to describe to you a few things about a so-called 'natural' birth:

  1. What is the perineum? It's the part between your vaginal opening and your anus. I had no idea.
  2. What is perineal bruising? It's pressure brought on by pushing a baby out, and (if my body is any indication, and if the post-partum nurse from Legacy is right) often it doesn't really start hurting until days after the birth. Something about nerve endings being bent. Who knows. I'm not sure how long it lasts -- thoughts?
  3. What does it feel like? Well, it hurts to sit. And lie down. And climb stairs. And bend over. Hopscotch? Oh. Oww. EEEeeeee! (Yes, I tried to hopscotch. What was I thinking?) Basically, it feels very similar to tailbone pain -- a condition I'm all-too familiar with, having suffered it occasionally during pregnancy with both Monroe and Truman. It hurts to change diapers, nurse, and walk around the house.
  4. What do you do? Other than the doctor-ordered ibuprofen (which I'm taking a little more frequently-than-prescribed), baths, with herbs. Both Midwifery Today and eHow have lists of herbs -- I just sent Jonathan to Limbo for calendula flowers, comfrey root, rosemary, witch hazel, and yarrow flowers. We already have myrrh, which I'll add. Essentially, you steep a two-cup tea of a "handful" of each herb for 30 minutes, then add to a sitz bath, a regular bath, or dilute by half and put in your squirt bottle. I'll let you know how it works!

I'd love to hear wisdom on perineal bruising, or just commiseration... you guys are great for that!


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Warm water (from the squirt bottle they provided at the hospital) plus Dermoplast spray. Move slow and take it as easy as possible. It takes weeks and weeks sometimes. Don't forget the stool softener just in case. And no matter what, don't look. If you get out the mirror to look, it will hurt twice as much. Congrats and good luck!

Arnica 30c or higher a few pellets under the tongue every 15 minutes for an hour then as needed. Sitz baths work great but you have to do contrasting hot and cold. Start with soaking in hot/warm water for 5 minutes then sit in cold for 1-3 minutes. Doing several rounds of this is beneficial. Getting an extra plastic tub for the cold water from Freddies is the easiest way to do it. It really works! Also, be sure to be eating a really great diet high in Vitamin C, lots of fruits and veggies and plenty of water to help heal the tissues.

Best of luck and congrats!!

This went away pretty quickly for me. It could end up healing in a week or so instead of weeks and weeks. Hang in.

i pushed for 5 hours with stella, and i had such pain and bruising, i really thought i was going to die. for real.

DO take the stool softeners. promise me you will.

DO make the tea and soak in it if it's comfy. i found that it wasn't comfy to get in and out of the tub, so i used my water bottle (with warm tea) and squirted in on EVERY. SINGLE. TIME. i went to the bathroom.

DO NOT look. if you already have, DO NOT do it AGAIN!

i was alternating between motrin AND tylenol to help with the pain (motrin, 2 hours later tylenol, 2 hours later motrin...)

it really took at least 6-8 weeks to feel a little more *normal*.

congrats! your birth story was an awesome read!

I love how everyone's telling me not to look ;) never fear. I don't need that much information!

I agree with megan -- the bath was nice but getting out of the tub, agony. for a moment I thought I would never, ever be able to stand up straight! I'll try the warm squirting, and work on the diet thing. I knew there would be a diet component, guess it's time to reach in the fridge for all those greens and roasted veggies I cooked when I was nesting. such smart cookies, my hormones.

and thanks for the congrats all :)

Ah, the memories. With my daughter the swelling went down in less than 2 weeks but I only pushed for 10 minutes. With my son (#2), I pushed for about 4 hours and his head was at an angle so I ended up with a hematoma the size of a softball (no exaggeration) that took many months to go away -- 4 months before I could sit in a normal chair for any length of time. No baths for me, not even sitz, but directing a hot shower to the area helped and eventually alternating heat (heating pad) and cold (gel pack) helped along with ibuprofen and acetaminophen. Good luck!

I know that the natural way is usually the way to go and I myself, usually go natural versus otherwise. I am no MD, but I can say that my MD prescribed me pills after I came in bawling. I'm no drug rep but the percoset worked hands down over the vicodin. Neither get in the way of breastfeeding, but again - take the stool softeners! Tylenol and Advil were jokes.

Also, I know it may be embarassing, but purchase a doughnut (one of those round either inflated or padded seat cushions) that have the hole cut out in the middle. It helps, and after you use it for a day or so you will feel some relief of the pressure and sitting won't be as uncomfortable (or standing up after sitting). These are usually reserved for the aged or wheelchair bound, but I recommend them highly! Also if you are having tailbone pressure I would recommend them as well. Kind of embarassing to take out to the restaurant, but once you sit on it you won't sit without it - at least til you're back up to parr.

Good luck, hang in there.

In my immediate postpartum days, the nurses fixed up a set of things that really helped: a surgical glove filled with ice, tucks pads, and a large amount of Epi-Foam. Somehow that was all fit into those stretchy underwear shorts, and I guess I've blocked this part out, but there must have been a pad or something for the bleeding too. I took home as much Epi-Foam as possible and used it all. If you can find some, it's well worth it.

Does this pain only happen with 'natural' birth?

Oh! And I sat on a boppy pillow -- much more comfortable than the inflated, rubber ring!

I agree with Amy: The DONUT!! It saved my life...er, my tush. It made sitting down bearable. I hauled it around with me for a good while. However! Quality control in the donut factory is not what it should be, so get a spare in case it springs a leak.

Beware the ibuprofen! Really. I took a little more than prescribed postpartum for cramping from a breast infection and pain and was in the hospital when my baby was two and a half weeks old with a perforated ulcer. It is bummer to be in labor for two days and push for two hours only to be cut open a few weeks later due to an ulcer that I didn't even know I had that was exacerbated by tons of ibuprofen. They say Tylenol is better.
I also filled disposable diapers with ice and taped them shut. I know it's ironic, since I am now cloth diaper user, but it did help.

Great comments! I wanted to second or third the donut. I carried that around with me for a good two months. I bought an extra one to just leave in the front seat of the car, so I could drive and then I always had one when I was around town. You can buy them at medical supply stores. I got mine at the Beaverton Pharmacy.

And, no, perineum pain isn't just with 'natural childbirth'! I did a vaginal birth with an epidural. My pushing stage of labor was only 10 minutes (gratefully) but because the babe came out so fast I ended up with a bad tear (not great).

I'm not sure what's least fun: bruising or tearing! From this thread it looks like the treatments are the same. The only thing I would add with healing a tear is that the spray on topical pain killer I was given at the hospital really helped. So in addition to rinsing etc... I used that spray for quite awhile!

Also, I would highly recommend at some point a treatment from a chiropractor familiar with energy work, or a cranial sacral session. I started chiropractic treatments about 1 month after the birth and it really helped with my postpartum recovery. Your body has just been through a big miracle both physically and energetically with both pregnancy and birth. I wanted all the help I could get!

Congrats on the new babe!

I had not so much pain from pushing (7 minutes), but I had a fairly sizable tear, and this was a natural waterbirth. I was quite sore for a while. I used, icepacks, ibuprofen, the water bottle, and this really neat comfrey gel I got from my midwives. I'm not sure where to get it though.

FYI, with tears at any rate, you can heal well on the surface and still have significant pain later (months) with more vigorous activities so give yourself a break and don't freak out. It will get better over time.

Congratulations and hang in there

Oh my. This is still very fresh in my mind. I read your VBAC story with much interest as I just had a VBAC myself 4 months ago. I had a 2nd degree tear and *still* have pain. I haven't done the deed yet because I'm SO scared it will hurt so bad I might die. It still hurts when going #2 when I haven't had my raisin bran that day. Ugh.

Like another poster, I had so much pain down there I thought I would die. Literally have a heart attack. It hit me a few days later, also. I had stiches all over the place down there...and did make the mistake of looking. Oh dear. It was unrecognizable even a month after. I haven't looked since (but have been told it is normal by the doc).

I was also told to take a bunch of hot baths, but getting in and out of the tub (not to mention sitting on the bottom) hurt so bad I would cry every time. It was pain beyond what I had expected. I really needed the epidural for the recovery instead of the birth!! I had forceps, but from what I've heard, tears hurt no matter how you get them. I couldn't sit up for about 2 months without major pain down there. I think, unfortunately, some women get over it really slowly. Hopefully you aren't one of them and next week you'll feel better.

I also tried to get back into my normal routine way too soon. I felt like a "lazy bum" for lying around on the couch for weeks, and started doing too much too fast (like picking up my toddler...bad idea). That really made it all worse down there.

So my advice, along with all the rest, is to just lay low, relax and keep up with the painkillers. Do the hot baths if you can, and it will go away eventually. I finally feel somewhat "normal" again...probably when my daughter was 3 months old. And of course, no wiping, just use that handy peri-bottle. It was my best friend for probably 2 months. :)

Congrats on the VBAC and baby, and hope you feel better soon!

Arnica is your friend when it comes to swelling and bruising. The gel is nice and cooling, and tabs taken by mouth help as well. Soaking helps by bringing circulation to speed the reabsorption of fluids, and just plain feels nice. I'll echo everyone else - it should be gone really, really soon. Until then, take it easy!

I recommend doing kegels. I was a bit scared to try them at first, but it really helped to start the healing. I believe it helps to bring new fresh blood into the area and remove the bruised blood.

It's comforting to hear about your pain, Sarah. I am 3 weeks post VBAC and have a 3rd degree tear, but thankfully no hemorrhoids. The OB said I look fine and healed, but I feel uncomfortable, and worse, I think the sweet victory of the VBAC has been neutralized by a recovery that doesn't seem much better than the C-Section recovery. I haven't found that my friends have had such long recoveries from V-births. I'm guessing that has given you some grief as well. I am so happy that you are able to get out and about and walk. I feel funny walking and am causing myself all sorts of back pain by tensing up in a weird way to compensate for my perineal sensitivities. Oh, and do borrow a donut or boppy to sit on.

I just thought I'd update everyone before I posted again. After I wrote this, I went to see Dr. Kehoe and the pain had gotten even worse -- she said that my perineum looked fabulous and it was possible I broke my tailbone while giving birth. She gave me percocet. Naturally, while the percocet got me through an awful few days, it gave me hemorrhoids! (Mine appeared as big, gross blisters... at first I was internet-diagnosing everything from a terrible infection to herpes, but my pediatrician and a nurse friend assured me they were, indeed, hemorrhoids)

Once I got off the percocet (after 3 or 4 days) the hemorrhoids very slowly began to heal.

Now that I've been spending the past week in two positions: standing or lying on my side/tummy, I've heard from a number of other mamas who also injured their tailbone during birth. All I can say if you're among the injured is, I'm so sorry! and it does seem to get better with time; I'm now walking with very little pain and even finding a rare chair that's possible to sit normally on. I wonder if sometimes an injured tailbone is mis-diagnosed as perineal pain?

With that, I'm going to go make a cover for my donut now :)

if your pain never goes away, you may have pudendal nerve issues that are worse... if the comments above don't help you and you've been suffering for over a year, check out www.pudendal.info for more. there's hope.

i have read you post, it was great, nice, keep it up.

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