For the first 24 hours, it is important to lie down for approximately 20 to 40 minutes each hour to reduce swelling and assist healing.

If you have lower-back pain, lying on your side is often more comfortable.

Wrap ice or a cold pack in a thin piece of dampened cloth, and apply it to the sore area for 10 to 20 minutes at a time, repeating each hour as necessary.

You can also put an ice pack in the inside lining of a sanitary pad, or use a frozen pad or diaper as a cold compress.

This is especially important in the first 24 hours to help decrease swelling and ease pain. 

Shower or bathe every day. If you have a first- or second-degree tear, consider taking sitz baths after your first couple postpartum days.

Taking sitz baths—soaking your pelvic floor for 10 to 20 minutes several times a day—can help reduce irritation and swelling.

Studies show that cold sitz baths relieve pain more effectively than warm ones. Start with lukewarm water, and gradually add ice cubes.

Check with your physician before adding medications or epsom salts. After each sitz bath, dry any tears or stitches by gently patting them with a towel or using a hair dryer on cool.

With an extra-sensitive perineum, you cannot wipe as you normally would when using the bathroom. Instead, use a squeeze (or peri) bottle.

Hospitals often send mothers home with a peri bottle to help keep the area clean without friction. You can use this squirt bottle to wash away urine, feces, or anything containing bacteria that could induce irritation or an infection.

When finished, gently pat the area dry with baby wipes, medicated pads, or clean toilet paper.

Once the wound is healed, you can wipe gently from front to back.

Soak a pad in aloe and/or witch hazel, freeze it, and place it either between a sanitary napkin and your perineum or directly on the area for cooling relief.

Change your padsicle at least every four hours to reduce the risk of infection.

The “pelvic elevator” can help strengthen your pelvic floor while reducing perineal pain and swelling. Try a set of three of these exercises each hour.

• Imagine your pelvic floor is an elevator in a three-story building
• Sit upright on a chair and breathe in, lengthening your spine
• Hold your breath, and feel your pelvic floor squeeze, closing the elevator door
• Exhale
• Breathe in, keeping the elevator doors closed and lifting your pelvic floor to level two
• Exhale
• Breathe in as you lift your pelvic floor to level three
• Breathe out as you release your pelvic floor to ground level

When sitting, use a pillow, padded ring, or inflatable “donut” cushion for 30 or fewer minutes.

Making slight adjustments to your sitting position is important during this time to avoid blood pooling.

If you’ve undergone perineal repair, try to sit with your legs together rather than crossed.

Drink plenty of water to avoid constipation. Straining with bowel movements will stretch the perineum and can cause pain.

You can also avoid constipation by eating fiber-rich foods such as fresh fruits and vegetables.

You should expect bleeding for up to six weeks postpartum. Shelve your tampons, and use pads exclusively. Change your pad at least every four hours.

Wear something comfortable that won’t aggravate your skin. Loose-fitting, full-coverage underwear is ideal for healing. (Thongs can create a better environment for bacteria to grow.)

Bleeding should taper off around the second week but can last for up to six weeks postpartum, at which point it may temporarily stop and start up again.

• Change sanitary pads frequently, and add an ice pack or witch hazel pads to help reduce swelling and discomfort.
• Mesh underwear, often supplied by hospitals, can hold high-absorbency maxi pads in place while saving your nicer underwear from stains.

Pain management is an important part of the healing process. There are several ways to combat discomfort:

• Sitz baths
• Ice packs
• Frozen padsicles

If your doctor approves, take an over-the-counter pain- or inflammation-reducing medication like acetaminophen or ibuprofen.

You can also use a topical numbing spray such as Dermoplast (benzocaine rectal ointment or spray) to help reduce perineal discomfort.

Avoiding constipation is important as your perineum heals. Remember to:

• Drink plenty of water
• Eat foods with fiber such as vegetables, fruits, and whole grains
• Take a stool softener or fiber supplement, as recommended by your doctor
• Try perineal massage and self-acupressure

Use a perineal irrigation (peri) bottle to spray warm water on your perineum during and after urinating to ease the burning. This will also help keep everything clean and avoid infection. Then, pat gently with medicated pads, clean toilet paper, or a baby wipe. Don’t rub.

As your perineum heals, you may feel itchy due to vaginal dryness, changing hormones, stitches, or postnatal bleeding (lochia). Itchiness can also be a sign of healing, or of a yeast infection. The following may help relieve itchiness:

• Use sitz baths and peri bottles for good postpartum hygiene.
• Wear loose-fitting underwear.
• Hydrate.
• Use natural, pH-balanced soaps and detergents.
• Try a natural vaginal moisturizer.
• Apply ice packs and witch hazel pads.
• Try salt baths to support the perineum, if your doctor approves.
• Use a benzocaine rectal ointment or spray, or other topical agent.

• Foul-smelling discharge from your vagina
• Burning pain with urination
• Passing urine more frequently than usual
• Urge to pass urine frequently, but only passing a small amount
• Vaginal bleeding after your sixth postpartum week
• Severe pain in your perineum, pelvis, or lower abdomen
• High fever when you are not sick otherwise
• Passing gas or stool through the vagina
• Passing sutures or sponges
• Blistering or herpes
• Persistent perineal irritation resistant to remedies outlined in “How to solve itching.”

• A fever high enough that your provider recommends in-person evaluation
• Nausea and vomiting
• Severe abdominal or pelvic pain
• Heavy vaginal bleeding in which you are soaking through more than one pad every hour