Overview of perineal wound breakdown and what to expect
What is it?
After childbirth, you may have had stitches to repair any perineal tears, or an episiotomy.
It is rare for the stitches to simply to come undone.
However, occasionally an infection or pressure on the stitches from bleeding underneath can cause the stitches to breakdown, leaving an open or gaping wound.
This is called perineal wound dehiscence, or breakdown.
How do I know if this has happened to me?
Wound breakdown can cause an increase in pain, new bleeding or pus-like discharge. You may also begin to feel unwell.
Sometimes women notice some stitch material coming away soon after they have had their baby, or can see for themselves that the wound has opened.
What can be done about it?
If you are concerned there is a problem with your stitches you should see a healthcare professional. They will examine your stitches and look for signs of infection.
They may take a swab from the perineum to try and find out what is causing the infection.
Most women will be given a short course of antibiotics and advised to take pain relief.
Anti-inflammatory pain relief such as ibuprofen may help, and is safe in breastfeeding.
If the infection is making you unwell, you may require admission to hospital for intravenous antibiotics.
Will the wound be re-stitched?
If there is an infection the wound will not be re-stitched. This is because it can trap infection inside, and infected tissues may not stitch back together well.
If there is no infection, or the infection has been treated, the wound may be re-stitched in theatre.
You will be advised as to which option is best for you.
What can I expect as it heals?
New tissue will grow and this gradually fills the gap where the stitches were.
This process varies in women and depends on where the wound is, how deep the gap was, and how long any infection was present.
The new tissue may look red and may bleed a little.
Usually, when the healing process is complete, there will be a red scar for a short while. This will eventually fade like any skin scar.
Re-sutured wounds heal a bit faster but there is a small risk that it will become infected again.
What can I do to help the healing?
Keeping the area as clean and dry as possible will help. Wash only with water at first.
After washing try not to rub the area with a towel, instead let the area dry naturally.
Do not use shower gels, or any other creams or oils, on the wound.
Ensure that you change your sanitary pads regularly.
Once any bleeding or discharge has settled, it may be helpful to leave your underwear off overnight in order to allow some air to circulate.
Will this cause me any problems in the future?
Most women who have experienced wound breakdown, experience no further problems.
Once the wound is healed, it will not break down again with exercise or sex.
However, if you experience any problems, or are concerned, you should see your healthcare professional.
With any perineal wound, ‘over- healing’ can sometimes occur. This leads to raised red patches of tissue called ‘granulation tissue’.
This can be uncomfortable or continue to cause bleeding.
It can sometimes be confused with new infection, but it is not solved by antibiotics.
Granulation tissue will usually settle on its own and does not require any treatment.
Granulation tissue can sometimes be treated in a perineal or gynaecology clinic with a painless procedure using silver nitrate.
Rarely, it will persist and may need to be surgically removed.
If you need treatment, your healthcare professional will explain what is suitable for you.
Will it happen in future births?
Having experienced wound breakdown once, does not make it any more likely to happen with further vaginal births.
If you have any concerns in any future pregnancies, discuss these with your healthcare professional, so that you can make a birth plan that you are comfortable with.