Perineal tears after birth: what to expect and how to recover
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Time to read 13 min
Nobody's favourite topic. Also one of the most common experiences of vaginal birth — and one of the least discussed in antenatal classes, birth books, and pretty much everywhere else Australian women turn for information before having a baby.
Up to 85% of women who give birth vaginally experience some degree of perineal tearing. That's not a rare complication — it's the statistical norm. Most tears are minor and heal without difficulty. All tears, regardless of degree, require proper care and attention in the weeks after birth. And knowing what to expect makes a significant difference to how manageable the recovery feels.
This guide covers everything: the four degrees of perineal tearing and what they actually mean, what an episiotomy is, how long healing takes at each stage, what the five practical steps are that Australian midwives recommend, when to see your GP, and the questions most Australian mums have but often don't ask.
Table of Content
What is the perineum and why dos it tear? The four degrees of perineal tearing - What they mean What about an episiotomy - is it the same as a tear? The recovery timeline - what to expect at each stage What actually helps - the five step recovery approach Products Featured In This Blog Everything you need to know to know about perineal stitches Pelvic floor physiotherapy - why it matters after any tear When to contact your midwife or GP Frequently Asked Questions You might also be interested in
What is the perineum and why dos it tear?
The perineum is the area of skin and muscle between the vaginal opening and the anus. During vaginal birth, the baby's head stretches this tissue as it descends through the birth canal. In many births, this stretching exceeds what the tissue can accommodate without tearing — resulting in a perineal tear of varying depth.
Several factors influence whether and how severely the perineum tears: the size of the baby, the speed of delivery (rapid births give tissue less time to stretch gradually), the position of the baby's head, the position of the birthing parent, and individual tissue characteristics. A first-time vaginal birth carries a higher risk of significant tearing than subsequent births, as the tissue has not previously been stretched in this way.
It's worth noting that perineal tears are not a sign that something went wrong in your birth. In the majority of vaginal births they are simply what happens as a baby passes through. The focus after the birth is entirely on healing — which, with the right care, goes predictably and well for most first and second degree tears.
The four degrees of perineal tearing - What they mean
Perineal tears are classified into four degrees based on how deep the tear extends into the surrounding tissue. Here's what each one involves and what you can expect from recovery.
FIRST DEGREE
Skin only
The tear affects the skin of the perineum only, without extending into the underlying muscle. Often doesn't require stitches and heals relatively quickly with good basic care.
Typical healing: 1–2 weeks for soreness to significantly ease.
SECOND DEGREE — MOST COMMON
Skin and muscle
Extends through the perineal skin and into the muscle beneath. The most frequently occurring type. Requires stitches. Healing is gradual but most women feel significantly better by four to six weeks.
Typical healing: 2–4 weeks for stitches to dissolve, ongoing tenderness for longer.
THIRD DEGREE
Into the anal sphincter
Extends into the muscle of the anal sphincter. Requires repair in theatre under anaesthetic and specialist follow-up. Bowel symptoms — urgency, leakage — can occur during healing and warrant prompt disclosure to your care team.
Typical healing: 3–6 months with appropriate support. Pelvic floor physio essential.
FOURTH DEGREE
Through to rectal lining
Extends through the anal sphincter to the rectal mucosa. Relatively rare. Requires surgical repair and specialist obstetric follow-up. Recovery is more complex and longer than first or second degree tears.
Typical healing: 6+ months. Ongoing specialist care required.
What about an episiotomy - is it the same as a tear?
An episiotomy is a surgical incision made by the midwife or obstetrician to enlarge the vaginal opening during delivery — typically when the baby needs to be born quickly, when forceps or vacuum are being used, or when a controlled cut is judged preferable to an uncontrolled tear in a specific situation.
In terms of healing and recovery, an episiotomy is treated and heals similarly to a second-degree tear. It requires stitches, involves the same postpartum soreness and swelling, and responds to the same recovery measures — cold therapy, peri bottle rinsing, witch hazel, rest.
The key practical difference between an episiotomy and a spontaneous tear is the incision line. An episiotomy is a straight surgical cut — typically at a 45-degree angle — rather than the irregular edge of a tear, which can sometimes make the healing process more predictable. That said, both heal well with appropriate care.
If you had an episiotomy, everything in this guide applies to you. The four-step recovery approach, the timeline, and the warning signs are all the same.
The recovery timeline - what to expect at each stage
DAYS 1-3
Peak intensity.
Swelling, bruising, and pain are at their most significant. Sitting is uncomfortable; standing and walking may be too. Cold therapy (ice pads) is the most effective relief in this window. Pain management matters — paracetamol and ibuprofen taken on a regular schedule, as advised by your midwife, is significantly more effective than waiting for pain to become severe before taking anything. Your midwife will check the repair before discharge and advise on what's appropriate for you.
DAYS 4-14
Active healing.
Swelling begins to reduce and dissolvable stitches start to break down. The area is still tender — particularly when sitting for extended periods, standing up quickly, or during toilet visits. Cold therapy remains useful through the end of the first week. Witch hazel (through cooling pad liners and healing foam) provides ongoing anti-inflammatory relief as the cold therapy becomes less necessary.
WEEKS 3-6
Progressing recovery.
Most first and second degree tears are significantly healed by six weeks. Stitches have typically dissolved by this point. Tenderness may persist, particularly with prolonged sitting or during sex (when you return to it — there is no rush). Some women experience ongoing sensitivity or tightness near the site of a tear for months — this is within the normal range but worth raising with your GP at your six-week check.
BEYOND 6 WEEKS
Longer-term considerations.
For deeper tears or episiotomy, full tissue healing continues well beyond the six-week mark. Scar tissue around the repair can cause tightness, and pelvic floor function may be affected. Pelvic floor physiotherapy is strongly recommended for all degrees of perineal trauma and is widely available in Australian cities and regional centres. Ask your GP for a referral — you don't need to be struggling significantly to benefit from it.
What actually helps - the five step recovery approach
These are the five practical steps Australian midwives consistently recommend for perineal tear recovery — in order of when you'd use them at each bathroom visit.
Rinse — peri bottle after every toilet visit
The single most important daily practice for perineal healing. After every toilet visit, fill a peri bottle with warm water and rinse the perineal area front to back rather than wiping. Wiping over stitches or torn tissue is painful and can disturb healing. Rinsing is both more comfortable and more hygienic — it cleanses without friction.
Frida Mom Upside Down Peri Bottle — angled nozzle reaches properly without contortion.
Cold therapy — ice pads in the first 72 hours
Cold reduces swelling, numbs pain, and slows inflammation at the peak soreness period. Activate an ice pad with a bend and place it inside your underwear. The soft top layer is comfortable against stitched tissue — unlike a traditional ice pack or bag of frozen peas, which are both hard and uncomfortably cold. Use in the first 72 hours when swelling is at its most significant.
Witch hazel liners — ongoing anti-inflammatory relief
Witch hazel has proven astringent and anti-inflammatory properties that directly support perineal healing. Cooling pad liners containing witch hazel sit across the full length of your maternity pad for continuous front-to-back coverage. Replace with every pad change. Particularly useful from day three onward when cold therapy alone is less necessary but inflammation and tenderness are ongoing.
Frida Mom Perineal Cooling Pad Liners — witch hazel, full coverage, replace every pad change.
Healing foam — targeted relief on stitches and haemorrhoids
Witch hazel foam absorbs directly into tissue rather than into the pad — meaning the active ingredient reaches the stitches, swelling, and any haemorrhoids (extremely common after birth) directly. Pump once onto a cooling liner before wearing. More targeted than a liner alone and particularly useful if you have stitches close to the surface or significant haemorrhoidal discomfort.
Frida Mom Perineal Healing Foam — witch hazel foam, use on top of a cooling liner.
Rest — horizontal, as much as possible
Physical activity increases blood flow to the perineal area, which increases swelling and slows healing. The first two weeks genuinely call for as much horizontal rest as possible. This is not laziness — it has a direct and measurable effect on how quickly perineal tissue heals. Accept every offer of practical help. Let the dishes wait. Lie down with the baby.
No product required. Just permission.
Products Featured In This Blog
Everything you need to know to know about perineal stitches
Do perineal stitches need to be removed?
Most modern perineal sutures used in Australian hospitals are dissolvable and do not require removal. They break down gradually over two to four weeks. If you're unsure what type of stitches you received, ask your midwife before discharge — this is an important question and entirely reasonable to ask.
Is itching normal?
Yes — itching is a normal and common part of the healing process as tissue regenerates around the stitch sites. It typically peaks at around days five to ten. Witch hazel (through cooling pad liners or healing foam) helps reduce the itch while supporting healing. Resist the urge to scratch — disturbing the repair site increases infection risk and slows healing.
What does infected stitches look like?
Signs of infection include increasing rather than decreasing pain after the first few days, redness and heat around the repair that is worsening rather than improving, swelling that is getting worse not better, unusual discharge or smell from the wound, and stitches that appear to have separated or come apart. Any of these warrant prompt assessment by your GP or midwife — don't wait for your six-week check.
Can I feel my stitches dissolving?
Some women notice small pieces of dissolving suture material appearing in their underwear or pads as stitches break down — this is completely normal and doesn't mean anything has come undone. If you're uncertain about what you're seeing, show your midwife or GP.
Pelvic floor physiotherapy - why it matters after any tear
Pelvic floor physiotherapy is recommended after any degree of perineal tearing — not just third and fourth degree tears. This recommendation reflects the fact that perineal trauma affects the pelvic floor regardless of the formal degree classification, and that early physiotherapy assessment provides a meaningful benefit to long-term pelvic floor function.
A pelvic floor physiotherapist can assess healing, identify any areas of concern with the repair, guide safe and gradual return to exercise, address any concerns about continence, and treat scar tissue that develops around the repair site — something that can cause ongoing tightness or pain during sex if left unaddressed.
In Australia, you can see a pelvic floor physiotherapist without a GP referral, though a referral may attract a Medicare rebate depending on your circumstances. Most major Australian cities and many regional centres have physiotherapists who specialise in women's health and postnatal care. Ask your GP, midwife, or MCH nurse for a recommendation.
The best time to book your first appointment is at around two to three weeks postpartum — early enough to catch any issues during active healing, late enough that the initial soreness has eased to a manageable level. You don't need to be experiencing significant problems to benefit. Proactive assessment is always more useful than reactive treatment.
When to contact your midwife or GP
Most perineal tears heal without complication. The following, however, warrant prompt contact with your midwife or GP — don't wait for a scheduled appointment if you're noticing any of these:
Signs of infection:
increasing pain rather than decreasing pain after the first few days; redness, heat, or swelling around the repair that is worsening; unusual discharge from the wound; any smell that seems abnormal; fever or chills alongside localised wound symptoms.
Wound separation:
if the repair appears to have come apart or there is a gap in the wound that wasn't there before. This can sometimes occur with a deep sneeze or cough, or with constipation-related straining. Prompt assessment is important.
Bowel and bladder symptoms:
difficulty controlling bowel or bladder function — urgency, leakage, or inability to hold — particularly after a third or fourth degree tear. These symptoms warrant prompt disclosure to your care team and should not be normalised as "just what happens after birth."
Ongoing pain beyond six weeks:
if significant pain, tightness, or discomfort is persisting at six weeks or beyond — particularly during sex — raise this at your six-week GP check. Ongoing pain at the repair site is treatable. Pelvic floor physiotherapy addresses this directly and effectively.
Frequently Asked Questions
HOW LONG DOES A PERINEAL TEAR TAKE TO HEAL?
First and second degree tears typically heal well within two to four weeks, with significant improvement by the six-week mark. Dissolvable stitches usually break down over two to four weeks. Third and fourth degree tears take considerably longer — often three to six months — and require specialist follow-up. Healing is not linear; most women have days that feel much better followed by days that feel worse, particularly if they've been more active.
DO ALL VAGINAL BIRTHS INVOLVE TEARING?
Not all — but the majority do. Up to 85% of women who give birth vaginally experience some perineal trauma, including grazes, first degree tears, and second degree tears. The likelihood of significant tearing is higher in first-time vaginal births and when instrumental delivery (forceps or vacuum) is used. Perineal massage in the weeks before birth has some evidence for reducing the risk of severe tearing in first-time births — ask your midwife for guidance.
IS IT NORMAL FOR PERINEAL STITCHES TO ITCH?
Yes — itching around stitch sites is a normal part of the healing process as tissue regenerates. It typically peaks between days five and ten. Witch hazel through cooling pad liners or healing foam helps reduce the itch while supporting healing. If the itch is accompanied by increasing pain, heat, unusual discharge, or smell, see your GP — these can indicate infection.
WHEN CAN I EXERCISE AFTER A PERINEAL TEAR?
Gentle walking from the end of the first week is generally appropriate for first and second degree tears. More demanding exercise — running, HIIT, heavy lifting — should wait until after your six-week GP check and, ideally, until you've been assessed by a pelvic floor physiotherapist. Returning to high-impact exercise before the pelvic floor has been properly assessed is one of the most common contributors to long-term pelvic floor problems in Australian women. The six-week clearance is a minimum starting point, not a signal that everything is fully healed.
WILL SEX FEEL DIFFERENT AFTER A PERINEAL TEAR?
For many women, yes — at least initially. Scar tissue, tightness around the repair site, and reduced lubrication (particularly during breastfeeding, when oestrogen levels are lower) can all affect comfort during sex after a perineal tear. Most women who experience difficulty find that it improves significantly with time and, where scar tissue is a factor, pelvic floor physiotherapy. There is no expected timeline for returning to sex — whenever it feels right and comfortable for you is the right time. If pain during sex persists beyond a few months, raise it with your GP or pelvic floor physio.
CAN I PREVENT PERINEAL TEARING?
You can reduce the risk but not guarantee prevention. Perineal massage — typically beginning at 34–36 weeks — has moderate evidence for reducing the risk of significant tearing in first-time vaginal births. Warm compresses applied to the perineum during pushing are used by some Australian midwives to support tissue flexibility. Birth position also influences tearing risk — upright or side-lying positions tend to reduce perineal trauma compared to lithotomy (on your back with legs raised). Discuss these options with your midwife as part of your birth planning conversations.
