Most perineal stitches and caesarean wounds heal well over a few weeks, with the sharpest pain in the first days and a slow fade after that. Healing should trend towards less pain, not more. A wound that becomes more painful, redder, swollen, hot, or starts leaking fluid needs checking, and so does a fever. This page describes what usually happens so a change is easier to spot, and it does not replace being examined.

Perineal stitches

A tear or a cut (episiotomy) between the vagina and the anus is repaired with stitches that dissolve on their own. They usually do not need removing.

The first three to five days are the sorest. Sitting, standing up, and the first bowel movement are the moments people notice most.

What tends to help. Keeping the area clean and dry, changing pads often, and washing hands before and after. Pouring warm water while passing urine can reduce the sting. Lying down takes pressure off, and many people find sitting on one hip more comfortable than sitting square.

Pain relief. Ask your midwife, doctor or pharmacist what is suitable for you, including while feeding a baby. This page names no medicines and no doses on purpose.

Tell someone if pain is increasing rather than easing, if stitches feel like they have given way, or if there is a bad smell. NICE's postnatal guidance expects wound healing and pain to be reviewed at postnatal contacts rather than left to the six-week check.

Caesarean wounds

A caesarean is major abdominal surgery, and recovery reflects that even when everything goes smoothly. ACOG describes a longer recovery than after a vaginal birth, with limits on lifting and driving in the early weeks.

The dressing is usually removed within the first day or two. The scar is often numb around it, itchy as it heals, and tender to press for weeks.

Day to day. Keep the wound clean and dry, and pat rather than rub. Loose clothing that does not sit on the scar helps. Supporting the scar with a hand or a cushion when you cough, laugh or get up genuinely reduces the pull.

Lifting and driving. Follow your own team's advice. It depends on your surgery and your healing, and a general rule from the internet is not a substitute for it.

What healing looks like week by week

Week one. Sore, swollen, and worse on movement. Bruising is common.

Weeks two to three. Pain becomes intermittent rather than constant. Perineal stitches dissolve. A caesarean scar starts to feel firm and raised.

Weeks four to six. Most people can move normally, with occasional twinges. Scar tissue keeps changing for months, and numbness around a caesarean scar can last a long time.

Healing is not a straight line, and a busy day can set it back a little. A trend of steadily increasing pain is different, and that is the one to report.

Signs a wound needs checking

• Pain that is increasing rather than settling.
• Redness spreading, or skin that is hot to touch.
• Swelling, or a lump appearing under the scar.
• Fluid, pus or blood leaking from the wound.
• An offensive smell.
• Fever, shivering, or feeling generally unwell.
• Stitches that seem to have separated, or a wound edge that has opened.

Any of these deserves a same-day call. See postpartum warning signs for the wider list, including the ones that need emergency care.

Scars, sensation and time

A caesarean scar usually fades from red or dark to pale over many months. It can stay numb, tight or itchy long after it has healed, and a shelf above the scar is common.

Perineal scar tissue can feel tight and can make first sex after birth uncomfortable. That is worth raising rather than enduring — see sex after birth and your pelvic floor after birth.

Ongoing scar pain months later is not something you have to accept. Ask.

When to see a doctor

Contact your midwife, doctor or maternity unit for a wound that is more painful, red, swollen, hot, leaking or smelly, for a fever, or for stitches that feel as though they have given way. Seek urgent care for severe pain, a wound that has opened, or feeling very unwell.

Take a photograph if you cannot see the area yourself. It is much easier than describing it.

Seek care now: Contact local emergency services or go to the nearest emergency department for severe tummy or wound pain, a wound that has opened, heavy bleeding from a wound, or fever with confusion, a racing heart or feeling very unwell. Femio cannot examine a wound.

Frequently asked questions

Do stitches after birth need removing?

Usually not. The stitches used for perineal repair normally dissolve by themselves.

How long is a caesarean recovery?

Most people feel much better by six weeks, with lifting, driving and exercise guided by their own team. Scar sensation can take far longer to settle.

Is itching a bad sign?

Itching is common while a wound heals. Itching with spreading redness, heat or discharge is not, and needs checking.

Can I shower with stitches or a caesarean wound?

Showering is usually fine once you are home. Pat the area dry rather than rubbing, and ask your own team if you were given specific instructions.

The pain is worse on one side. Does that matter?

Tell someone. Increasing or one-sided pain is worth assessing rather than watching.