By Ali Weatherford

It would be incredibly rare to NOT be sore and swollen “down there” after a vaginal birth. For some people, this is minimal and passes quickly. For others it can be very uncomfortable and last for many days or even weeks.

Why does this happen?

The perineum is the wall of skin and soft tissue between the vagina and the anus. I don’t usually like to get too graphic, but picture this with me.

A 7.5 pound baby wiggles and squirms lower and lower in your body until the big 13.5 in diameter head is resting on your pelvic floor. The pelvic floor is the muscles and ligaments and tendons just on the other side of that perineum. That baby is a large weight that is more than that part of your body is used to supporting.

And then the baby moves even lower. The head begins to move into the vaginal canal and the opening widens. For the vaginal opening to widen, the perineum has to stretch. It continues to stretch and sometimes even tears to open wider and accommodate the large head. This might take minutes, or it might take hours. Either way, there is a lot of pressure and strain there.

The perineum is being pushed very far outside its normal ranges. How do your other body parts feel when pushed outside normal ranges? Have you ever worked out a little too hard at the gym? Or decided it was time to learn how to swim or bike or run? After going through that, those muscles will be overworked, overstretched, and overtired. They get sore.

So even if you don’t have any tearing while giving birth, you will probably be sore from the extra weight of pregnancy, stretching, and hard work. Most often, the skin also responds to the stress with some swelling. You might even have stitches or a tear that is healing without stitches.

You may have some vaginal soreness and swelling after a cesarean too! Most everyone has a little swelling down there at the end of pregnancy. Then if you labored or pushed at all before having a cesarean, that can add to it. It won’t be as much as if you had a vaginal birth, but it does happen sometimes.

And finally, a lot of people aren’t prepared for this, but your literal bottom might also be sore and swollen from hemorrhoids which can be caused by pregnancy or birth.

What can you do about it?

There are a lot of great tips to help you feel better. If you have stitches or hemorrhoids, that will be a different kind of discomfort, but sometimes that can make the soreness and swelling worse. Most of the things you would do to help your stitches heal are also good for the soreness and swelling in all the parts. Before trying any kind of medication or new product, make sure to talk to your care provider about it. Even with a very natural product, there could be some contraindications you should know about depending on your circumstances.

Some of these things might not work for you, so just focus on the things that do!

  • Cold: Ice packs can be very helpful. You will probably be offered these at the hospital. You can also make your own to have at home. A fun tip is to soak big menstrual pads in water and freeze them. Then you have an ice pack that is also absorbent for the postpartum bleeding! Some people use bags of frozen veggies or other cold packs. Make sure they are cleaned often, and that you cover it with a cloth before putting it onto your skin.
  • Rest: Resting is generally good for everything while you’re recovering postpartum. The more you are standing and walking, the worse the swelling and soreness will be. So put your feet up!
  • Pillow: Sitting on your bottom might be uncomfortable. If it is, sometimes a donut-shaped pillow can make you more comfortable. You can get an inflatable pillow at a local drugstore or online. I had an extra breastfeeding pillow that was about the right size and shape, and that worked for me!
  • Topical products: You might want to try a balm, salve, ointment, spray, or lotion. There are a lot of options out there, and one of these might be very helpful for you. It’s hard to know until you try. Some people don’t like the idea of putting something “down there”. If you have very heavy bleeding, these products might also not provide relief for very long.
  • Analgesics: You will want to ask your doctor about safe medication options before trying something, but you can often use these to help. Most of the time, an over the counter medication like acetaminophen or ibuprofen is enough to provide the relief you need.
  • Sitz bath or a soak in the tub: Some people get a lot of relief from soaking in water. A sitz bath is a small plastic tub designed to fit in your toilet. You can also just get in the bathtub. Epsom salts can be added to the water and can be good for soreness and healing. Epsom salts are easy to find at any grocery store or pharmacy.
  • Witch hazel: You can buy pre-soaked pads or buy a bottle of witch hazel and some cotton pads. Witch hazel can help reduce swelling and it’s antibacterial. This can also be a little harsh for some people. Be sure to get alcohol-free witch hazel and talk to your care provider before using.
  • Rinse, don’t wipe: Wiping just won’t feel good for a while. You also don’t want toilet paper lint sticking to your stitches or tear site! You might also just like to rinse the area occasionally because blood on your stitches can be irritating. Your hospital or birth center will probably provide you with some kind of spray bottle for this. Peri-bottles can be purchased if you’d like something that’s a little easier to spray while you’re sitting on the toilet. Once you’re home, hand-held toilet sprayers or a bidet can be handy for rinsing. Gently pat dry or you can even use a hair dryer on a cool setting if you really want to stay hands off!
  • Really good nutrition and hydration: Most people won’t tell you this but just about EVERYBODY will be a little freaked out when it’s time to pee and poop after giving birth. It might hurt, or it might just feel weird and a little out of your control. It’s best to make sure this process is as easy as possible. When you’re well-hydrated, your urine will be less concentrated and sting less coming out. When you’re well-hydrated AND are eating your fruits and veggies and lots of great high-fiber foods, you are more likely to have regular and easy bowel movements. This is especially helpful if you have a lot of soreness from a significant tear and stitches.

Discomfort Will Pass

It’s hard to know how uncomfortable you’ll be “down there” until the time comes. Some people will hardly notice a difference, but most people will have at least a few days of discomfort. Remember that it will pass!

Also know that if you get the “all clear” for normal activity at your 6-week checkup but things don’t feel quite right to you, you’re probably right. Trust your intuition and consider seeing a specialist. It’s not supposed to hurt forever.

A urogynecologist or colorectal surgeon might be needed if you had a complex tear or even just a tear that didn’t heal quite right. A pelvic floor physical therapist might be helpful in some situations too. Your body went through a lot during pregnancy and birth. It’s very important to treat it kindly so you will heal quickly and THOROUGHLY. Get the help that you need so you can rest and heal for those first few weeks postpartum. You’ll be glad you did.

Our articles are not intended or implied to be a substitute for professional medical advice, diagnosis, or treatment.

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