Dear Doctor,

I gave birth a little over a month ago but the stitches still hurt terribly. I was advised by the nurses to only use water when washing myself but a cousin who has had three natural births tells me to add a little salt in the water. Would you recommend this? I’m told that stitches heal after two weeks. Why am I not healing? It hurts when I urinate and even sitting sometimes is a problem. Is there anything I can do to speed up the healing process?

Yvette

Dear Yvette,

Did you have stitches for a perineal tear or episiotomy? Episiotomy is usually done during first delivery if the birth passage is too tight.  It is also done in case of a large baby or breech presentation or if the labour is prolonged. To facilitate the birth of the baby, a cut is made in the muscular layer of perineum. It is done only when the benefit to be obtained is considered more than any potential harm due to a minor surgical procedure. Sometimes during a normal labour, due to force exerted by the baby coming out, the perineal tissue/muscles may get cut causing a tear. In both situations, stitches are put to aid in repair of the torn tissue.

These stitches usually heal within two to four weeks. Healing may be delayed if infection occurs after stitches are put. In cases of reduced immunity like uncontrolled diabetes or HIV/AIDS also healing may be delayed.  But till that time, they hurt while sitting or passing urine or even if one has sex. Fresh stitches hurt more.  It is important to keep the stitches clean and dry to avoid any infection. For this purpose, one should keep the area clean, take a warm shower and pat it dry with a soft  towel. Do not scrub this area or use any harsh soap or lotion over it.  Allow few minutes of this area to be exposed to air also, by putting on a panty for about 10 minutes after a shower. Use only cotton panties, and strictly avoid nylon ones.  After passing urine, it is good to wash the area with lukewarm water to avoid any contamination. Sanitary pads used should be changed every three to four hours to avoid dampness. The sanitary pad used should be positioned such as to cause minimum discomfort. Sex is best avoided at this time to avoid both pain and infection. Sexual intercourse can be done after healing of stitches.  Hands should be clean while handling the perineal area in any way for any purpose.  Salt water has no added benefit over ordinary water in aiding healing of stitches. 

To ease the pain, a woman can use a cushion for sitting which is inflated on both sides. This would make sitting comfortable. Ice packs can be put over the stitches. Adequate rest also helps in good healing of the episiotomy/ perineal tear wound. Avoid standing for a long time continuously.

Dr. Rachna Pande is a specialist in internal medicine.

E-mail- rachna212002@yahoo.