Take a painkiller regularly. Paracetamol is fine if the pain is not too bad but if you find that they aren’t working an anti-inflammatory might be better. They work by reducing swelling which in turn reduces pain. Tell the midwife whilst you are in hospital if you are struggling with the pain or discomfort. You can try the anti-inflammatories out in hospital before you leave and go home with a prescription. Don’t sit and suffer, talk to a midwife and tell her that despite the painkiller you are still in pain. It’s no good expecting that 1 or 2 tablets will do the trick. Follow the instructions on the packet very carefully and take the suggested dose regularly. If you are at home mention the pain to your community midwife. She can check you over and discuss analgesia at the same time-your GP could prescribe you something stronger.

Apply something cool to the area. (Steen, 2000). There are specially designed gel pads available and you can buy them from some super market pharmacies and larger chemists. However, they are quite pricey. Try a cold flannel or spray the area with a cooling jet of water. This will also keep the area clean and hopefully free from infection. Change your pads regularly as well.

Try lavender and teatree compresses- 5 drops in 50mls of warm water as often as needed. It smells good too!

Another tip to help with the pain is to sit on either 2 cushions, or a feather pillow that has been karate chopped in the middle. You’ll see a dip. Your buttocks sit on either side with your sore bits over the dip. This reduces the pressure on your perineum.

Eat a diet with lots of fresh fruit and veg. When your body is healing it needs vitamins and minerals to aid the process.
(see dietary advice)

Exercise your pelvic floor. Squeezing and lifting and then relaxation of the muscles that make up the perineum help to improve the blood supply to the area, reducing swelling and aiding healing. The pelvic floor also acts as a support for your bladder, womb (or uterus) and bowel. When one or all of them move out of place they are said to have prolapsed. So, while you are helping your painful parts to heal, you are also strengthening the muscles that keep those important organs in the right place. (Sampselle et al, 2000). And dare sex be mentioned? By improving the tone of these muscles, it could improve your sex life. If you already have a baby you’ll be asking, " what’s that?"

Just in case you aren’t sure where your pelvic floor is, it is the set of muscles you use when you stop passing urine mid flow. This is a good test of your pelvic floor but only do it once a week at the most as you may develop a problem with completely emptying your bladder that could lead to cystitis (infection of the bladder). (Bump et al, 1991). Immediately after baby is born you will probably think that your pelvic floor has emigrated, but the strength and feeling will return by about 3 months. Begin slowly with some gentle squeezes. The muscles of your pelvic floor should be lifted and tightened comfortably. To relieve some of the soreness in your perineum, lots of quick squeezes will help.

There are two main exercises for the pelvic floor taught to the postnatal women here. One helps to strengthen the muscles to prevent a prolapse. The other is aimed at preventing stress incontinence or the leaking of urine from the bladder which tends to occur mainly when coughing or sneezing.

TO PREVENT A PROLAPSE.

Close around your back passage as though to stop passing wind. At the same time close around your front passage as though to stop yourself from passing urine. As you close and tighten you should feel a lifting inside. Hold for 4 seconds and relax. Initially, trying to hold for 1 second might be difficult. Don’t worry. Keep practising and gradually things will improve.

The muscles in these areas are difficult to isolate completely-once one part is lifted they all tend to come along. But by making an effort to include the front and back passage these exercises will work the muscles more effectively.

TO PREVENT STRESS INCONTINENCE.

Close around your back passage as though to stop yourself passing wind. At the same time close around your front passage as though to stop yourself passing urine. As you close and tighten you should feel a lifting inside you, then relax. This is a quick squeeze.

Do both these exercises 5 times. They can be done anytime, anywhere and in any position. So sitting, lying, standing, kneeling-it doesn’t matter. Choosing feed times at first is good because feeding baby is something you will be doing a lot of initially. It will act as a reminder to do these very important exercises. When baby stops feeding so frequently use the washing up, talking on the phone, ironing-any time when you can concentrate on doing them properly. These exercises are for life, so no shirking!

Any pain that you feel should be temporary. It may last a week or two but if you are at all worried ask your midwife, health visitor or GP for advice.

This information has been strenuously checked over by our obstetric physiotherapists. If you have a problem and need more advice contact your community midwife, health visitor or obstetric physiotherapist.

References:

Steen M. 2000.Feme pad: out of the ice age and into the new millennium.B.J.M. 8(5) 312-315.

Sampselle et al, 2000. Continence for women: test of AWOHNN’S evidence-based protocol in clinical practice. (Ass. of Women’s Health Obs and Neonatal Nurses). Journal of Obs, Gynae and Neonatal nursing. 29(1): 18-26.

Bump et al, 2000. Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction. American Journal of Obs and Gynae. 165(2): 322-329.