If your perineal tear has reopened after childbirth, the most important first step is to contact your midwife, GP, or the maternity unit where you delivered. Wound breakdown after perineal repair is not rare, affecting up to 25% of women with more severe tears in the first six weeks postpartum. While it can be frightening, most reopened perineal wounds heal fully within a few weeks with proper care.
How to Tell if Your Tear Has Reopened
A reopened perineal wound typically causes a noticeable increase in pain after a period where things were getting better. You may see fresh bleeding, feel a gap where stitches once held the skin together, or notice a pus-like discharge. Some women also start to feel generally unwell, which can signal infection alongside the wound breakdown.
Signs of infection overlap with signs of reopening but have their own distinct red flags: red or swollen skin around the wound, persistent pain that doesn’t ease with rest or pain relief, discharge of pus or liquid, and an unusual or foul smell. If you notice any of these, don’t wait to see if they resolve on their own. Contact your healthcare provider the same day.
What to Do Right Away
Keep the area as clean as possible. Gently rinse with warm water after using the toilet, and pat dry rather than wiping. Avoid using soap directly on the wound. Change your maternity pad frequently to keep the area dry and reduce bacteria exposure.
A sitz bath (a warm, shallow bath where you sit in a few inches of water) can help relieve pain and increase blood flow to the area, which supports healing. You can use your regular bathtub or buy a small plastic basin that fits over your toilet seat. The warm water helps keep the wound clean and can ease discomfort during bowel movements. If your pain hasn’t started improving after two or three sitz baths, that’s a sign you need professional evaluation sooner rather than later. If you’ve recently given birth, ask your provider for specific guidance on timing and frequency before starting sitz baths.
Use stool softeners to avoid straining. Constipation and hard bowel movements are one of the most common reasons perineal wounds reopen. Stool softeners and gentle laxatives taken regularly for the first six weeks postpartum significantly reduce the risk of further breakdown.
Will You Need Surgery Again?
Not necessarily. Many reopened perineal wounds heal without being re-stitched, through a process called secondary intention, where the body gradually fills in the wound from the bottom up. Your provider will assess the size and depth of the opening, whether infection is present, and which degree of tear you originally had.
One study comparing early re-stitching to letting wounds heal on their own found a noticeable difference at two weeks, with re-sutured wounds closing faster. But by six to eight weeks, 97% of all reopened wounds had healed regardless of which approach was used. So while re-suturing can speed things up in the short term, it isn’t always necessary for a good outcome.
For more severe tears (third or fourth degree, involving the anal sphincter), wound breakdown carries higher stakes. Roughly 25% of women with these injuries experience reopening in the first six weeks, and 20% develop an infection. If the original repair involved the sphincter muscles, your provider will likely want to examine you more urgently to make sure the deeper layers are intact. Poorly healed sphincter injuries can occasionally lead to complications like abnormal connections between the rectum and vagina, so timely follow-up matters.
How Reopened Wounds Are Managed
If your provider decides the wound can heal on its own, the standard approach involves keeping the wound open enough to drain properly and doing regular dressing changes. Moist-to-dry dressings, changed frequently, help gradually clean the wound bed and reduce bacteria. Over time, new tissue fills in from the base of the wound upward.
In some cases, your provider may gently remove dead tissue from the wound edges to encourage fresh healing. Warm water rinses or gentle irrigation can also help with initial cleaning. For larger or more complex wounds, additional therapies like vacuum-assisted wound therapy (a device that gently suctions fluid from the wound) can speed things along by reducing swelling and pulling wound edges closer together.
If re-suturing is recommended, it may not happen immediately. When a skilled provider isn’t available right away, the wound can be safely packed and the repair delayed for 8 to 12 hours without affecting outcomes.
How Long Recovery Takes
Reopened perineal wounds take an average of about three weeks to heal, though the range is wide: some close in as little as one week, while others take up to 16 weeks. In one prospective study tracking women with wound breakdown, roughly 69% of wounds healed within four weeks of the first clinical review.
The healing timeline depends on the size and depth of the reopened area, whether infection is present, and how well you’re able to keep the wound clean and avoid straining. Nutrition, hydration, and rest all play a role as well, though those factors are harder to optimize when you’re also caring for a newborn.
Activity and Lifestyle During Healing
Avoid heavy lifting and strenuous physical activity for at least two to three months, particularly if you had a third or fourth degree tear. This includes exercises that put pressure on the pelvic floor like squats, running, or high-impact movements. Carrying your baby is generally fine, but try to avoid lifting anything significantly heavier.
Hold off on sexual intercourse until the wound has fully closed and you feel comfortable. There’s no universal timeline for this. Let healing and your own comfort guide the decision, and don’t hesitate to ask your provider to check whether the wound has closed before resuming.
Pelvic floor exercises (Kegels) are still important during recovery, but start gently. Strengthening the pelvic floor muscles supports the healing tissue and helps prevent long-term issues with continence. If you’re unsure whether you’re doing them correctly or if they cause pain, a pelvic floor physiotherapist can help.