When it happens · 4 min read
Tearing, stitches, and sitting down again
It's the recovery nobody describes above a whisper: stitches somewhere you can't see, a first trip to the bathroom you're genuinely afraid of, and no way to gauge whether what you're feeling is healing or a problem. Here's the plain version.
Last updated August 9, 2026
What the degrees actually mean
Tears are graded one through four: first-degree is skin-deep and often needs few or no stitches; second-degree — the most common — reaches into muscle and is stitched; third and fourth extend toward or through the anal sphincter, are much less common, and get more careful repair and follow-up. Episiotomy (a deliberate cut) is no longer routine — ACOG recommends against it except for specific situations, so if you had one, it was a judgment call in the moment, not a default you should have avoided.
Stitches are dissolvable — nothing gets removed — and the repair itself typically heals over several weeks, with the first two being the sore ones.
The toolkit, in order
First 24 to 48 hours: cold — ice packs wrapped in cloth, or pads chilled with witch hazel, 10 to 20 minutes at a stretch, for swelling and pain. After that: warmth — a sitz bath (a few inches of warm water, in the tub or a basin that sits on the toilet) two or three times a day soothes and keeps the area clean. Ongoing: the peri bottle is your bathroom companion — squirt warm water while urinating to stop the sting and instead of aggressive wiping; pat dry front to back.
The first bowel movement is the psychological boss fight, and stool softeners are the cheat code — start them early (your OB almost certainly already recommended them), drink water, don't strain, and consider supporting the perineum with a clean pad of tissue while you go. Fear of that first trip is universal; the reality is nearly always better than the dread.
Healing versus a problem
Expect: soreness that steadily improves, itching as things knit (a healing sign), and twinges with sitting or stairs for a couple of weeks. Call your OB for: pain that worsens after the first few days rather than easing, a feeling that stitches have given way, discharge that smells foul, fever, or new trouble controlling urine, gas, or stool. Those last ones matter double — they're both a now question and a six-week-visit question, because leaking that persists is treatable and under-reported in equal measure.
Say it at the six-week visit
If sitting still hurts, if sex sounds impossible, if you leak when you laugh — say it in the appointment, in those words. Pelvic floor physical therapy is the evidence-backed next step for persistent pain and incontinence, referrals are routine where patients ask, and the folklore that these are simply the permanent price of childbirth is wrong. The six-week visit is the on-ramp; take it.
Common questions
- How long until I can sit normally?
- Most first- and second-degree tears feel dramatically better within two weeks, with lingering twinges after. A cushion or nursing pillow under you early on is fair play, not fragility.
- Did I tear because something was done wrong?
- No — most first vaginal deliveries involve some tearing; tissue, speed, and baby position drive it far more than anything anyone chose. Routine episiotomy was retired precisely because cutting preemptively didn't help.
- When is it safe to use a sitz bath?
- Generally after the first day or two (cold does the early work), and your discharge instructions will say — warm shallow water a few times daily is soothing and safe for stitched tears.
If it's this, not that
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