What is better - a rupture on its own or an incision during labor during childbirth: what is the danger of an internal tissue rupture, what does it look like. Internal stitches after childbirth: what to do if they hurt and how to treat them? After giving birth, the tears were heavily stitched

Lacerations are a common injury that occurs during childbirth. They occur at the stage of expulsion of the fetus from the uterus. Perineal rupture is one of the most common injuries of this type. It is mainly associated with insufficient elasticity of organ tissues.

Causes of trauma to perineal tissue during childbirth

The perineum is a collection of pelvic floor muscles between the anus and the back wall of the vagina. It consists of the anterior (genitourinary) and anal regions. During childbirth, as the fetus passes through the birth canal, the soft tissues of the perineum are stretched. If elasticity is insufficient, rupture is inevitable. The frequency of pathology is approximately 1/3 of the total number of births.

Predisposing factors include:

• first birth after the age of 35, when there is a natural decrease in muscle elasticity;
• incorrect behavior of a woman in labor - especially typical for inexperienced primiparous women who tend to panic and not follow the commands of the doctor and obstetrician;
• untimely or incorrectly provided medical care;
• use of obstetric forceps or vacuum extraction;
• rapid delivery - pressure on soft tissues increases significantly;
• inflammatory processes in the genital organs, leading to thinning and decreased elasticity of the muscles;
• scars left after previous injuries or surgical procedures;
• weakness of labor, prolonged pushing, causing swelling.

The threat of perineal rupture increases with the birth of a large fetus (more than 4 kg), or with birth after 42 weeks of gestation (post-term baby).

The classification of birth injuries of the perineum allows us to distinguish the following degrees of severity of ruptures:

• 1st degree – damage to the outer layer of the vagina or violation of the integrity of the skin occurs;
• Grade 2 – injuries to the muscle layer of the organ are noted;
• 3rd degree – the external sphincter is subject to trauma up to complete rupture;
• Grade 4 – occurs in rare cases, characterized by injuries to the walls of the rectum.

If the posterior wall of the vagina, the muscular layer of the pelvic floor and the surface skin are affected, while maintaining the integrity of the anus, a central perineal rupture is diagnosed. In this case, the birth of a child occurs through an artificially created channel. This severe injury is extremely rare.

Injuries must be treated immediately as they can have serious consequences. The most dangerous among them is severe bleeding. Through an open wound, pathogenic microorganisms can easily enter the body, causing an inflammatory process in the genitals.

More long-term negative consequences of birth trauma to the perineum include disturbances in the vaginal microflora. 3rd and 4th degree ruptures can lead to urinary and fecal incontinence and other disorders of the urethra and rectum.

Diagnosis of damage is not difficult. Immediately after the end of childbirth (exit of the placenta), the doctor examines the condition of the birth canal, which allows you to determine the presence of ruptures and their severity.

Treatment

After identifying injuries, they are sutured using special vaginal speculums. It is very important to determine the severity of the damage. First and second degree perineal rupture requires suturing, which is performed under local anesthesia. The integrity of the perineum is restored with catgut sutures, which dissolve on their own over time, or with silk sutures, which must be removed. In the first degree, the sutures are applied in one layer, in the second - in two.

Treatment of grade 3 tears involves the use of general anesthesia. The woman in labor is examined not only the muscle layer, but also the anus and rectum. In this case, suturing begins with restoring the integrity of the walls of the rectum and sphincter. Then sutures are applied to eliminate damage to the skin. Suturing is carried out immediately or within half an hour after birth.

If there are risks of ruptures during childbirth, during the birth of a large child and in the case of rapid labor, an episiotomy (perineal incision) is indicated. Thanks to this intervention, the vaginal opening becomes wider, which prevents damage to the rectum and blood vessels.

This helps not only to avoid injury to the mother in labor, but also stops bleeding and minimizes negative consequences for the child.

Before making the incision, the genitals are treated with an iodine solution. The dissection is performed using special scissors at the moment when the pushing becomes most intense. This moment is more favorable for manipulation, since with strong tension the woman feels less pain. The length of the incision is 20 mm.

Caring for sutures after suturing tears

How long does it take for a perineal rupture to heal after childbirth and how to properly care for the sutures?

Self-absorbing sutures take two weeks to heal. Usually the process goes well. Seams made from other materials will tighten within a month. The duration of recovery depends on the individual characteristics of the body and the severity of the ruptures. The patient must know the rules of care and follow medical recommendations that will help her recover as soon as possible.

Rules of conduct after childbirth:

1. Regularly treat the seams with brilliant green or a solution of potassium permanganate (at least 2 times a day). Immediately after birth, this is done by a midwife; later, processing is done independently.
2. Observe the rules of personal hygiene: wash the genitals with warm water as often as possible, change pads every 2-3 hours;
3. Wear only cotton underwear. It should be free and not put unnecessary pressure on the perineum.
4. When taking a shower, direct the water stream from top to bottom. Do not rub your genitals with a washcloth or hard towel. Dry the skin using gentle blotting movements.
5. While at home, it is recommended to dry the affected area using air baths, ointments (Solcoseryl, Bepanten), and do special gymnastic exercises.
6. Do not lift weights above 3 kg, avoid physical activity and sports.
7. Introduce into the diet foods that ensure normal bowel movements and eliminate constipation.
8. The sexual life of the spouses can be resumed no earlier than 1.5-2 months after the injuries have completely healed.

Separately, we should highlight the need for regular visits to the toilet. The process of urination and defecation causes severe pain. Fear of pain and discomfort forces a woman to postpone the process until the last minute. The accumulation of feces puts even more stress on the muscles of the perineum, which only aggravates the severity of the situation.

To relieve pain, painkillers and glycerin suppositories can be prescribed to soften stool. In case of severe swelling, apply an ice pack. For third-degree ruptures, antibacterial drugs are prescribed to prevent infection of the rectum.

During the first 10-14 days after suturing the ruptures, sitting is prohibited. Mom should rest more and not make sudden movements. You should eat while standing or lying down using a bedside table. You need to feed your baby while lying down.

How long can you sit?

You can sit on hard surfaces after two weeks, on soft surfaces after three weeks. When returning from the maternity hospital in a car, the patient is recommended to take a reclining position to avoid pressure on the perineum.

Complications

Common complications include:

• painful sensations;
• seam divergence;
• severe itching and swelling;
• suppuration;
• bloody issues.

To relieve pain and itching, heating with a quartz or infrared lamp and lubricating the sutures with Contractubex ointment are prescribed. Itching often indicates the healing process, but if it is too bothersome, washing the genitals with cool water is recommended.

Discharge of pus usually indicates infection. In this case, antibiotics, Levomekol, Vishnevsky, Solcoseryl ointments are prescribed. Chlorhexidine and hydrogen peroxide are used to disinfect the wound cavity. The presence of bleeding requires additional suturing of the damaged area.

The most dangerous complication occurs if the stitches come apart. In this situation, it is strictly forbidden to self-medicate. The woman should immediately call an ambulance. Repeat stitching is usually required at a medical facility.

Prevention of ruptures

There is a common belief that they are inevitable. This is not true. Damage to the perineum can be prevented by undergoing thorough preventive preparation during pregnancy. Preventive measures include performing special intimate gymnastics and perineal massage.

Massage

The best prevention is regular massage. It can be done at any time, but the best period is still the third trimester. The benefits of massage are as follows:

• activates blood circulation, improves metabolism in tissues;
• trains the muscle tissue of the perineum;
• gives the muscles the necessary softness, pliability and elasticity;
• promotes relaxation, which significantly reduces the risk of injury.

For maximum effectiveness, perineal massage to prevent ruptures is performed using natural oil. You can use flaxseed, pumpkin, burdock, and olive oils. There is also a special oil for perineal massage, which can be purchased at the pharmacy.

Before the massage you need to take a warm shower. The intestines and bladder should be emptied, and hands should be washed thoroughly. The perineum, genitals and fingers are lubricated with oil. A woman needs to take a comfortable position and relax as much as possible. With fingers inserted into the vagina, make gentle movements towards the anus, pressing on the back wall of the vagina. Pressures should be alternated with regular massage movements.

The duration of the massage is 5-7 minutes. Usually it is difficult for a woman to carry out the procedure on her own, since her stomach is in the way, so the help of people close to her is very desirable. A number of contraindications should be taken into account in which massage cannot be performed. In particular, these are inflammatory and infectious diseases of the genital organs. In this case, massage can be carried out only after complete recovery, otherwise it will contribute to the further spread of infection in the body.

Massage is strictly not recommended if there is a threat of miscarriage or incorrect presentation of the fetus and if the pregnant woman has skin diseases. It is very important that the procedure does not cause any negative emotions or physical discomfort. Before performing it, you need to obtain the consent of the doctor who is seeing the expectant mother.

Gymnastics

Effective prevention includes performing special gymnastic exercises that help improve the elasticity of the perineum.

Exercise 1. Stand sideways to the back of the chair and rest your hands on it. Take your legs to the side one by one 6-10 times.

Exercise 2. Place your feet wide. Slowly squat down, holding your body in this position for a few seconds, then slowly rise up. Do the exercise 5-6 times.

Exercise 3. Place your feet shoulder-width apart. Breathing deeply, alternately draw in your stomach and then relax its muscles. The back should be straight.

Exercise 4. Alternately tense and relax the muscles of the anus and vagina. The exercise can be done both in a lying and sitting position. This exercise can be performed not only at home, but also at work and even on public transport.

Nutrition

A pregnant woman should also pay attention to her diet. It must include vitamin E. You can take it either in capsules or drink vegetable oil, which is rich in these vitamins. The menu should include fish that is rich in fatty acids or fish oil. From 28-30 weeks it is recommended to take a dessert spoon of apple cider vinegar before breakfast.

Eliminating meat in the third trimester also helps prevent ruptures. If a woman is not ready for such a decision, she should at least not include smoked products on the menu.

Other preventive measures include:

• regular visits to the gynecologist, following all his recommendations;
• timely registration of pregnancy (no later than 12 weeks);
• attending prenatal training courses to teach proper behavior during childbirth;
• timely detection of inflammatory processes in the genital organs and their complete cure even at the stage of pregnancy;
• following all instructions from the doctor and obstetrician during childbirth.

Labor can take place in different ways. If something doesn’t go according to plan and ruptures appear, knowledge in this area will allow you to trust the doctors and not be nervous again.

On the eve of childbirth, women prefer to prepare informatively, so they learn a lot of new things about the body. Labor may be accompanied by ruptures that occur for various reasons.

Regardless of this, there are recommendations that allow you to avoid an unfavorable situation. Women who give birth for the first time most often experience ruptures. That’s why it’s so important for them to arm themselves with information that can be decisive.

Causes of ruptures after childbirth

Even with a favorable course of labor, stretching of the perineum has its limit. During the passage of the fetus, there is an additional impact on the birth canal, which can cause certain complications.

Internal breaks

Internal ruptures include ruptures of the cervix and uterus. Such complications are accompanied by bleeding, requiring blood transfusion, and can even be fatal. A woman should follow all the instructions of the obstetrician, then all risks will be minimized. Reasons that may trigger:

1. Premature attempts. The cervix has not yet had time to open to the appropriate size, but the process has already begun.
2. Decreased elasticity of cervical tissue.
3. Presence of scars, surgery on the cervix.
4. Childbirth in a pelvic proposal.
5. Late or rapid labor.

External

About 16 percent of women in labor experience a perineal rupture. The main reasons include:

1. Rapid labor due to additional pressure. Labor has to be artificially slowed down.
2. Narrow pelvis of a woman in labor.
3. Big fruit.
4. Premature attempts and incorrect actions of a woman in labor who does not listen to the recommendations of the obstetrician.
5. With age, the tone of the perineal tissue decreases.
6. Scars from sutures, if sutures remained previously after operations or the first birth.
7. Athletes have overly pumped muscles, which inhibit labor.
8. Anatomical features, the so-called “high crotch”.
9. Incompetence of the gynecologist who conducts childbirth, errors in the process.
10. Infectious diseases.

What is better - rupture itself or periniotomy?

Doctors try not to let the situation rupture. The torn edges of the wound are more difficult to connect with each other, suppuration may appear over time, and their fastening may not be as precise.

Therefore, when the doctor sees that a critical moment cannot be avoided, he makes a careful incision. This approach allows us to prevent the occurrence of undesirable consequences. Such edges are easier to join more accurately and with better quality.

Before stitching, the doctor assesses the condition of the wounds, sets the degree of severity, and from this decides which threads to use and which painkillers to inject. Using silk threads, the doctor warns that they will have to be removed in 4-7 days. But catgut or vicryl self-absorbing sutures do not require additional intervention. The advantages of a surgical incision are smooth edges, depth control, and some guarantee that it will not be prolonged arbitrarily.

How is perineal perineotomy performed?

Periniotomy is made as a direct incision to the anus. This option does not involve cutting the muscles, therefore it is considered less traumatic.

There is a risk that the incision may continue to the rectum and even extend into it.

Therefore, this technique is used less frequently, more often for women in whom the distance from the vagina to the rectum is large. In 95 percent of cases, doctors try to use an episiotomy, the incision is made obliquely towards the ischial tuberosities.

Is it painful to stitch up tears after childbirth?

Much depends on individual tolerance, as well as the affected area. Some women require anesthesia for the procedure.

If the cervix is ​​ruptured, then most often no pain medication is used. In other cases, the degree of rupture is assessed.

How do you sew it up?

First, the perineal muscles are sutured using absorbable suture material. Sutures made of non-shrinkable material are placed on the skin. When the incision is straight, the specialist applies a cosmetic suture. The thread runs in a zigzag pattern, appearing outside at the beginning or end of the cut. This results in a thinner scar. A technique is often used when tissue and skin are sewn together with one thread, using absorbable material.

Is anesthesia used?

The choice of anesthesia - local or internal - directly depends on the degree of damage. It may not be used at all if the tissue of the cervix, which is insensitive after childbirth, is sutured.

To apply sutures in the vagina, a local anesthetic (Novocaine, Lidocaine) or general (short-term intravenous anesthesia) is required. The perineum is sutured under Novocaine or Lidocaine. In some cases, pain medication may not be used, because some physiological mechanisms provide protection from pain during childbirth.

What if there are uterine ruptures?

Uterine rupture is a dangerous complication that threatens the life of the pregnant woman and the child. An immediate response from medical staff is required, necessary manipulations are required, and a blood transfusion is possible. Reasons: malpresentation of the fetus, prolonged labor, dilation of the cervix, suture dehiscence after cesarean section.

How long does it take for an incision and rupture of the birth canal to heal?

Perineal healing takes longer and is more difficult than cervical ruptures. For the best effect, rest and asepsis are required, which is complicated under modern conditions. After all, the mother needs to constantly monitor the baby and it is impossible to ensure complete rest of the perineum and secure a special bandage.

To achieve rapid healing, ensure maximum hygiene.

Change the gasket every 2 hours, go through all procedures for treating seams with antiseptic agents. After each visit to the toilet, it is necessary to wash with warm water and a solution of potassium permanganate. The procedure is recommended to be carried out within 1.5-2 months after birth.

It is forbidden to sit down, because the stitches may come apart, so women in labor eat while standing or lying down. It is necessary to ensure maximum rest for the muscles and get up and walk as little as possible. In the first days after childbirth, it is not recommended to eat bread and other flour products to avoid bowel movements. Stitches are removed during consultation, but even after this, hygiene is required.

In contact with

Among the questions that can be heard in these by no means quiet conversations, there is always the following: “Is it torn? How many seams?” Indeed, rupture is one of the most common birth injuries for women. Every woman has heard about the possibility of such problems; but, unfortunately, not everyone knows about the measures to prevent ruptures that both doctors and the woman in labor can take.

Cervical ruptures

Causes. As you know, during childbirth the uterine os opens. The pushing period, during which the baby is born, begins when the cervix is ​​fully dilated. In this case, pushing itself, the desire to push, is a reflex that appears when the presenting part of the fetus (head or pelvic end) puts pressure on the pelvic floor muscles. Since different women have different perceptions of pain, the time at which pushing occurs is different for different women, so in some women in labor, the pushing reflex appears when the cervix has not yet fully dilated. In this case, the cervix still covers the fetal head. If you start pushing when the cervix is ​​not yet fully open, the fetal head, advancing during pushing, overcoming resistance, tears the cervix. Therefore, with premature attempts, there is a possibility of cervical rupture.

Depending on the depth, there are three degrees of cervical rupture.

I degree ruptures include ruptures of the cervix on one or both sides with a length of no more than 2 cm. II degree ruptures include ruptures with a length of more than 2 cm. III degree ruptures reach the junction of the cervix into the body of the uterus or pass to the body of the uterus.

Manifestations. Shallow tears of 0.5-1 cm in length usually do not manifest themselves in any way. Deeper ruptures are accompanied by bleeding. Bloody discharge may appear immediately after a cervical rupture, that is, at the beginning of the pushing period, after the birth of a child, the bleeding intensifies. However, it should be noted that bleeding does not always accompany damage to the cervix. Signs of inflammation in the postpartum period are the appearance of greenish or yellowish discharge with an unpleasant odor.

Prevention. To prevent this complication, it is necessary to start pushing only after the next examination by an obstetrician. If the doctor determines that the opening of the cervix is ​​complete, then pushing will not be traumatic.

Treatment. A cervical rupture must be sutured. Absorbable materials are always used to repair the cervix, so sutures are not removed. For grade III cervical ruptures, when there is a suspicion that the ruptures have spread to the body of the uterus, a manual examination of the uterus is performed to determine the extent of the rupture. Only after this the tissues are restored.

Complications. They are usually associated with inflammation in the vaginal and cervical areas. Therefore, to prevent complications in case of massive ruptures and in the presence of signs of inflammation, antibacterial drugs are prescribed immediately after childbirth.

If no stitches were placed during the rupture or if they came apart, a subsequent complication such as ectropion (eversion) of the cervix. This complication leads to the fact that the inverted mucous membrane of the cervical canal is exposed to external influences. Since the vagina naturally maintains an acidic environment, and the cervical canal is alkaline, when the inverted mucous membrane comes into contact with the acidic environment of the vagina, the mucous membrane is constantly exposed to this aggressive factor. This leads to the appearance ectopia on the cervix 1 , which, in turn, is a predisposing factor for cell degeneration, i.e. may cause cancer.

Another complication that may arise due to suture dehiscence on the cervix is isthmic - cervical insufficiency. In this case, the cervix does not perform its obturator function, which can lead to miscarriage, and the pregnancy is terminated at 16-18 weeks.

Vaginal lacerations after childbirth

Causes. These ruptures occur when the fetal head does not advance for a long time and remains in one place, as well as with premature attempts.

Manifestations. Vaginal rupture is manifested by bleeding that occurs during the pushing period of labor, or hemorrhage occurs under the vaginal mucosa, which is detected during examination of the birth canal.

Treatment. The tears are stitched up; in this case, absorbable material is used, which eliminates the need to remove sutures.

Complications. There is a small chance of inflammation in the scar area. In this case, the uterine cavity can connect with the cavity of the rectum or bladder, so-called vaginal-rectal or vaginal-vesical cysts are formed. fistulas. Such complications are treated surgically by excising (cutting out) the passage connecting the organs. Fortunately, these complications are extremely rare.

Perineal lacerations after childbirth

Causes. Perineal ruptures occur due to the fact that the fetal head presses on the skin and muscles of the perineum. Rupture occurs when there is insufficient extensibility of the soft tissues of the perineum. At the moment of removal of the head, the midwife provides special assistance - a series of manipulations, the purpose of which is to prevent rupture. When providing this benefit, the woman is asked not to push, so as not to force the course of events. At this time, the midwife seems to move the soft tissue of the perineum from the baby’s head. The woman in labor should breathe frequently and shallowly, but not push. After the birth of the head, the baby turns his face to one of the mother’s hips, after which the shoulders are born. The midwife first removes one shoulder, then the other. At this point, the woman is also asked not to push. If you force events, then the shoulders are born not one by one, but together, which can also lead to vaginal rupture. According to the depth of damage, perineal ruptures are divided into three degrees. First degree ruptures include ruptures of the perineum over a short distance, mainly damaging the skin of the perineum and a small area of ​​the vaginal mucosa. In case of a II degree rupture, the muscles of the perineum are partially damaged along with the above tissues. With third-degree ruptures, the sphincter, the closing muscle of the rectum, is damaged.

Prevention. The main preventive measure is its incision. It is undertaken in the following cases:

1. If there is a threat of perineal rupture. If the doctor delivering the baby sees that the skin of the perineum is turning bluish, this tells him that a rupture may occur. In this case, the perineum is dissected. In this case, dissection of the perineum is more preferable, since the edges of the cut wound, which is obtained as a result of cutting the perineum with scissors, are smooth and directed to the side, but not towards the rectum. Such conditions are more preferable for wound healing.
2. If the fetus is premature or if the fetus experienced a lack of nutrients and oxygen during pregnancy. In these cases, the path is made easier for the weakened fetus by eliminating the last barrier that it passes during the birth process - the perineum.
3. Birth with breech presentation. Since in a breech presentation the pelvic end is born first and only after that the larger head, an incision is made in order to avoid pinching the head in the perineal area.

The incision is made as follows. At the height of the contraction, when the tension of the muscles of the uterus and the anterior abdominal wall is maximum, scissors are inserted between the skin of the perineum and the presenting part of the fetus and the skin is cut. If the scissors are directed to the side, then they say that an episiotomy has been performed; if downward, towards the rectum, then they speak of a perineotomy.

The procedure is carried out without pain relief, because during pushing the pain from cutting the skin is not felt.

Treatment. Sutures are placed on the muscles and skin of the perineum and the vaginal wall. There are different methods for applying them. According to one of them, sutures are applied to each layer (muscle and skin) separately. In this case, the vagina and muscles are restored with absorbable threads, and suture material is applied to the skin of the perineum, which must be removed 4-5 days after birth. According to another method (it is used for grades I-II tears and cuts), the suture is applied according to a special pattern, with one thread capturing all the layers that need to be restored. These sutures are performed with absorbable threads.

Complications. In the postpartum period, inflammation and suture dehiscence may occur. In this case, the wound takes longer to heal and a change in the anatomical structure of the perineum is possible.

How is tissue restoration surgery performed?

Inspection of the soft birth canal and its restoration, if necessary, is carried out immediately after the birth of the placenta. If the birth was carried out in a separate maternity box, then the operation to examine and restore the perineum is carried out in the same box where the birth took place. If the maternity unit does not have a box system, then the birth is carried out in the delivery room, after which the woman is transported on a gurney to a small operating room. Considering that there are absolutely no pain receptors in the cervix, in a situation where cervical ruptures are minor and the woman tolerates the manipulation well, it is possible to restore the cervix without pain relief. In this case, discomfort will only be associated with stretching of the cervix. When restoring the walls of the vagina and perineum, anesthesia is always used.

If the birth took place against the background epidural anesthesia (the anesthetic is injected into the space above the dura mater), then immediately after birth an anesthetic is added to the epidural catheter, and after 15-20 minutes pain relief occurs. In this case, the examination begins against the background of continued epidural anesthesia. In this case, the woman is conscious, but does not feel the manipulations.

For significant ruptures of the cervix, ruptures or incisions of the perineum and ruptures of the vaginal walls, use intravenous anesthesia . To do this, after the birth of the placenta or after a significant rupture is detected, an analgesic substance is injected into the vein, under the influence of which the mother falls asleep. The woman does not experience any sensations during the operation.

For small perineal tears it is used local anesthesia . Injured tissues are injected with an anesthetic ( NOVOCAINE and so on.).

After childbirth

If there are stitches on the cervix, hygiene rules must be observed. If there are stitches on the perineum, in order to avoid their divergence, the postpartum woman is not allowed to sit for 10 days (with the exception of the toilet). On days 5-7, you are allowed to sit on a ball or a slightly inflated children's circle. You can also sit on the buttock on which there is no seam, on a hard surface.

It is necessary to strictly observe hygienic requirements: wash after each urination and defecation, change sanitary pads every 2-3 hours. For massive incisions, it is recommended to apply an ice bottle to the suture site.

Try to ventilate the seam area as often as possible. To do this, you need to lie on the bed without underwear. While you are in the hospital, the midwife cleans the stitches with brilliant green once a day. You can continue air baths at home and use ointment to speed up healing SOLCOSERYL or BEPANTEN after consultation with a doctor. If redness, swelling, pain, or purulent discharge appears from the suture area, you should contact a antenatal clinic or maternity hospital.

To speed up healing, you can use the following exercises to strengthen the pelvic floor muscles.

1. Starting position (ip) - sitting on a hard chair. Inhale, and as you exhale, tense the muscles located between the sit bones as much as possible (you should, as it were, pull the anus into yourself). Count to 10, then exhale and relax.
2. I.p. – standing between your thighs, hold a small ball. Pull your anus in, take 10 steps forward, 10 steps back. Repeat 10 times.
3. I.p. - standing with crossed legs. Retract your anus and take 10 steps forward and 10 steps back. Repeat 10 times.
4. I.p. - lying on your back. Raise your legs at an angle of 45 degrees and move them relative to each other in a horizontal plane (crosswise).
5. I.p. - lying on the right side. Pull your anus in. Raise and lower your left leg. Then roll over to your left side and repeat the exercise with your right leg.

These same exercises can also be used to prevent ruptures during pregnancy.

1 Cervical ectopia is a pathological lesion of the cervical mucosa, in which the usual squamous stratified epithelium of the outer part of the cervix is ​​replaced by columnar cells from the cervical (cervical) canal.

Childbirth is a natural process, but it is painful and traumatic for a woman. During passage through the birth canal, the child stretches the maternal tissues, which leads to small wounds and serious ruptures. If there is a threat of rupture, as well as premature birth, the fetus is too large and other problems, the doctor performs an incision (episiotomy). Incisions and tears are sutured for rapid healing. How to behave, how long it will take to recover, what complications there may be with sutures on the perineum - look in this material.

Sutures on tears after childbirth

Rapid labor, insufficient tissue elasticity, and incorrect behavior of the woman in labor (starting to push too early) lead to the appearance of ruptures. A correctly and timely episiotomy is much better than a rupture: the doctor uses a sharp scalpel to make a neat incision that is easy to stitch up. Lacerations that occur during childbirth require more stitches, can leave an unsightly scar, and take up to 5 months to heal (internal stitches).

Types of postpartum sutures:

1. Internal - located on the walls of the vagina, cervix. Usually performed with self-absorbable threads.
2. External - located on the perineum. They are performed with both self-absorbable and regular threads.

External seams on the crotch

The longest and most painful process in childbirth is the dilatation of the cervix. She needs to go a long way from about 1 cm of dilation (this is how women usually end up in the maternity hospital) to 8–10 cm. The process is accompanied by strong contractions and can last from several hours to several days.

Compared to dilation of the cervix, the birth of the baby itself takes a matter of minutes. At the midwife's signal, the woman begins to push, helping the baby pass through the birth canal, and soon he is born. Attempts take on average from 20–30 minutes to 1–2 hours. This process should not be delayed; it can lead to asphyxia in the newborn. Therefore, when the doctor sees that independent birth is impossible or difficult, he makes an incision.

An incision (episiotomy) is a surgical cut through the perineum and back wall of the vagina. There are perineotomy (incision from the vagina to the anus) and mid-lateral episiotomy (incision from the vagina to the right ischial tuberosity).

Types of episiotomy: 1 - child’s head, 2 - mid-lateral episiotomy, 3 - perineotomy

For some unknown reason, women in labor try their best to avoid tears and especially incisions. On women's forums you can often find the proud “not torn,” which generally implies that the mother is well prepared, the normal course of labor, the normal size of the fetus and high tissue elasticity. But when the doctor talks about the need for an incision, and the woman in labor actively protests, is indignant and even screams, this is fraught with negative consequences, primarily for the baby.

Possible consequences for the child:

• Damage to the cervical spine.
• Damage to the nervous system due to lack of oxygen.
• Hematomas on the head, fractures and cracks, hemorrhages in the eyes due to excessive pressure on the soft bones of the skull.

An even and neat cut 2–5 cm long will help mother and child get to know each other faster. After childbirth, the doctor will close it with a continuous cosmetic suture, which, if properly treated, heals very quickly, in about a month. After healing, it looks like a thin “thread”, slightly lighter in color than the skin.

It's a completely different matter if we're talking about breaks. Firstly, it is impossible to predict in which direction the fabric will tear and to what depth. Secondly, it has an irregular shape, torn, even crushed edges are difficult to connect as they were. In this case, several stitches are required; in some cases (for third-degree tears that reach and extend to the vaginal walls), general anesthesia may be required.

What are they stitching with?

Episiotomy incisions and minor perineal tears are sutured with self-absorbable sutures. They are much more convenient, they do not need to be removed, and within 2-3 weeks the threads dissolve without a trace (depending on the material!). Small debris and nodules may come out with the discharge and remain on the pad or underwear.

Deep injuries and cuts are sutured with nylon, vicryl or silk threads. The doctor will remove them in 5–7 days. They tighten the wound tightly and ensure good healing.

In some cases (for severe tears), metal staples are installed. They are removed in the same way as nylon or silk threads, but can leave small scars and holes.

Example of a seam after removing metal staples - holes in the skin are visible

Seam care

While you are in the maternity hospital, under the supervision of specialists, a nurse takes care of the suture. It is usually treated daily with a solution of brilliant green. After discharge, you should continue to care for your suture as directed by your doctor. If everything heals well, it is enough to follow the rules of hygiene, wash yourself after each visit to the toilet, do not wear tight underwear, use natural pads, and provide air access. For inflammation and suppuration, the doctor prescribes therapy (levomekol, solcoseryl, and in especially severe cases, antibiotics).

Internal seams on the vagina, on the cervix, on the clitoris

Internal sutures are placed on the cervix and vaginal walls in case of ruptures during childbirth. Doctors say the main cause of injuries is improper behavior of the mother in labor. Early attempts, when the cervix has not yet opened, lead to its rupture. “Aggravating” circumstances are operations on the cervix, age-related decrease in tissue elasticity. Ruptures of the vaginal walls are provoked, in addition to the above reasons, by the presence of old scars, emergency childbirth, and a high position of the vagina relative to the anus. Of course, one cannot deny the possible guilt of the obstetrician - incorrect tactics also lead to injuries.

In some cases, after applying internal sutures to the vagina, mothers complain of pain in the clitoris. The clitoris itself is not sutured, but the seams and ends of the threads may be located next to it, stretching and injuring the delicate area. In general, if the discomfort is too severe, it is best to see a doctor. Gradually the threads will dissolve and the pain will go away.

What are they stitching with?

Internal seams are made only with absorbable threads. The reason is complicated access to injuries. Most often, catgut or vicryl, sometimes lavsan, are used for this. The final dissolution time for all types of self-absorbing materials is 30–60 days.

Seam care

Internal seams do not require special care. It is enough for the mother to follow the doctor’s recommendations, not lift heavy objects, abstain from sexual activity for 1–2 months, and maintain personal hygiene. Be sure to visit the gynecologist at the appointed time, even if nothing worries you, only a doctor can assess the condition of the tissues, the speed of healing and other factors.

Read more about caring for internal and external scars in the article -.

How long do stitches take to heal?

Be prepared for discomfort and discomfort in the area of ​​the incisions and tears for about 2-3 months. The recovery process is individual for each woman, depending on her well-being, state of health, pain threshold, and age. Some people already feel like they were before pregnancy after two weeks, while others need a year or more to recover.

Take your time to return to an active sex life! Restrictions are not the doctor’s whim or his reinsurance, but primarily concern for your health. For 2–3 months after childbirth, sexual intercourse will be painful until the injured area with a fresh scar restores sensitivity.

Something went wrong if:

1. The suture site bleeds after discharge.
2. Even at rest, you feel pain inside, a feeling of fullness (may be a sign of a hematoma).
3. The seam becomes inflamed, discharge with an unpleasant odor occurs, and the temperature may rise.

All these signs, as well as other changes in the condition that seem suspicious to you, are 100% reason to consult a doctor immediately.

Self-absorbing internal sutures

The recovery time depends on the material and severity of the tear. Catgut disappears within 30–120 days, lavsan - 20–50 days, vicryl - 50–80 days. If you feel good, there is no pain or discomfort inside, you are full of strength and energy - everything is fine. Pay attention to your diet, you need to avoid constipation. If necessary, take a laxative as directed by your doctor.

External seams

With proper care and no complications, the sutures in the perineum will heal completely within 1–2 months. To do this, the mother should rest more, it is recommended to stay in bed if possible, and maintain hygiene. One of the reasons for frequent inflammation of the external sutures is postpartum discharge from the uterus. Change your underwear as often as possible, provide access to air (if possible, you can avoid underwear, at least at home), use special pads with antibacterial impregnation.

The external suture during episiotomy (regular) ceases to bother you after about 2 months

When to remove threads from external seams

Staples and threads are removed 3–7 days after birth, most often on the fifth. The doctor assesses the condition of the woman in labor, the speed of healing and, based on the information received, makes a decision on discharge.

Does it hurt to remove the threads?

It all depends on your pain threshold. The procedure is unpleasant, but quick. If you are afraid of pain, ask your doctor to spray a local anesthetic on the stitch.

When can you stand up and sit down with stitches after childbirth?

For two weeks you can only lie down or stand. Sitting is strictly prohibited! A reclining position, leaning on the headboard of the bed, is allowed. This also applies to check-out; warn your relatives in advance that the entire back seat of the car will be occupied by you and the baby.

Why such strictness? If you try to sit down prematurely, it is possible that the seams will come apart. And this is not only painful, but will also require re-suturing, doubling the wound healing time.

How long do stitches hurt?

Pain, pulling sensations and discomfort from external and internal stitches should go away within two weeks after birth. If three weeks have passed and you still have a lot of pain where the stitches were placed, be sure to tell your gynecologist. Do not delay, in this case it is better to be on the safe side to avoid possible consequences.

Symptoms of complications on sutures after childbirth:

1. Pain (for external seams), sensation of pulsation and twitching inside (for internal seams).
2. Swelling of the suture, suppuration, is often accompanied by a sharp increase in body temperature.
3. Seams coming apart.
4. Continuous bleeding.

If you experience any or all of the symptoms, consult your doctor. Don’t wait, don’t use advice from the internet, don’t trust recommendations from friends and acquaintances. Frivolity is unacceptable here!

The seam has come apart - reasons:

• Mom tried to sit up before her due date.
• Lifted weights (more than 3 kg).
• Returned to sexual activity.
• Accidentally caused an infection in the wound.
• Didn't follow hygiene rules.
• I suffered from constipation.
• She wore tight synthetic underwear.
• Didn't take proper care of the stitches.

The problem can be recognized by a feeling of burning or itching at the suture site, swelling (perineum), pain and tingling, bleeding, increased temperature, and general weakness. What to do? Immediately go to see your doctor, and in especially serious cases, call an ambulance.

"Microlax" after childbirth with stitches

Let us separately dwell on the problem of constipation. Strong efforts during defecation can lead to divergence of the external and internal seams. A laxative will help you, but if you are breastfeeding, your pediatrician should prescribe the drug. Microlax microenemas are suitable as an emergency remedy; they are safe for nursing mothers and will quickly and painlessly solve a delicate issue. They have a mild effect, the result occurs within 10–15 minutes after use.

The stitches hurt

If everything is in order, the healing process is going well, the gynecologist finds no problems, but the stitches hurt - what is the reason? Perhaps you have a low pain threshold, your tissues need more time to heal, or your lifestyle is too active at the moment. In any case, if you are confident in your doctor (it may be worth consulting with another specialist), allow your body to rest a little. You should not return to active training, lift weights, sit on a hard chair for a long time and do daily general cleaning. All this will have to wait.

Does pain occur only during sexual intercourse? This is a temporary phenomenon, try changing your position, use lubricants. Gradually, your body will return to its previous shape and adapt to the changes.

Sutures become inflamed and festered, causes, treatment

Inflammation and purulent discharge appear when an infection enters the wound. It can penetrate both from the woman’s body (postpartum discharge, infections not treated before childbirth) and from the outside, if hygiene rules are not followed. Your doctor should prescribe the final treatment regimen for you.

Drugs used:

1. Anti-inflammatory and healing ointments: levomekol, syntomycin, Vishnevsky ointment and others. They will relieve swelling, have an antiseptic and antibacterial effect, and stop the inflammatory process.
2. Suppositories, in particular, “Depantol”, “Betadine” - accelerate the healing of mucous membranes, treat infectious and inflammatory diseases of the genital area.
3. A course of antibiotics, antipyretic and anti-inflammatory drugs - the doctor will select therapy in such a way that breastfeeding can be maintained.

Suture granulation, what is it, treatment

Granulations are new tissue that grows during wound healing (healthy cells, blood vessels, etc. are formed). Normally, this is a natural process, but sometimes granulations grow at the site of the sutures after childbirth and can cause discomfort and feel like small growths. Treatment is at the choice of the gynecologist. Most often, granulations are removed locally or in a hospital.

Polyps on the suture, what they are, treatment

A polyp usually refers to the granulations or pathologies already mentioned above during the formation of a scar. They can also disguise condylomas and papillomas. They look and feel like strange growths (one or more formations) at the suture site and around it. Treatment is usually surgical.

Seal (bump) on the seam

If a fairly large lump is felt on the seam, the first thing you should do is visit your gynecologist. Most often, a nodule from a self-absorbing suture is mistaken for a lump, which will disappear fairly soon. But there may be other options. In addition to the granulations and papillomas listed above, an abscess with purulent contents may form at the suture site. This is a dangerous symptom that signals improper suturing, infection of the wound, or rejection of the threads by the body. Seek help immediately.

How to speed up the healing of stitches

First and foremost: none of the methods should be used before consulting a doctor!

Avoid wearing underwear, especially while sleeping. If there is heavy postpartum discharge, you can sleep on a special absorbent diaper.

Take care of your diet. You need enhanced nutrition, forget about extra calories for a while. The body has experienced stress and needs healthy, high-quality products.

Perhaps traditional medicine recipes will help you. Tea tree oil and sea buckthorn oil promote the healing of injuries.

When can you wash after giving birth with stitches?

Showering is allowed and recommended after each visit to the toilet. But with a bath, and even more so with a visit to the bathhouse and sauna, you will have to wait a little longer. On average, doctors allow you to take a bath two months after birth, if the healing process is successful, without any problems. You can also focus on your body, if postpartum discharge has not stopped yet, you should not rush to take a bath. The fact is that for a long time after childbirth, the cervix remains slightly open and bleeds, and tap water cannot be called sterile. Bacteria, once in a favorable environment, begin to actively multiply, triggering inflammatory processes in a weakened body.

Cosmetic stitches after childbirth

The cosmetic seam after healing is almost invisible on the skin. He came to gynecology from plastic surgery. Main features: passes inside the tissue, has no visible signs of needle entry and exit.

For cosmetic sutures, self-absorbing threads (lavsan, vicryl) are usually used. It is performed on smooth, neat cuts and passes through the thickness of the skin in a zigzag manner, called continuous.

Regular and cosmetic suture after childbirth during execution and after healing

Caring for sutures - a reminder for a woman in labor

1. Change the sanitary pad every two hours, regardless of the presence of discharge. If possible, avoid wearing underwear.
2. Do not forget about treatment with antiseptics if prescribed by a gynecologist.
3. After visiting the bathroom, take a shower, and if this is not possible, wipe the perineum with a sterile napkin using gentle blotting movements.
4. Do not sit down for two weeks.
5. Monitor your diet, exclude gas-forming and fixing foods (baked goods, cereals, etc.). If necessary, take a laxative and do microenemas in consultation with your doctor.

With proper care, external and internal seams, regardless of the material with which they are made, heal quickly and do not leave large scars. Take care of yourself, follow the recommendations of the gynecologist, and very soon you will be able to return to normal life.

Ruptures during childbirth occur quite often. They occur in every third woman in labor. More often this occurs in women who give birth to their first child after thirty. The ruptures can be both internal and external. In the place where the rupture occurred, a painful hematoma appears, bleeds, and swelling appears.

Causes of ruptures after childbirth

During childbirth, the baby walks head first, stretching the internal tissues of the perineum, which, in principle, are elastic, but can stretch to certain limits.

• with inflammatory and genital infectious diseases they become less elastic;
• previous births were accompanied by ruptures, the remaining healed scars do not stretch and can rupture again;
• unprofessionalism of the staff or incorrect actions of the mother during childbirth.

Treatment of ruptures after childbirth

Once labor is complete, the obstetrician checks the birth canal. Having detected ruptures, he applies sutures. Internal sutures do not require anesthesia, since the uterus and cervix are slightly sensitive. External tears are repaired using anesthesia.

Sutures that do not require removal of suture material are placed in the area of ​​the cervix or vagina. Sutures made of lavsan or catgut are placed on perineal tears and are removed before the woman is discharged. During the entire stay in the maternity hospital, the sutures are treated with antiseptics or a weak solution of manganese; if a bacterial infection is additionally detected, the doctor prescribes antibiotics.

The healing period of ruptures after childbirth

Particularly severe ruptures do not allow a woman to sit; she can only take a standing or lying position. So, she can only eat while standing, and feed the baby while lying in bed. Tears can take three weeks to heal, depending on the depth of the tear. You need to try to rest as much as possible during this time.

After visiting the toilet, you need to carry out hygiene procedures by directing a stream of warm water from front to back. Then the skin is blotted with a soft cloth. Gaskets must be changed frequently, at least once an hour. With minor tears and small sutures, healing of the wounds occurs within two weeks; the sutures are most often removed before discharge from the hospital, and all unpleasant sensations cease within a week.

To relieve pain, the doctor may prescribe analgesics, and also prescribe healing ointments, as well as creams that can quickly get rid of scars.
A physical therapist will assess the condition of your pelvic floor muscles and tell you what exercises you can do to strengthen them. These muscles allow a woman to control urination and bowel movements, so you should not neglect exercises, this way you will avoid problems in this area. Exercise will also help speed up healing by increasing circulation to the area of ​​the tear. The pelvic floor muscles usually recover approximately six months after childbirth. If you perform strengthening exercises all this time, the tissue at the site of the rupture will remain elastic, and the scars will disappear almost without a trace.

A month and a half after giving birth, be sure to see a gynecologist so that he can make sure that the recovery process occurs without deviations. When you see a doctor, you can ask him any questions that interest you. If the scar is not smoothed out and is painful, then the doctor will teach you how to massage the perineum yourself, this will help restore elasticity to the skin at the site of the tears.

Your doctor will be able to give you recommendations as to when you can resume sexual activity. The anxiety of a woman who has gone through childbirth, accompanied by ruptures, is understandable and natural. Discuss your experiences with your husband, ask him not to rush you, devoting enough time to foreplay before sex. The main thing is that the woman must feel ready to resume sexual activity.