here's how to tell if your vaginal stitches aren't healing properly
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Here's How To Tell If Your Vaginal Stitches Aren't Healing Properly After Childbirth
Ouch.
by Jennifer Parris
Updated: July 8, 2022
Originally Published: Feb. 27, 2018
As if childbirth wasn’t enough to deal with, there’s all the afterbirth stuff nobody talks about that you have to contend with, too — like tearing. Either by an episiotomy or by chance, you could get a gash during delivery that requires stitches. And since you (and your vagina) have gone through a lot during labor, it might not be easy to know if everything is alright down there postpartum. If you’re concerned, there are signs of infection in after-birth stitches to watch out for that mean they aren’t healing properly.
It happens to the best of us, but if you tore during delivery or had an episiotomy, you’re going to need stitches. And while having a tear in your perineum might make you wince just thinking about it, it’s imperative to make sure that it heals properly. Thing is, you just might not know what to look for. “It can be really hard to determine because immediately postpartum, there’s a lot happening in the vaginal area,” Dr. Kiarra King, M.D., FACOG, OB-GYN, tells Romper “The mom will have some bleeding occurring because of normal postpartum changes, so it’s not an easy place to look and see what’s happening.”
The good thing is, though, that most people will never have to confront an infected tear — with basic care, they tend to heal up very well. However, when the tear is deep, as with a third- or fourth-degree laceration, the healing process can be much more complicated. A 2015 study published in the Obstetrics and Gynecology journal found that 3.3% of people giving birth had a third-degree laceration and 1.1% had a fourth-degree laceration. And those rates increase during a second pregnancy if a tear occurred in the first, according to a 2014 study in BJOG.
How long do after-birth tears take to heal?
Ultimately, the healing process will depend on how well you take care of the vaginal stitches. Make sure you keep the area as clean as possible after going to the bathroom (that’s where that spray bottle they give you in the hospital comes in handy), cleaning yourself well so you can decrease the chance of infection.
If you happen to have a more severe perineal tear, how long will it take to heal? "Repaired vaginal lacerations or episiotomies take a long time to heal, like any injury. The stitches usually take three to seven days to dissolve," board-certified OB-GYN Dr. Mary Jacobson, chief medical director at Alpha Medical, tells Romper. "Be patient and give the repair six weeks to heal — and expect several weeks of soreness and tenderness during the healing process. If your vaginal repair isn’t healing properly, you may have an infection."
No matter what kind of vaginal tear you have, here are some signs that your stitches aren't healing properly.
Signs of infection in after-birth stitches
1
The stitches smell
While you can expect to bleed for up to six weeks post-birth, the smell of blood will be different from stinky stitches. If your stitches smell bad, that's a sign of infection you absolutely shouldn't ignore. “Foul-smelling or green infected looking discharge that is new is a sign you might have an infection,” certified nurse midwife Michelle Barcus tells Romper. Jacobsen notes that this is one of the first signs you should reach out to your doctor.
2
Excessive redness
Excessive redness or swelling in the vaginal or perineal area is another red flag indicating infection. "Significant swelling in the area" is a sign you should call your doctor, according to Jacobsen. Barcus explains that "swelling that is getting worse and redness to the tissue area surrounding the stitches" are signs you should see your provider right away. Basically, anything icky or weird from this wound might merit a call. Even if you just think there might be something icky or weird about it — call your provider. While you're probably busy with the baby, it's equally important to take care of yourself.
3
Your stitches hurt — like, a lot
if your after-birth stitches hurt a lot, they could be infected
skaman306/Moment/Getty Images
You shouldn't have to put up with excessive pain after birth — ever. While some aching and soreness is normal, let your doctor know if the pain is serious. But how can you tell what’s normal healing and what’s not? “If they deemed your vaginal exam to be normal at the hospital before discharge, then I would use that as a baseline,” advises King. “But if you get home and have extreme pain that is not relieved by the pain medication you’ve been provided, that would be the time to give the doctor’s office a call.” If you describe your symptoms, they might tell you it’s part of the healing process, but they also might have you come in for a quick exam to ensure everything is OK.
4
Your stitches have gaps and breaks
You should always keep an eye on your stitches to make sure that there aren’t any breaks or gaps. You’ll need to use a mirror so you can get a good look down there to ensure that they’re healing properly. “If you're looking for signs and symptoms of the sutures actually breaking down, you might feel increased pain in the lower portion of the vagina, or you may see a suture come out when you're urinating or having a bowel movement,” Dr. Vonne Jones, M.D., FACOG, OB-GYN, tells Romper. “Sometimes patients say that they hear a pop where they feel like a split happened, and then they'll notice a difference in their discharge because of it.”
5
You have a fever
One sure sign your wound may not have completely healed despite treatment is if you develop a fever, according to Jacobsen. This can be another sign of an infection, so you'll want to reach out to your doctor ASAP. "You want to monitor for any signs of infection, such as new onset fevers (>100.4 [degrees Fahrenheit])," says Barcus. If you’re feeling feverish, call your OB-GYN, since it might not be immediately obvious if you have an infection.
6
You have fecal incontinence
One of the less fun parts of the postpartum phase is all the gassiness you might experience. But if you have to scurry to the bathroom to go number two, or if you're leaking fecal matter when passing gas, your laceration might be worse than anticipated, and stitches might not be enough. A fourth-degree tear, by definition, can impact your rectum. "Be sure to do your Kegel exercises daily in order to prevent urinary and fecal incontinence as you age," Jacobsen says. "Kegel exercises strengthen your pelvic floor muscles. Your pelvic floor muscles support the uterus, bladder, small intestine, and rectum."
If at any time something seems wrong with your stitches, you’ll want to contact your OB-GYN right away. They’ll be able to identify immediately if there’s a potential infection or something has gone astray with your stitches and provide proper medical treatment. Soon, you (and your vagina) will start to feel like yourselves again.
Studies cited:
Friedman, A. M., Ananth, C. V., Prendergast, E., D'Alton, M. E., & Wright, J. D. (2015). Evaluation of third-degree and fourth-degree laceration rates as quality indicators. Obstetrics and gynecology, 125(4), 927–937. https://doi.org/10.1097/AOG.0000000000000720
Edozien, LC, Gurol-Urganci, I, Cromwell, DA, Adams, EJ, Richmond, DH, Mahmood, TA, van der Meulen, JH. (2014). Impact of third- and fourth-degree perineal tears at first birth on subsequent pregnancy outcomes: a cohort study. BJOG2014; 121: 1695– 1704. https://doi.org/10.1111/1471-0528.12886
Experts:
Dr. Kiarra King, MD, FACOG, OB-GYN
Dr. Vonne Jones, MD, FACOG, OB-GYN
Dr. Mary Jacobson, Chief Medical Director at Alpha Medical
Michelle Barcus, certified nurse midwife
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This article was originally published on Feb. 27, 2018
C-Section
A post-cesarean incision is closed with strips of medical tape during the healing stage. The area ma...
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What You Need To Know About Keloid C-Section Scars
Learn why some C-section scars may look thick, raised, or bumpy.
by Ashley Jones
June 14, 2022
When recovering from a cesarean section, the body goes through a myriad of changes. As a C-section incision heals, small, inherent differences in the skin can develop on the scar itself. If the scar tissue grows outside the boundaries of the incision site, appears lumpy or discolored, it could be what’s known as a keloid C-section scar.
Keloid C-section scars can develop up to a year after delivery and, although you may not like the way they look, they usually are not a cause for medical concern. Read on to learn what causes keloid C-section scars, how to care for them, and what can be done to minimize their appearance.
Why is my C-section scar keloid?
A keloid scar on your C-section incision site may appear raised, thick, or shiny. Dr. Kim Langdon, an obstetrician with Medzino, tells Romper that the definition of a keloid scar is “is an abnormal proliferation or continued growth of the scar tissue that creates a raised scar due to excess collagen that is usually a different color than the surrounding skin.”
In addition to their raised texture and appearance, keloid scars can vary in size and color. According to Langdon, a keloid C-section scar may look “reddish, brown or purplish, depending on your skin color.” In some cases, people with keloid scars report that an itching or stinging sensation can sometimes be felt across or around the scar.
How do you get rid of keloids after a C-section?
If you’re looking for a way to get rid of a keloid C-section scar, board-certified OB-GYN Dr. Cynthia Flynn tells Romper that “Mederma scar cream or 1% hydrocortisone cream can help.” However, Flynn also notes that these topical creams shouldn’t be applied until after your doctor has evaluated your C-section scar, which usually happens at your 6-week postpartum visit.
Laser therapy is another option for getting rid of keloids after a C-section. Birth educator and doula Sara Lyon tells Romper that “laser therapy can help to reduce the symptoms (pain and itchiness) and the visibility of keloid C-section scars.”
For keloid C-section scars that are particularly bothersome, your doctor may suggest surgery to remove excess tissue growth or masses that extend far outside the original incision area. Langdon explains that when it comes to keloid C-section scars, “surgical excision is possible but they may return.” And according to Lyon, “surgical treatment is risky because a body that’s overproducing scar tissue might do the same in the surgical healing.”
Why is my C-section scar raised?
Collagen’s growth pattern is to blame for the raised appearance of keloid C-section scars. “While scar tissue is composed of the same kind of collagen as normal skin, the alignment of the collagen fibers differ in their organization pattern (aligned in scar tissue versus woven in normal tissue). When the harder, more rigid scar tissue builds outside of the wound or incision site, it’s known as ‘keloid,’” Lyon explains. “Keloid scar tissue can grow into the body from the incision, externally in small or large masses, or laterally, beyond the edges of the standard scar.”
“Much like stretch marks, some people are genetically predisposed to develop keloid tissue,” Lyon says. A keloid scar can develop anywhere on the body. While there is a genetic component to the development of keloid scars, unfortunately, there’s no way to know ahead of time whether or not your C-section scar will become keloid. “There is little understanding of why keloid tissue grows more in some people than in others, or in one location more than another,” says Lyon.
A thick, raised keloid c-section scar can develop on the abdomen across the incision site.
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Flynn tells Romper that due to the genetic component on keloid scar formation, if your parents have keloid scars, you may develop them as well. “About 10% of people are prone to keloids,” Flynn explains. “Some of the risk factors are dark skin, Asian descent, Latino descent, pregnancy itself and young age.”
Information published by the American Academy of Dermatology concurs. The organization lists family history of keloid scars, being of African, Asian, or Hispanic heritage, and being younger than 30 years of age as keloid development risk-factors.
Does a C-section keloid go away on its own?
If you have a keloid C-section scar, it is unlikely to go away on its own. Lyon tells Romper that “keloid scar tissue will rarely abate spontaneously.”
The genetic component of keloid formation means that you can’t completely stop a keloid scar from forming but, as with many things, an ounce of prevention can be worth a pound of cure. In short, proper wound care can go a long way toward helping your C-section scar appear smoother as it heals. Lyon recommends “adequate rest in the first 6 weeks of healing, wearing a compression garment like a postpartum corset, using silicone patches over the scar and doing consistent scar massage.”
Though Flynn also explains that “some keloids never go away,” she says that typically a year or two after birth “most become softer, smaller, and much less noticeable.”
Though most keloid scars are harmless, if you’re concerned about how a keloid C-section scar looks, feels, or has healed, it’s always best to consult your doctor.
Sources interviewed:
Dr. Kim Langdon, OB-GYN with Medzino
Dr. Cynthia Flynn, board-certified OB-GYN for JustAnswer.
Sara Lyon, doula, owner of Glow Birth & Body, author of You’ve Got This
C-Section
A mother's healed C-section scar can be seen as she lays with her baby.
AleksandarNakic/E+/Getty Images
Your C-Section Scar: Healing & Care Basics
What to expect as the site of your C-section incision heals.
by Ashley Jones
July 6, 2022
I had no idea what to expect following my first unplanned cesarean birth. Though my primary concern was my baby’s well-being, I also worried about how recovering from a C-section would impact my body. Today, I’m proud to bear the permanent mark on my abdomen where both of my sons made their entrance into the world, but going through the different C-section scar healing stages was a true learning experience.
How do I know if my C-section scar is healing properly?
Though the timing can vary from person to person, board-certified obstetrician Dr. Cynthia Flynn explains that “a C-section scar takes four-to-eight weeks to heal both internally and externally” and adds that “this incision is in a very forgiving area of the body and tends to heal quickly.”
The proper way to care for a C-section incision will “depend on many factors, such as if you have staples or sutures and whether any infection occurred,” Flynn says. In most cases — regardless of the type of closure that was used — you can expect to be allowed to remove the initial wound dressing or bandage about three days after your C-section. “After it is removed, it is safe to use mild soap and water in the shower,” Flynn says, noting that diluted baby soap is a particularly safe and effective choice for cleaning your incision site. “Keep the area clean and dry,” she continues.
You may experience some pain as your C-section scar heals, but this is a normal and expected part of the recovery process. Numbness, itching, stinging, and pressure can all occur. These sensations come primarily from nerve regeneration and new tissue growth. As always, if you’re uncomfortable or concerned about the way something looks or feels, your first step should be to contact your doctor. Excess pain may be a sign of a C-section scar infection.
What should a healing C-section scar look like?
A C-section incision is a wound from major surgery. As such, it will go through the classic stages of healing as your C-section scar develops. The stages of C-section scar healing can be broken down into four clear steps.
1: Hemostasis
“The first phase, hemostasis, lasts about two days,” says Flynn. “Blood vessels constrict and clotting factors are released.”
2: Inflammatory Stage
The next stage of C-section scar healing lasts about a week. “During this phase, white blood cells and enzymes enter the wound and clear bacteria and debris,” Flynn explains. “This prepares the wound bed for growth of new tissue. The wound might be red, swollen, or painful at this stage.”
3: Proliferative Phase
Now, you’re nearly two weeks postpartum and entering stage three of healing, which will last about three weeks. “The proliferative phase, or stage three, involves healing and filling in of the wound,” Flynn says. “Granulation tissue forms and new blood vessels form. The wound contracts and re-epithelializes. This means that new skin layers form.”
4: Remodeling
By the time you get to stage four, you should have had a check-up and be well on your way towards real healing. This final phase of healing lasts for months or even years as your body recovers from the major surgery that is a C-section. “Remodeling or maturation... is when scar tissue forms,” says Flynn. “Collagen is produced and the wound becomes stronger and more flexible.”
There is a vast range of “normal” when it comes to the way a C-section scar looks. Some scars will barely be visible once healed, while others may be thick, shiny, or become a keloid scar. Though most scars will appear red or purple in color at first, the majority of C-section scars will fade and become less noticeable with time.
How to minimize scarring of a C-section scar
While proper wound care and post-operative rehabilitation strategies can help minimize the appearance of your C-section scar, it’s worth noting that “much of what goes into healing and scarring is genetic, so it is predetermined and cannot be altered,” Flynn reiterates.
Go easy on yourself as you begin the stages of healing from your C-section, and try to be patient as your body develops a C-section scar. To maximize healing, rest when you can, keep your incision site dry, and attend scheduled post-natal appointments with your healthcare provider.
One popular way to minimize scarring after a C-section is to apply scar-diminishing creams once your C-section scar is fully healed.
Mother and baby with a c-section scar closed by staples in an article about how to care for your c-s...
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How are C-section incisions closed?
C-section incisions are closed using different methods, depending on your doctor’s preference. Externally, your doctor may use one or more of the following methods to close the skin of your abdomen following a C-section:
Surgical staples
Surgical glue
Non-dissolvable stitches
As for the different types of C-section incisions, and how they heal, there are really only two main types — horizontal incisions and vertical incisions. “About 95% of all C-sections are horizontal skin incisions and low transverse uterine incisions.” Flynn says. Though vertical C-section incisions are very rare, it’s worth noting that they typically takes longer to heal than horizontal incisions.
Kathleen Rustici, M.D., is a board-certified obstetrician with SCL Health Medical Group, affiliated with Saint Joseph Hospital in Colorado. She tells Romper that the dissolvable Vicryl sutures are used most often to close C-section incisions internally. “This suture is absorbable, but can take up to 8 to 10 weeks to fully dissolve,” she explains. “This is a good thing, because we want to hold that tissue together long enough for it to fully heal back together before the suture dissolves.”
How long does it take for a C-section incision to heal internally?
Though most experts agree that the main healing stages of a C-section scar can take anywhere from a few weeks to two months after giving birth — with “healing” defined as a closed wound and stitches that have dissolved — the internal healing process can take much longer.
It usually takes an entire six weeks to regain full strength throughout the skin’s internal layers, Rustici tells Romper. This is why physicians advise postpartum patients not to do any heavy lifting until after their six-week checkup. “We really want those internal layers to heal entirely before there is additional strain put on them,” she continues.
Rustici also says that internally, “the incision on the uterus can take even longer to fully heal.” For this reason, she explains that it’s generally recommended to wait a year after having a C-section before getting pregnant again to allow ample time for internal healing. “Getting pregnant too soon can increase the risk of uterine rupture, which is the separation of the prior scar on the uterus,” she says.
As your C-section scar is healing, it’s important to keep an open dialogue with your healthcare provider. Every person’s body heals on its own timeline, and your provider is the best resource for understanding whether or not you are fully healed internally.
How do I know if my C-section incision is open?
If your C-section incision is open, it’ll likely be hard to miss. You may notice oozing or puffiness at the incision site first, followed by gaping. People with open C-section incisions will also usually experience increased pain. A C-section incision that is open can be a warning sign of a potential infection and is definitely a reason call your doctor right away.
Call your doctor right away if you experience anything that might indicate infection, including:
Fever
Redness
Heat or burning sensations
Any type of drainage at your C-section incision site
The best way to avoid your incision opening and keep potential infection at bay is with proper post-operative care. “Avoiding infection by keeping the incision clean and dry is helpful,” says Flynn. “Try to rest and do not do much except caring for yourself and the baby. Extra strain on the area can stretch the incision while it is still healing. Do not pick at scabs or healing areas.” Flynn adds that staying hydrated and consuming a healthy diet can aid in your post-surgical healing as well.
Can a C-section scar reopen after years?
Unfortunately, yes, C-section scars can sometimes reopen. “While this is rare, it can happen,” Flynn tells Romper. “It is more common in women who are overweight or have a seroma [fluid collection] develop.” It is also possible, though still extremely uncommon, for a C-section scar to reopen when stretched during a new pregnancy.
It is important to keep in mind, however, that “all of these possibilities are rare and not likely,” Flynn says. “In nearly 20 years in the field, I’ve never heard of such a thing happening outside of labor, and that itself is extraordinarily rare in a VBAC situation.”
Can you have a C-section scar infection years later?
The most common time for your C-section scar to become infected is within the first few days and weeks following birth. Very rarely, an infection can be so deep inside or lay dormant within the body that the signs and symptoms of a C-section scar infection don’t pop up until months after birth, but in general it is not something to worry about.
If a C-section scar is reopened at any point in time, bacteria on the skin can potentially lead to an infection, but again, this is extremely uncommon. “Often the area that opens leads to infection from the skin bacteria,” says Flynn. “Again, keeping the area clean and dry can prevent most of these issues.”
If the old saying that “knowledge is power” holds any weight at all, knowing what to expect from your C-section scar while it’s healing — both in the short and long term — can be empowering for new moms.
Experts interviewed:
Dr. Cynthia Flynn, board-certified OB-GYN.
Kathleen Rustici, MD, a board-certified OB-GYN with SCL Health Medical Group, affiliated with Saint Joseph Hospital in Colorado.
how do you know if your stitches ripped after birth?
