You tore. Now what?
Maybe your provider said "just a little 2nd degree" while you were holding your baby for the first time, and you nodded like you knew what that meant. Maybe it was bigger than that, and you're scared to sit down, pee, or (let's be real) poop.
Here's the part I tell every patient before they leave labor and delivery: most tears heal well. Your body is very good at this. And there's a lot you can do in the first few weeks to make it hurt less.
This is the plain version. What's normal, what actually helps, and when to call. If you're still pregnant and want to know what the degrees mean, start with Will I Tear During Birth?
How long does it take to heal?
Everyone heals on their own timeline, but here's the general shape.
1st and 2nd degree tears: soreness is worst in the first few days and usually much better by 2 to 3 weeks. Stitches usually dissolve on their own as the tear heals, so no removal is needed. Most tears heal within about 6 weeks, and most people have no lasting problems.
3rd and 4th degree tears: soreness lasts longer, and you'll need more support with pain and bowels. Healing takes longer, and many hospitals check in around 10 to 12 weeks. About 7 in 10 people have no symptoms by a year, and help exists for the rest.
If you're on the slower end of this, it doesn't mean something went wrong. It means you're you. If anything is getting worse instead of better, that's when to call (more on that below).
The first few days: what actually helps
Cold, early on
An ice pack or cold gel pad wrapped in a cloth, 10 to 20 minutes at a time. The research on cooling is weak, but it suggests cooling may ease pain and swelling in the first day or two, with no clear harm to healing. You've probably seen "padsicles" on TikTok: frozen pads with witch hazel and aloe. Same idea, different packaging. Never put ice straight on skin.
Your peri bottle is your new best friend
That squirt bottle the hospital sends home with you? Fill it with warm water and spray while you pee. It dilutes the urine so it stings less, and it rinses you off after. Then pat dry, front to back. No wiping, no rubbing.
Stay ahead of the pain
Take the pain medicine your provider recommends on a schedule for the first few days, instead of waiting until it's bad. Ask what's safe with breastfeeding if you're nursing. Most common postpartum pain relievers are, but check.
Sit smart
Sit on a firm surface and squeeze your bum cheeks together as you sit down. Lying on your side to feed or rest takes the pressure off completely. Some people like a cushion. Skip anything that makes it feel worse.
Warm water later
After the first day or two, a shallow warm bath or sitz bath can feel really good and helps keep the area clean. Plain water is fine. You don't need anything fancy in it.
The first poop (yes, we're talking about it)
This is the one everyone is scared of. You're not going to rip your stitches. Here's how to make it easier:
Take the stool softener. If they offer one, say yes. If you had a 3rd or 4th degree tear, you'll usually be sent home with one, plus a laxative. Take it.
Water and fiber. Drink a lot, eat fruit, veggies and whole grains. Prunes are not a joke. It's soup season, which means it's poop season.
Put your feet up. A stool under your feet gets your knees above your hips. Lean forward, elbows on knees.
Support the stitches. Hold a clean pad or folded toilet paper gently against your perineum while you go. It feels less like everything is falling out.
Breathe, don't strain. Long exhale, let it come. No bearing down like you're pushing a baby. You already did that.
It may take a few days to go the first time. That's normal. If it's been several days, or it's really painful, call.
Keeping it clean
Rinse with warm water every time you use the bathroom. Change your pad often, every few hours. Wash your hands before and after. A daily shower is plenty.
My recovery shopping list
Everything above, in one place: the peri bottle, ice pads, witch hazel pads, a sitz bath, a stool softener and a toilet stool. These are the ones I'd actually use myself. Shop my Perineal Tears: Prevent & Heal list on Amazon. Check with your provider before using a numbing spray or any medicine, stool softeners included.
As an Amazon Associate I earn from qualifying purchases. If you buy through these links, I may earn a small commission at no extra cost to you.
If you had a 3rd or 4th degree tear
These tears involve the muscle that controls your bowels, so the plan after is a little bigger. You'll usually go home with:
A stool softener or laxative, so you don't strain on the repair
Pain medicine, and sometimes antibiotics
A follow-up check. Many hospitals see you around 10 to 12 weeks, sometimes in a special clinic with a pelvic health physical therapist
Ask for a referral to a pelvic floor physical therapist if nobody offers one. In a lot of places it's standard. In the US it often isn't, and you have to ask. They help with strength, control, scar tissue and getting back to sex and exercise without pain.
And if you get pregnant again, bring it up early. Most people with a previous 3rd or 4th degree tear have another vaginal birth without a repeat, but it's worth a real conversation with your provider about your options.
When healing doesn't feel normal
Most tears heal well. But some don't heal the way you expected, and almost nobody warns you about this part.
It's worth getting checked, even months later, if you have:
Sex that still hurts, or isn't possible at all, after you've been cleared
A tight, pulling or ridge-like feeling at the scar
A sore spot that stings or bleeds a little when touched
An opening that feels too tight, or a sense that something is "off" or different
Pain sitting, inserting a tampon, or during exams
Leaking pee, gas or poop that isn't getting better
Not being able to have sex after a tear is not something you just have to live with. It's common. It's treatable. And "give it time" is not a treatment plan once it's been months.
What a pelvic floor physical therapist actually does
A pelvic floor PT is a physical therapist trained in the muscles and tissue of the pelvis. For a painful scar, they may:
Assess the scar and the muscles around it, including an internal exam if you consent
Work on the scar tissue directly to soften it and help it move
Teach you to relax muscles that have tightened up to guard against pain
Use breathing, dilators and a gradual plan so sex stops being something you brace for
Give you a home program, so the progress keeps going between visits
Other things your provider can check
Extra healing tissue (granulation tissue). A raw, sore spot that bleeds easily. It's usually treated quickly in the office.
Dryness from low estrogen. Common while breastfeeding. Lube helps, and some people are prescribed a vaginal estrogen.
A scar that healed too tight. Less common. Sometimes it needs a small procedure to revise it, often after PT has been tried.
How to ask for help
You can say it exactly like this: "Sex has been painful since my tear. I'd like to be examined and referred to a pelvic floor physical therapist."
If you get brushed off and it's been months, ask again, or ask a different provider. In many US states you can book a pelvic floor PT directly without a referral. Check what your insurance needs.
When to call your provider
Don't wait these out. Call if you have:
A fever, or chills
A bad smell from the area, or pus
Pain that's getting worse instead of better, or stitches that feel like they've opened
Trouble peeing, or burning that doesn't settle
Constipation that won't go away
Trouble controlling gas or poop, or leaking stool
Redness, swelling or heat around the stitches that's spreading
Get emergency care right away for very heavy bleeding (soaking a pad an hour) or large clots, chest pain or trouble breathing, pain or swelling in one calf, or a bad headache with vision changes.
Sex, exercise, and getting back to you
Sex. There's no magic date. A lot of people wait until after their postpartum visit, often around 6 weeks, but the real answer is when you've stopped bleeding, it doesn't hurt, and you actually want to. Go slow, use a lot of lube (breastfeeding can make you drier), and stop if it hurts. Pain with sex that doesn't improve is worth bringing to your provider or a pelvic floor PT. It's common, and it's treatable.
Pelvic floor exercises. Gentle squeezes can usually start in the first days, as long as they don't hurt. Leaking a little when you laugh or cough is common after birth. If it's not improving, ask for a referral.
Exercise. Walking first. Save running, jumping and heavy lifting until you've been cleared and you feel ready, not just because a calendar says so.
The part nobody talks about
Some people feel nothing about their tear. Some feel embarrassed, or angry, or like their body failed them. Some can't stop replaying the moment it happened. All of that is normal.
You didn't do it wrong. A tear is something that happened to you, not something you did.
If your birth is sitting heavy, you don't have to carry it alone. My Birth Story Debrief is one 60-minute virtual session where we go through what happened, in clinical terms, so the parts that never made sense finally do. It isn't therapy. If you're struggling with your mood, anxiety or sleep beyond the baby blues, please tell your provider. That's postpartum care too.
Quick answers
How long does a 2nd degree tear take to heal? Most 1st and 2nd degree tears heal within about 6 weeks. Soreness usually eases a lot by 2 to 3 weeks.
Do I need to get my stitches removed? Usually not. Most dissolve on their own as you heal.
Will I rip my stitches when I poop? Very unlikely. Take the stool softener, drink water, put your feet up, and support the area with a pad.
Is ice or heat better? Cold is most helpful in the first day or two for pain and swelling. Warm water (a shallow bath or sitz bath) often feels better after that.
When can I have sex after a tear? When you've stopped bleeding, it doesn't hurt, and you want to. Many people wait until their postpartum visit.
Still pregnant and reading ahead? Smart. Two things that make this part easier:
The Ultimate Birth Bag System ($27) gets three bags packed and by the door by 36 weeks, without the stuff the hospital already gives you. Your recovery supplies are ready before you need them.
Not sure what to buy? My free Hospital Bag Gear Guide lists what actually makes labor, recovery and going home easier.
And if you haven't yet, read Will I Tear During Birth? for what may lower your odds.
Sources
Tommy's. Perineal tears.
Gloucestershire Hospitals NHS Trust. Third and fourth degree tears following childbirth.
University Hospitals Birmingham. Perineal tears during childbirth.
East CR, et al. Local cooling for relieving pain from perineal trauma sustained during childbirth. Cochrane Database of Systematic Reviews, 2020. Cochrane Library.
This post is education, not medical advice. Talk with your own provider about your body and your recovery.