In this patient information, you will receive advice on pain management and hygiene, and how to relieve pressure on your pelvic floor while the tear heals.

When the anal sphincter muscle is torn, it is normal to experience pain during the first month. You may have difficulty controlling urine and gas (farts), and in rare cases, bowel movements.

Read here on how to take care of your body while the tear heals and who to contact if you experience problems.

Follow-up
You will be offered a follow-up appointment 10-17 days after the birth. Contact the department if you have not received an appointment.

Contact the department immediately if:

• You cannot control bowel movements.
• You cannot feel when you need to have a bowel movement.

You can contact the Maternity Reception 4023 at phone number 35 45 96 30 at any time.

Also contact the department if:

• The swelling around the tear worsens.
• The pain from the tear becomes more intense.
• You think your stitches have come undone.

You will be called for follow-up with a specialized midwife via eBoks.

The pmidwife will examine your pelvic floor muscles in the vagina and the anal opening. You will be asked if you have problems controlling urine, gas, or bowel movements, and if you have pain. You will also receive guidance on how to continue rehabilitating your pelvic floor muscles.

Your Tear
In the first weeks after birth, you may experience stinging and swelling and tenderness where you tore. It is a good idea to have your tear examined before you leave the hospital so you know what it should look like and you can monitor it with a mirror. As your tear starts to heal, it may itch or feel tight. The tear will heal after about a month, but it may take longer for all the stitches to dissolve.

All women who have given birth vaginally may experience tenderness and a feeling of heaviness in the pelvic floor, but your pain should decrease within the first 14 days.

Pain Relief Medication
You will be offered pain relief medication while you are in the hospital. Even if you are breastfeeding, you can continue to take pain relief medication when you get home.

We recommend that you take:

• 2 tablets of paracetamol (e.g., Pamol or Panodil) 500 mg up to 4 times daily along with 2 tablets of Ibuprofen (Ipren) 200 mg up to 3-4 times daily.
• Take the tablets as long as you are in pain. Stop with Ibuprofen first, but continue with paracetamol for a few more days.

Pain-Relieving Ice Pack
You can use an ice pack to relieve your pain. You can buy reusable ice packs at the pharmacy or similar shops. You can also make ice packs from sanitary pads that are wet and placed in the freezer. Always wrap the ice pack in a cloth to avoid frostbite.

We recommend using an ice pack for 15 minutes at a time with a few hours in between. You can continue to use ice packs as long as you need them.

Toilet Visits
After a bowel movement, you can rinse with water instead of wiping for the first 7-10 days, and then gently pat the area dry with a towel. After the first 10 days, your skin will have healed, and you can use toilet paper to wipe.

After urinating, you can wipe with toilet paper. If it stings when you urinate, it may help to rinse with water while you urinate.

You can continue to rinse with water during toilet visits if you find it more comfortable, but stop if your skin becomes irritated.

Avoid Constipation
It is important to reduce pressure on your pelvic floor while it heals. Therefore, you should avoid constipation. It is important that you:

• Eat a diet rich in fiber and eat regularly.
• Drink 1.5-2 liters of fluid daily.
• Avoid straining to have a bowel movement.

While you are in the hospital, you will be offered Magnesia, a laxative. It softens your stools, making them easier to pass.

We recommend that you:

• Take 1-2 Magnesia tablets each evening.
• Usually take the laxative only once a day.
• Stop or reduce if you get diarrhea.
• Continue as long as you need it – even after you get home.

It is gentler on your pelvic floor to continue taking Magnesia than to become constipated. Magnesia is neither harmful nor addictive. It is available over the counter.

Rehabilitating Your Pelvic Floor
We recommend that you start rehabilitating your pelvic floor muscles immediately. This is done by doing pelvic floor exercises (Kegel exercises). Talk to the physiotherapist about the initial postnatal body training.

You can find information about pelvic floor exercises at www.kvindekrop.dk.

Protect Your Pelvic Floor Initially
In the first 3-4 weeks after birth, your tear needs peace and quiet to heal.

Here is how to relieve your pelvic floor:

• Avoid constipation and straining during bowel movements.
• Support your perineum, e.g., with a folded sanitary pad, while having a bowel movement to make it less uncomfortable.
• Avoid sitting or standing for long periods if it causes pain. Sit on a soft cushion. Avoid sitting on a ring cushion.
• Lie down and rest when you feel pain or need a break.
• Lie down to breastfeed, if possible, to relieve your pelvic floor.
• Avoid lifting heavy objects; it should not hurt to lift.
• Take short walks – you should also be able to get back home.
• Do pelvic floor exercises (Kegel exercises). They should not be painful.

Your Pelvic Floor After the First Month
You can gradually start to increase your activity level after the first month. If you experience pain during an activity, it is often a sign that the activity is too strenuous for your pelvic floor. You can reduce the strain by, for example, taking shorter walks.

If you feel up to it, you can start postpartum gymnastics after the first month, preferably with an instructor who has special knowledge about the pelvic floor after childbirth. Over the next few months, you can also gradually resume your normal physical activities, such as running or fitness. If in doubt, consult the physiotherapist.

When Can You Have Sexual Intercourse Again?
You can have sexual intercourse when your pelvic floor and anal sphincter have healed, which takes 4-6 weeks. Initially, you may experience tenderness at the vaginal opening or deeper inside the vagina.

Many new mothers find that their vaginal mucous membranes feel dry and sensitive. Therefore, it is a good idea to use a silicone-based lubricant and possibly some numbing gel (Xylocain gel 2%) during intercourse. Both are available over the counter.

The most important thing is that you feel ready to resume sexual activity. Talk to the physiotherapist or doctor if you have problems with pain during intercourse

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