You tense before every sneeze and lower yourself onto the sofa like it might bite. Perineal healing after tears or episiotomy is slower and stranger than anyone warned — and fear of making it worse can shrink your whole day.
This page follows NHS and NICE postnatal guidance on pelvic floor recovery, separates ordinary soreness from red flags, and helps you prepare for your six-week check without shame.
How you might be feeling
Healing tissue commands attention — a sting when milk lets down, a pull when you stand too fast, dread before the toilet. You might avoid mirrors or obsess over them. Partners may not see the swelling you feel sitting at an angle on a cushion.
Fear of the first poo overlaps here — see constipation resources if that dread dominates. Some mums feel betrayed by a body that bled, tore, and now leaks when they laugh.
Six-week check anxiety is real: will they say you are not healing? Bringing notes turns the visit from verdict to collaboration. Pelvic floor weakness is not your fault — pregnancy and birth stretch support structures regardless of birth type.
What is usually normal
NHS your body after birth pages describe perineal soreness, bruising, and stitches dissolving over weeks. RCOG patient information notes most tears heal well with hygiene and pain relief.
Expected: gradual improvement, ache after busy days, occasional leaking early on, sensitivity near stitches. Not expected: fever, worsening pain after initial improvement, heavy fresh bleeding, inability to pass urine.
Pelvic floor exercises — gentle lifts and releases — can start when comfortable; women's health physio personalises pace if unsure. Caesarean mums still need pelvic floor care — pregnancy pressure applies regardless of delivery route.
What you can try tonight
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Pain relief on schedule — paracetamol/ibuprofen if approved for you.
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Ice or warm bath — whichever stage you are in; twenty minutes max ice.
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Ring cushion or rolled towel when sitting — reduces direct pressure.
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Front-to-back pat dry after toilet; loose cotton underwear.
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Three gentle pelvic floor lifts if comfortable — stop if pain spikes.
When to contact someone
Contact general practitioner (GP), maternity triage, or NHS 111 for fever, foul discharge, sudden worsening pain, heavy bleeding, or inability to urinate.
Pelvic health physiotherapy referral if leaking persists, you feel bulging, or pain blocks daily life.
999 or A&E for heavy bleeding soaking a pad hourly, collapse, or severe uncontrolled pain.
At your appointment
Discuss:.
- Tear grade or episiotomy if known
- Pain trend — better, same, worse
- Continence and bowel movements
- Sex and tampon questions if relevant
- Pelvic floor physio referral and safe exercise return
Related reading
- Stitch-specific fears: Episiotomy stitches recovery
- Vaginal overview: Vaginal birth recovery checklist
- Body grief: Postpartum body changes worries
- Hub: Mum body recovery hub
Official sources
If printable helps
Track healing in the mum recovery daily check-in. Plan rest in the postpartum rest planner. Questions on six-week check appointment prep before the visit.