Perineal Care After Cesarean Birth

Proper perineal care is important in preventing infection of the bladder and uterus after a cesarean. Keep the perineum clean and free from caked or dried blood. Change sanitary pads at least every 4 hours to help prevent infection. Change pads every time you use the bathroom and when you bathe. Do not use tampons until your doctor says it is OK. Use proper perineal care every time you change pads, urinate, or have a bowel movement until all vaginal discharge (lochia) has stopped.

Steps for Proper Perineal Care

(See TIP 2 on the right)

1. Wash your hands. “Peel” off the sanitary pad from front to back. This avoids dragging germs from the anal area to the vaginal area. Throw soiled pads in a lined trash can or plastic bag, not in the toilet. Be careful not to touch the soiled area of the pad.

2. After urinating and while still sitting on the toilet, use the peri-bottle to squirt warm water over the outside of the perineum, beginning at the front and moving toward the back. Do not squirt water up into the vagina. Pat the area dry from front to back with toilet paper. Use a clean piece of toilet paper on each wipe. Drop used toilet paper into the toilet after each wipe. White, unscented toilet paper is best.

3. After a bowel movement, wipe from front to back with toilet paper. If you have hemorrhoids, gently wipe or pat, again from front to back, with witch hazel pads to reduce minor itching or burning. Use a clean piece of toilet paper or witch hazel pad for each wipe. Drop used toilet paper and witch hazel pads into the toilet after each wipe.

4. Do not flush the toilet until after you stand up; flushing water may splash onto the perineum. When opening or while putting on a clean pad, don’t touch the side that goes against your body.

5. Wash the peri-bottle and wash your hands thoroughly.

Strengthening the Perineal Muscles

The perineal muscles carried the increasing weight of your uterus and your baby during pregnancy. This extra weight can cause these muscles to lose some of their strength and tone. The perineal muscles will gradually regain much of their strength and tone during the first 6 weeks. Doing Kegel exercises can help regain strength and tone sooner.

Kegel Exercises

To do Kegel exercises, squeeze the perineal muscles as if you were trying to stop the flow of urine. Hold for 5 to 10 seconds and then relax. Do this exercise 10 times a day in sets of 10 repetitions. Do at least 10 Kegel exercises every time you urinate and at least 100 Kegels each day. No one can tell that you are doing Kegels and you can do them anywhere. Do a few during the commercials while you watch TV.

Doing Kegel exercises can reduce problems with leaking urine. It is common for small amounts of urine to leak from your bladder until the perineal muscles are back to their pre-pregnancy state. Leaking urine, called incontinence, can happen when you cough, sneeze, strain, laugh, or pick up your baby.

Kegel exercises will help you regain control of your bladder. You probably did Kegel exercises during your pregnancy. You should keep doing these exercises when you return home from the hospital.

You may notice that you have to urinate quite often for the first 4 to 5 days while your body gets rid of fluid it no longer needs. Due to the effects of anesthesia, the return of normal bladder function may take 4 to 7 days.

More About Self Care After Cesarean Birth

Introduction to Self-care After Cesarean Birth
Preventive Self Care
Perineal Care
Physical Changes and Healing
Vaginal Birth After Cesarean (VBAC)
Breast Care
Activities and Healthy Exercise
Nutrition and Diet
Family Planning and Birth Control
Normal “Baby Blues” or Postpartum Depression
Your Postpartum Check-Up
Get as Much Rest as You Can
When to Call Your Doctor

Newborn having umbilical cord clamped.
Newborn having umbilical cord clamped.

Involution is a normal process where the uterus continues to contract until it shrinks to its non-pregnant size of a pear.

When you are ready to change sanitary pads, have a clean sanitary pad, witch hazel pads, and the peri-bottle (squeeze bottle) nearby. Rinse out the peri-bottle and fill it with warm, not hot, tap water. Then follow steps 1 through 5 in the pink box.

You can make witch hazel pads with soft 2” x 2” non-sterile gauze pads and witch hazel. Always apply the witch hazel to a clean gauze pad so you will not get germs into the witch hazel. You can buy pre-soaked witch hazel pads at your pharmacy.

To make cold witch hazel pads, keep the bottle of witch hazel or some pre-soaked witch hazel pads in the refrigerator.

Coughing, sneezing, straining, and laughing put a lot of pressure on your incision. You will be more comfortable if you support your incision by holding a pillow or your hands against the incision before you cough or sneeze.