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Recovering from a Perineal Tear: When to Start Physio and What to Expect

Perineal tears are common after vaginal birth. While many women are told that healing simply takes time, recovering is not always straightforward. Understanding what’s normal, what isn’t and when to seek specialist support can make a real difference to your comfort and long-term pelvic health.

At PelviCare, we regularly support women through perineal tearing physio treatment as part of our postnatal physiotherapy service. Here’s what you can expect during recovery and when physiotherapy may help.

How Long Does a Perineal Tear Take to Heal?

Healing time depends on the degree of the tear.

  • First-degree tears (affecting the skin only) often heal within a few weeks.
  • Second-degree tears (involving muscle) usually take a little longer, often around 4–6 weeks.
  • Third- and fourth-degree tears (involving the anal sphincter) require more careful monitoring and can take several months to fully recover.

Stitches typically dissolve within a few weeks. Swelling and bruising tend to improve during the first 10–14 days. However, deeper muscle recovery and pelvic floor strength take longer. This is where many women benefit from structured pelvic floor physiotherapy rather than simply waiting for it to heal.

What Is Normal in the First 6 Weeks?

In the early weeks after birth, it’s common to experience:

  • Tenderness around the scar
  • Mild pulling or tightness
  • Discomfort when sitting for long periods
  • Temporary bladder urgency or slight leakage

What isn’t normal is persistent severe pain, worsening symptoms, difficulty controlling wind or bowel movements, or pain during sexual intercourse months later.

If symptoms continue beyond six weeks, or you feel unsure about your recovery, it’s sensible to have a postnatal assessment.

When to Start Physio 

Gentle pelvic floor activation can usually begin within days of birth, depending on your comfort. However, formal physiotherapy assessment is typically recommended around six weeks postnatally.

At PelviCare, we carry out detailed postnatal physiotherapy assessments to check:

  • Pelvic floor strength and coordination
  • Scar mobility and tissue healing
  • Core muscle recovery
  • Bladder and bowel function

For more complex tears, including obstetric anal sphincter injuries, earlier specialist input may be appropriate.

Managing Scar Tissue and Tightness

Scar tissue can sometimes become tight, sensitive or restricted. This may contribute to pain, pulling sensations or discomfort during sex.

As part of our perineal tearing physio treatment, we may use:

Importantly, not all pelvic floors are weak after birth. Some become tight and overactive. Strengthening alone is not always the answer. We assess each woman individually and create a personalised plan.

Rebuilding the Strength of the Pelvic Floor 

Many women are eager to return to exercise, running or high-impact training. Doing too much too soon can increase the risk of pelvic organ prolapse or ongoing bladder problems.

At PelviCare, we guide you through:

  • Evidence-based pelvic floor exercises
  • Core rehabilitation
  • Hypopressive exercises where appropriate
  • Gradual return-to-sport planning

Our Mummy MOT® offers a structured postnatal check to ensure your body is ready before you increase activity levels.

Find out more about our treatments in London.