Postpartum

Infected Birth Stitches: Warning Signs

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Perineal or episiotomy stitches are likely infected when pain increases after 3 days instead of easing, or when the area smells foul, leaks pus, or pulls apart. A fever or spreading redness adds to the picture. Infected repairs heal well with early treatment, so these changes are a reason to call promptly.

Last updated: July 2026

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How should birth stitches feel while healing?

Perineal stitches are meant to feel sore, swollen, and tender for the first several days, then improve a little each day. Most repairs dissolve on their own over 1 to 2 weeks, and the sharpest discomfort typically fades within the first 3 to 5 days as swelling settles.

Some pulling, itching, or a twinge when you sit is part of normal healing, and cool packs and good hygiene help. According to the American College of Obstetricians and Gynecologists, most obstetric lacerations heal well with routine care, and complications are the exception rather than the rule 1. A repair that is slowly getting more comfortable, without fever or foul odor, is following the expected path.

What are the warning signs of infected stitches?

Infected stitches reveal themselves when the trend reverses: pain that intensifies after 3 days, new swelling, or the area becoming hot and hard. A foul or rotten smell, yellow or green discharge, a fever, or stitches that come apart and leave an open edge are the key signals 1.

National postnatal guidance lists offensive-smelling discharge and increasing wound pain among the postnatal problems that warrant assessment 2. The general signs of an infected wound apply to a perineal repair, and a red streak spreading from the area is a more urgent one. Difficulty passing urine or stool because of escalating pain is another reason to check in.

Why does early treatment of an infected repair matter?

Early treatment protects both healing and long-term pelvic function. An infected or broken-down repair that is caught quickly can often be cleaned and managed before it widens, whereas a delay raises the chance of a larger wound or a repair that heals poorly 1.

Because the perineum supports continence and comfort with sitting and sex, a well-healed repair matters months down the line, and some people benefit from pelvic floor physical therapy as recovery continues. The American College of Obstetricians and Gynecologists recommends careful follow-up of higher-degree lacerations for exactly these reasons 1. Treatment is usually straightforward — wound care and antibiotics when infection is present — but it works best when started early.

When should I call about my stitches?

A prompt call is warranted when pain climbs instead of falling, when there is a foul smell or pus, when the stitches open, or when a fever appears. Knowing when a fever needs review helps, since a fever above 100.4°F with wound pain points toward infection rather than ordinary soreness.

According to postpartum care guidance, wound problems are among the warning signs that justify contacting a clinician before the routine visit, which itself should happen by 12 weeks with an earlier check-in within the first 3 weeks for concerns 3. Trouble controlling urine or stool, or a sense that the repair has given way, also warrants a same-day conversation.

When infected birth stitches need a clinician

A clinician can separate normal soreness from an infected or separated repair, usually with a gentle exam and, when needed, a wound culture or a plan to clean and redress the area. Describing when the pain changed, any odor or discharge, and whether the stitches feel open gives that visit a head start.

Because an untreated perineal infection can undermine healing and pelvic-floor recovery, guidance favors early review of these warning signs over waiting 23. Healing also varies across life stages — tissue repair and estrogen levels differ for a teenager, for someone in their peak reproductive years, and later during the perimenopausal transition, so recovery is not identical for everyone. Gale can help you organize what to describe before you call your obstetric clinician or midwife.

Common questions

The clearest clue is direction: normal stitches slowly get more comfortable, while infected ones grow more painful after about the third day. A foul smell, yellow or green discharge, a fever, or stitches that pull apart also point to infection and are worth reporting.

A mild scent from lochia is normal, but a clearly foul or rotten smell coming from the stitches themselves is not. When a bad odor comes with increasing pain, swelling, or discharge at the wound, it suggests an infected repair that needs review.

A repair can separate with or without infection, and it still deserves a clinician's look. Small openings often heal on their own with good care, while larger ones may need treatment. Increasing pain, odor, or an open edge is a reason to be seen.

Treated early, most infected repairs heal without lasting problems. A repair that heals poorly can affect comfort and continence later, which is why early treatment and, for some, pelvic floor physical therapy matter for long-term recovery.

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When birth stitches need prompt review

  • —Pain at the stitches that increases after the third day instead of easing is a reason to call your obstetric clinician.
  • —A foul smell, pus, or yellow-green discharge from the repair is a reason to seek prompt wound evaluation.
  • —Stitches that come apart or a repair that feels like it has given way is a reason to be seen the same day.
  • —A fever with wound pain, or a red streak spreading from the area, is a reason to seek urgent care.
  • —Feeling faint or very unwell with a high fever is a reason to call 911 or go to the nearest emergency room.

If you have a high fever with a spreading red streak or feel faint and very unwell, call 911 or go to the nearest emergency room right away.

This article is general health education, not medical advice. Whether birth stitches are healing normally or infected depends on an exam, and should be assessed by an obstetric clinician or midwife.

References

  1. 1.American College of Obstetricians and Gynecologists (2018). ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002841 ✓Normal healing of obstetric lacerations and the management of infected or broken-down perineal and episiotomy repairs, including the value of early review and follow-up of higher-degree lacerations.
  2. 2.National Institute for Health and Care Excellence (2026). Postnatal care (NG194). National Institute for Health and Care Excellence (NICE). link ✓Postnatal warning signs — offensive-smelling discharge and increasing wound pain — that warrant clinical assessment of a perineal repair.
  3. 3.American College of Obstetricians and Gynecologists (2018). ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002633 ✓Postpartum warning signs and follow-up timing: a contact within the first 3 weeks and a comprehensive visit by 12 weeks, with wound problems justifying earlier contact.

3 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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