From the Guidelines
Treatment options for perineal pain should prioritize a multimodal approach, including non-pharmacological and pharmacological methods, with a focus on reducing inflammation, blocking pain signals, and promoting tissue healing. For immediate relief, applying ice packs to the perineal area for 10-20 minutes several times daily during the first 24-48 hours can reduce swelling and numb the area. Sitz baths (sitting in warm water for 10-15 minutes, 2-3 times daily) can promote healing and provide comfort after the initial inflammation subsides. Over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or ibuprofen (400-600mg every 6-8 hours with food) can effectively manage pain and reduce inflammation, as supported by general medical knowledge and 1. For more severe pain, prescription medications such as topical lidocaine 2-5% ointment applied to the perineal area 3-4 times daily or oral opioids like oxycodone 5-10mg every 4-6 hours may be necessary for short-term use. Perineal support cushions or donut pillows can reduce pressure while sitting. Maintaining good hygiene, using gentle cleansing methods, and wearing loose cotton underwear help prevent irritation. Pelvic floor physical therapy may benefit those with chronic perineal pain by addressing muscle tension and improving function, as suggested by 1 and 1. In cases of Fournier’s gangrene, prompt antibiotic therapy, hemodynamic support, and early debridement are crucial, as emphasized by 1. For complex perianal disease, such as perianal Crohn's disease, infliximab therapy can be effective in closing fistula tracks, and azathioprine, 6-mercaptopurine, or methotrexate should be coadministered for maintenance of remission therapy, as discussed in 1. These treatments work by reducing inflammation, blocking pain signals, relaxing muscles, and promoting tissue healing in the perineal region. Key considerations include:
- Reducing inflammation and pain
- Promoting tissue healing
- Addressing muscle tension and improving function
- Managing complex perianal disease
- Preventing irritation and infection.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Perineal Pain
Perineal pain is a common issue that may affect women during vaginal delivery, resulting from either spontaneous tears or intentional episiotomies. Various treatment options are available to manage perineal pain, including:
- Topical lidocaine-prilocaine cream: Studies have shown that topical lidocaine-prilocaine cream can provide comparable results in reducing pain during perineal repair after vaginal delivery 2, 3.
- Local infiltration anesthesia: This method involves injecting a local anesthetic into the perineal area to numb the pain. However, studies have found that topical lidocaine-prilocaine cream may be more effective in reducing pain and improving patient satisfaction 2, 3.
- Paracetamol/acetaminophen: A single dose of paracetamol may improve perineal pain relief following vaginal birth and reduce the need for additional pain relief 4.
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs have been found to provide greater pain relief for acute postpartum perineal pain compared to placebo, and fewer women may need additional analgesia when treated with a NSAID 5.
- Aspirin: Single dose aspirin may increase adequate pain relief in women with perineal pain post-episiotomy compared to placebo, but the certainty of the evidence is low due to study limitations and imprecision 6.
Key Findings
- Topical lidocaine-prilocaine cream may be an effective analgesic during repair of perineal tears with no harmful side effects 3.
- Paracetamol may be effective in relieving perineal pain, but the certainty of the evidence is low due to unclear risk of bias and substantial heterogeneity 4.
- NSAIDs appear to be more effective in providing relief for perineal pain than paracetamol, but few studies were included in this analysis 5.
- Aspirin may be considered for use in non-breastfeeding women with post-episiotomy perineal pain, but the certainty of the evidence is low due to study limitations and imprecision 6.