Don’t Put Ice on Your Perineum!

Why Ice May Not Be the Best Choice for Perineal Care: Exploring Better Alternatives

Let’s talk about a topic that’s close to many of our hearts (and bodies): perineal care after labor and birth. For years, using ice has been a go-to remedy for reducing swelling and pain, but evidence suggests ice might not be the best choice - yep even those padsicles. If you’ve given birth before and experienced the relief of a cool padsicle you might think I’m being cruel for suggesting you give it a miss - or at a minimum use ice sparingly on this sensitive part of your body.

Home made padsicles - https://theeverymom.com/

The Cold Truth About Ice

Using ice on the perineum feels soothing for most since applying ice to an injury can reduce pain but it’s essential to understand that it might interfere with the progress of your body’s natural healing process. Here’s why:

Interrupting Inflammation

1. There’s a saying in biology about our lymphatic system - that it ‘brings in the groceries and takes out the trash’. Inflammation is a crucial part of the body’s healing process. It helps bring necessary nutrients and immune cells to the injury site. When you apply ice, it constricts blood vessels and reducse blood flow, potentially delaying this essential response. In a nutshell - ice makes it harder for your body to ‘bring’ in the good stuff your perineum needs as well as removing the stuff it doesn’t need - the ‘trash’ (dead cells etc).  

Lack of Long-Term Benefits

1. Recent studies have shown that while ice can provide temporary pain relief, it doesn’t contribute to long-term healing. In fact, it might prolong recovery by preventing the inflammation process from doing its job effectively.

False Sense of Healing

1. The numbing effect of ice can create a false sense of healing, leading you to believe you’re recovering faster than you actually are. This can result in overexertion or not giving your body the rest it needs. Be gentle with yourself during the postpartum.

NSAIDs: Another Common, Yet Problematic, Choice

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are commonly used to manage pain and inflammation. However, like ice, they can also interfere with the natural healing process:

Blocking Inflammation

1. NSAIDs work by blocking the enzymes that cause inflammation and pain. While this can provide relief, it also interrupts the body’s natural healing process, which relies on a balanced inflammatory response.

Potential Side Effects

1. Long-term use of NSAIDs can lead to side effects such as stomach irritation, increased bleeding risk, and even kidney issues. These potential risks make it important to consider other pain management strategies.

Healing Requires Inflammation

We tend to think of inflammation as a bad thing but there are times when inflammation is our best friend. When tissue is damaged through trauma you heal by using your immune system, the same biological mechanisms your body uses to kill germs. This is called inflammation. When germs get into your body, your immune system sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immune system sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process.  The special inflammatory cells called macrophages release a hormone called Insulin-like Growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.

Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation. The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can even cause nerve damage.

Anything that interrupts the inflammation process also delays healing. This includes:

• Cortisone-type drugs

• Most postpartum pain meds, such as NSAIDs like ibuprofen

• Immune suppressant medication

• Applying cold packs or ice

Exploring Better Alternatives

So, if ice, NSAIDs, and padsicles aren’t the best options, what should you use instead? 

Let’s explore two healing alternatives: sitz baths and red light therapy.

Sitz Baths: A Tried-and-True Remedy

Sitz baths have been a staple in postpartum care for ages, and for good reason. They offer several benefits for perineal healing:

Soothing Relief

1. Soaking in warm water can provide immediate soothing relief from pain and swelling. It helps relax the muscles and tissues in the perineal area. 

Promotes Circulation

1. Warm sitz baths increase blood flow to the area, which can enhance healing by delivering more oxygen and nutrients to the tissues.

Red Light Therapy: A Modern Healing Solution

Red light therapy is gaining traction as a highly effective treatment for promoting tissue healing and reducing inflammation. Here’s why it’s a great choice for perineal care (for targeted skin treatment - not using a panel):

Boosts Cellular Repair

1. Red light therapy penetrates deep into the skin, stimulating cellular repair and regeneration. This can speed up the healing process and reduce the time you spend in discomfort (get my free pregnancy/postpartum healing protocols for red light therapy).

Reduces Inflammation Without Hindering Healing

1. Unlike ice, NSAIDs, and padsicles, red light therapy reduces the side effects of inflammation (swelling & pain) but without interrupting the inflammation process. It helps balance inflammation, so your body can repair tissues effectively without unnecessary swelling. To optimize healing applying a cold compress immediately before your red light therapy results in deeper tissue penetration (as the free mitochondria are slowed down from ‘grabbing’ the energy and taking it around the body due to the systemic effect of photobiomodulation.

Safe and Non-Invasive

1. This therapy is non-invasive and safe, making it ideal for sensitive areas like the perineum. It’s a gentle way to support your body’s natural healing mechanisms. This recent 2024 study comparing ice therapy to PBM reinforced the evidence for this therapy with statistically significant benefits including less pain for the red light moms.

Bringing It All Together

While ice, NSAIDs, and homemade padsicles have been traditional remedies for perineal swelling and pain, recent evidence suggests they might not be the best choices for long-term healing. Most of the research on perineal injury focuses on pain management only rather than how the tissues heal so there is a gap in our current scientific knowledge. Instead, consider alternatives like red light therapy and sitz baths, which can provide effective relief and support your body’s natural healing processes. Don’t forget to get back to your pelvic floor exercises too, although in those first few days you might not believe you still have one (use the same pelvic floor visualizations from the GentleBirth app). Activating those muscles increases circulation to the areas that are healing.

You and your body are resilient. By choosing the best care methods, you can ensure a smoother, faster recovery and get back to enjoying your precious time with your little one. Happy healing!

Resources:

What does the Cochrane Review say about cooling therapies for the perineum?

“There is only a small amount of low or very low-quality evidence from small trials suggesting that cooling treatments may help relieve perineal pain after having a baby. Further research is needed to see if cooling affects how well the tears or cuts heal.”