Don’t Put Ice on Your Perineum!
Why Ice May Not Be the Best Choice for Perineal Care: Exploring Better Alternatives - Red Light Therapy
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
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
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
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
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
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 Needs Inflammation - Red Light Therapy for Postpartum Care
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
Receive a free protocol based on your health history and birth plan (vaginal or cesarean).
Exploring More Efficient Alternatives
So, if ice, NSAIDs, and padsicles aren’t the best options, what should you use instead?
Let’s explore two healing alternatives: red light therapy and sitz baths
Red Light Therapy: A Modern Healing Solution
I attend births as a birth doula (I’m also a midwife but not practicing in the USA). One of the first things I now do once mom is cleaned up and tucked in nursing her newborn is to apply my hand held laser very close to the perineum. I have two devices I use - blue wavelengths kill pathogenic microbes around the wound (reducing the risk of infection) and then I move to red light therapy. It reduces swelling in the tissues quickly, it’s often the swelling that causes more pain. The light triggers a cascade of anti-inflammatory macrophages and cytokines to accelerate wound healing in a tear or episiotomy. It takes about 5 minutes and doesn’t disturb mom. With my hand held laser I use two wavelengths - one for superficial penetration and NIR which penetrates more deeply into the tissues. It doesn’t get hot as photobiomoduation is NOT a thermal treatment. I do the same with my clients after a cesarean while they are in the recovery area (mom relaxes and breathes in her baby while I use the laser on her incision). It reduces moms need for heavy pain meds too which is such a fantastic benefit after a cesarean birth. Staff are always fascinated by the laser and it gives me an opportunity to share information about the research on wound healing.
In the days after birth as mom is getting the hang of breastfeeding if we run into any issues with nipple pain we’ll apply a similar treatment several times a day so while I help adjust positioning/latch etc mom can continue to nurse her baby without pain. (It’s a fantastic tool for blocked ducts - when the volume of milk has already come in during the first week we see the milk start to drip from the affected breast within minutes of starting the treatment - sometimes before I finish). My Solasta Laser has multiple uses for postpartum recovery and I provide protocols for any mum who purchases my laser so you can use it safely in the hospital and at home. And when your little one gets bigger and gets cuts, bumps and bruises you can continue using it…and that’s even before we explore how to use it for your own mental health…there’s so much I have to tell you!
Here’s why it’s a great choice for perineal care (panels don’t even come close). So if you’re reading this blog from a company promoting panels for postpartum recovery keep doing your research before investing.
Boosts Cellular Repair
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.
Reduces Inflammation Without Hindering Healing
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
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.
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
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
Warm sitz baths increase blood flow to the area, which can enhance healing by delivering more oxygen and nutrients to the tissues.
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!
(If you’re a midwife or birth doula - this is a must have addition to your birth bag).
https://blog.tracydonegan.org/blog/ultimate-guide-to-choosing-red-light-devices-for-fertility-
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.”
