“My Stitches Smell, Came Apart or Feel Open”: Wound Problems After a Third or Fourth Degree Tear
After a third or fourth degree tear, a smell, a hot throbbing feeling, a gap where the stitches were, or a raw red lump that bleeds are not things to wait out. They can mean infection, wound breakdown or granulation tissue. All three are common, all three are treatable, and all three need to be looked at by someone who knows what they are seeing. This guide explains what each one can mean, what doctors usually check, the questions to ask, and when a wound problem can point to something having gone wrong with the repair or the care afterwards.
She noticed the smell on day eight. She told herself it was the bleeding, the pads, the heat. By day eleven she was afraid to sit down at all, and when she finally held a mirror between her knees, she couldn’t see stitches where stitches should have been. Just something open and raw.
When she rang the hospital, she was told it was probably normal, and to mention it at her six week check.
If you are reading this because something about your stitches doesn’t feel right, please trust that instinct. I’m a lawyer, not a doctor, and I can’t tell you what is happening in your body. But I can tell you what these problems usually are, what the guidelines say should happen, and why “wait until six weeks” is not the right answer when a wound smells or has opened.
- your stitches or discharge smell bad, or there is green or yellow pus
- the area is hot, swollen, throbbing, or the pain is getting worse instead of better
- you can see or feel that the stitches have come apart or there is a gap
- you have a fever, chills, or feel generally unwell
- wind or poo is coming from your vagina
- you are bleeding heavily or passing large clots
Call your maternity unit (most have a 24 hour number), your GP or your midwife, and say you had a third or fourth degree tear. If you feel very unwell, go to your nearest emergency department or call 000.
Why wound problems happen after a severe tear
The perineum heals remarkably well most of the time. But it is also warm, moist, close to the bowel, and under pressure every time you sit, stand, wee or open your bowels. A third or fourth degree tear is a deep wound in exactly that place, which is why the guidelines treat it so carefully.
That care is meant to start at the repair. The Royal College of Obstetricians and Gynaecologists’ Green-top Guideline No. 29, published on RANZCOG’s website, recommends antibiotics after the repair of a third or fourth degree tear to reduce infection and wound breakdown, and stool softeners so that the repair isn’t strained. In Sydney, the Royal Hospital for Women’s procedure asks for antibiotics before the repair and for five days after, for 3b, 3c and fourth degree tears to be repaired in an operating theatre, and for a rectal examination at the end of the repair to make sure no stitches have been placed incorrectly.
Even with all of that, some wounds still become infected or come apart. That isn’t automatically anyone’s fault. What matters is whether it is recognised and treated properly.
What it can mean
Problem 1Infection: “my stitches smell”
Perineal wound infection
Bacteria growing in the wound, usually in the first days to two weeks after birth. Signs include a bad smell, pus or green or yellow discharge, redness, heat, swelling, throbbing pain that is getting worse, and sometimes fever.
In plain terms: normal healing gets a little better each day. Infection goes the other way: hotter, more painful, smellier. It needs to be examined, and often needs antibiotics.
What women describe
- “A smell like something rotting, different from normal bleeding”
- “Hot and throbbing, like it has its own heartbeat”
- “I couldn’t sit at all, it got worse not better”
- “I just felt unwell and shivery”
What usually happens
- An examination of the wound, and often a swab
- Antibiotics, sometimes through a drip if you are unwell
- Checking whether the wound has started to come apart
- Closer follow-up until it settles
One important note: if the smell is like poo, or you notice wind or poo coming from the vagina, tell whoever examines you. That can be a sign of a fistula, which is covered further down.
Problem 2Breakdown: “my stitches came apart”
Wound dehiscence (wound breakdown)
When the edges of a repaired wound separate, partly or completely, so the wound opens again. After a perineal tear it most often happens in the first one to three weeks, and it is frequently linked to infection.
In plain terms: the stitches have given way, and the wound is open. You might see a gap, feel a hole or a ridge, or notice that it suddenly hurts more, bleeds or leaks.
When a perineal wound breaks down, there are generally two options:
- Re-stitching (secondary repair). Once any infection is under control, the wound is cleaned and repaired again, usually in theatre. This matters most where the sphincter repair has come apart, because a sphincter that heals separated can affect bowel control.
- Healing by secondary intention. The wound is kept clean and left to heal from the inside out, without new stitches. It can take several weeks, and needs regular checks.
The research comparing the two is limited. A Cochrane review found too few studies to say firmly which is better for broken-down perineal wounds. That is exactly why it should be a proper discussion with you, by someone experienced, about the depth of the wound, whether the sphincter is involved, and what each option means for you.
Back to the overviewProblem 3Granulation tissue: “a raw red lump that bleeds”
Overgranulation (granulation tissue)
Healing tissue that grows too much and sits above the skin, usually appearing a few weeks after birth. It looks bright red, moist and raw, can bleed on contact, and can sting or ache, especially with sex or wiping.
In plain terms: it’s the body over-doing the healing. It is very common, not dangerous, and usually simple to treat, often in a clinic in a few minutes.
Granulation tissue is one of the most common reasons women are still sore, spotting or stinging at six weeks and beyond. It is often treated with a chemical applicator (silver nitrate) in a clinic, sometimes more than once, and occasionally removed. If you are told “it just looks a bit red, give it time” and it is still bleeding or painful weeks later, it is reasonable to ask whether it could be granulation tissue, and to ask for it to be treated.
Back to the overviewProblem 4Healed, but not right: “a dip, a flap or a hole”
Sometimes the wound closes, but not in the shape it should. Women describe:
- a dip, crevasse or hollow where the perineum used to be, sometimes described as having “no perineum”
- a flap or tag of skin that catches or rubs
- a one-sided, tight or uneven scar that pulls when you walk, sit or have sex
- a vaginal opening that feels wider, narrower or misshapen
These can happen after a wound has broken down and healed open, or where the original repair didn’t bring the tissues back together properly. Some settle with time, scar massage and pelvic health physiotherapy. Others can be improved with surgery, such as a perineal revision or reconstruction, usually once you are fully healed. A referral to a perineal clinic, urogynaecologist or colorectal surgeon is the way to find out.
Back to the overviewProblem 5Wind or poo from the vagina
If you notice wind or poo coming from your vagina, recurring vaginal infections, or a smell of faeces from the vagina, it can mean a rectovaginal fistula: an abnormal opening between the bowel and the vagina. It is rare, but it is more likely after a fourth degree tear, an infected repair or a wound that broke down. It needs specialist assessment, and it can be repaired. Our article on obstetric fistulas after childbirth explains more.
Back to the overviewWhat doctors usually check
When you go back with a wound problem, a doctor or midwife will usually:
- look at the wound in good light, for redness, pus, a gap, granulation tissue or a fistula opening
- take a swab if infection is suspected, and check your temperature and pulse
- check the depth of any breakdown, and whether the sphincter repair is intact, often with a gentle rectal examination
- ask about your bowels and wind, and whether anything is coming from the vagina
- decide on treatment: antibiotics, wound care, treatment of granulation tissue, or a plan for re-stitching or healing open
- arrange follow-up, and refer on to a perineal clinic, urogynaecologist or colorectal surgeon where needed
The Queensland Clinical Guideline on perineal care asks staff to teach women to check their wound daily for signs of infection and breakdown, and to advise women with a third or fourth degree tear to seek an earlier medical review if they see those signs. In other words: you are not meant to wait until six weeks.
Questions to ask the hospital or your GP
1. Is my wound infected? Have you taken a swab, and what did it show? 2. Has the wound come apart? How deep is it, and is the sphincter repair still intact? 3. Should it be re-stitched, or left to heal on its own? Why, and what are the pros and cons of each for me? 4. If it is left to heal, how often will someone check it, and who? 5. Is this granulation tissue? Can it be treated today? 6. Was I given antibiotics and stool softeners after my repair? 7. Where was my tear repaired (birth suite or theatre), and by whom? 8. Was a rectal examination done after the repair? 9. Should I be referred to a perineal clinic, urogynaecologist or colorectal surgeon? 10. Can you write down what you found and the plan, so I have it?
It is completely reasonable to ask for what was found to be written down, and to ask for a copy of your records later. Our guide to getting and reading your birth records explains how.
When a wound problem can point to something going wrong
Wounds can become infected or break down even when everything was done well. But a wound problem can point to a problem with care if, for example:
- a 3b, 3c or fourth degree tear was repaired in the birth room rather than theatre, without good light, anaesthesia or an experienced repairer
- no antibiotics or stool softeners were given after the repair
- there is no record of a rectal examination after the repair, and stitches were later found in the wrong place
- you reported a smell, heat or worsening pain and were told it was normal, or to wait for your six week check
- an infection was not treated promptly, and the wound broke down as a result
- the wound broke down and the options were never discussed with you, or the sphincter was not checked
- a fistula or a separated sphincter was missed for months
How the law looks at it
Whether care was negligent is judged against what was widely accepted as competent professional practice at the time. In New South Wales, section 5O of the Civil Liability Act 2002 (NSW) provides that a professional is not negligent if they acted in a way widely accepted by peer professional opinion as competent practice, unless that opinion is irrational. Other states have similar rules. The guidelines above, along with the national Third and Fourth Degree Perineal Tears Clinical Care Standard, are strong evidence of what competent practice looks like. That standard expects a tear to be repaired by an appropriately trained and experienced clinician in a suitable environment, followed by proper postoperative care and individualised follow-up.
The choice between re-stitching and healing open is also a treatment decision, and the law expects you to be part of it. In Rogers v Whitaker (1992) 175 CLR 479, the High Court held that doctors must warn patients of material risks of a proposed treatment, meaning risks a reasonable person in the patient’s position would be likely to attach significance to, or that the doctor knows, or should know, this particular patient would.
Time limits apply. In New South Wales, a claim generally has to be started within three years of when you knew, or ought to have known, that you had been injured, that the injury was caused by someone’s fault, and that it was serious enough to justify a claim, with an outer limit of 12 years (Limitation Act 1969 (NSW) s 50C). Other states and territories have their own rules, so it is better to ask early.
Our article “It’s just part of having a baby”: when a severe perineal tear wasn’t your fault explains the legal side in more detail, and our birth injury map shows how these injuries connect to others.
In my practice
The phrase I hear most often from women whose wounds broke down is “I knew something was wrong.” They noticed the smell. They felt the heat. They told someone. And they were reassured, sometimes more than once, until the wound was open and there was no reassuring anyone anymore.
When we get the records, the gap is usually not in the dramatic moment but in the ordinary ones: the phone call that wasn’t written down, the antibiotics that were never charted, the note that says “perineum healing well” on the same day the woman says she could barely sit. In my doctoral research on patterns of failure in medical negligence, this is a familiar shape. A warning is given by the person who knows her own body best, and the system isn’t set up to hear it.
If you are in this position now, the most useful thing you can do is be specific, and ask for it to be written down. “I had a 3b tear. My stitches smell and I think the wound has opened. I’d like to be examined today.” That is not making a fuss. It is giving the people caring for you the information they need.
Drawn from the experiences of many women I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What she noticed. A smell from about day eight, a hot, pulsing pain that got worse each day instead of better, and then, at the end of the second week, a gap she could see in the mirror.
What she was told. On the phone, that the smell was probably lochia and to keep the area clean. At a GP visit, that it “looked a bit inflamed” and to come back if it got worse. It wasn’t until she went to the emergency department that someone told her the wound had broken down, and that it would now have to heal open.
What the records showed. A 3b tear, repaired in the birth room late at night. No antibiotics charted after the repair. No rectal examination recorded at the end. No note of her phone call at all. Months later, an endoanal ultrasound showed that the sphincter repair had separated.
How she felt. “I kept thinking, I told them,” she said. “I told them the first time.” She felt foolish for being reassured, and angry that she had let herself be. Seeing the gaps in her records was painful, and it was also the moment she stopped blaming herself.
Both/and: complications happen, and they still have to be taken seriously
Both things are true. Wound infection and breakdown can happen after a careful repair and good care, and nobody is to blame. And a woman who reports a smell, heat or a gap deserves to be examined promptly, not reassured over the phone. The first doesn’t cancel out the second.
You don’t need to decide whether anyone was at fault to ask for what you need right now: an examination, treatment, a clear plan and follow-up. Those questions can be answered later, and the records will still be there.
The bigger picture
RANZCOG’s Birth Trauma Roundtable Final Report (July 2026) heard from women who described delayed diagnosis, inconsistent advice and no coordinated care after birth, and noted that Medicare funds a single postnatal attendance between four and eight weeks. Wound problems usually start before that appointment. That is why it matters so much that women know the warning signs, and that a phone call about a smelly or open wound is treated as the reason to be seen, not a reason to wait.
Practical things women say helped
General tips only. Please follow the advice of the clinician who is treating your wound.
- Look, or ask someone to look, with a hand mirror and good light, so you can describe what you see. A photo you can show a doctor can help too.
- Keep the area clean and dry: water only, pat dry, change pads often, and wash your hands before and after.
- Finish any antibiotics you are prescribed, and keep taking stool softeners so you don’t strain.
- Write down when symptoms started, who you spoke to and what they said. It makes the next conversation easier.
- If the wound is healing open, ask exactly who will check it and how often, and what would mean you need to come back sooner.
- Ask for a pelvic health physiotherapist once healing allows, especially if you have a tight, uneven or sensitive scar. You can search on Choose Physio.
Support
- National Continence Helpline: 1800 33 00 66, run by the Continence Foundation of Australia.
- PANDA: 1300 726 306, or panda.org.au.
- Birth Trauma Australia: birthtrauma.org.au.
- The Commission’s sheet, Recovering from a third or fourth degree perineal tear, which lists a smell, heat or increasing pain as signs to report.
If your wound has opened or become infected, you haven’t failed at healing. A deep wound in a difficult place has had a setback, and setbacks can be treated. Ask early, ask clearly, and ask again if you need to.
With care,
Rosemary
Frequently asked questions
Is it normal for perineal stitches to smell?
Normal postnatal bleeding has a mild, musty smell. A strong, bad or rotting smell, especially with pus, heat, swelling or pain that is getting worse, can be a sign of infection and should be examined the same day. A smell of faeces from the vagina should also be checked, as it can be a sign of a fistula.
What do I do if my stitches have come apart?
Contact your maternity unit, GP or midwife the same day and tell them you had a third or fourth degree tear. The wound needs to be examined to see how deep the breakdown is, whether it is infected, and whether the sphincter repair is intact. It may be re-stitched or left to heal on its own, and that choice should be discussed with you.
Will they re-stitch my tear if it opens?
Sometimes. Once any infection is treated, a broken-down wound can be repaired again, particularly if the sphincter repair has separated. Other times it is left to heal by secondary intention. The research comparing the two is limited, so the decision should depend on your wound and be talked through with you.
What is the raw red lump on my scar that bleeds?
It is often granulation tissue: healing tissue that has overgrown. It is common, not dangerous, and usually treated simply in a clinic, often with silver nitrate. If you have bleeding or stinging from the scar weeks after birth, ask whether it could be granulation tissue.
How long does a perineal wound take to heal if it is left open?
It varies with the size and depth of the wound, but healing by secondary intention usually takes several weeks, and sometimes longer. You should have regular checks during that time and know who to contact if it gets worse.
Can I feel a hole where my stitches were?
Some women feel a dip, hollow or gap after a wound has broken down and healed open, or where the original repair didn’t bring the tissues together well. It is worth having it assessed by a perineal clinic, urogynaecologist or colorectal surgeon, as it can often be improved.
Is it negligence if my stitches came apart?
Not necessarily. Wounds can break down even after good care. It may point to a problem if the tear was repaired in the wrong setting or by someone without enough experience, if antibiotics or stool softeners weren’t given, if warning signs you reported were dismissed, or if a separated sphincter or fistula was missed. Time limits apply, so it is worth getting advice early.
Questions about your care?
If your wound problems weren’t recognised or treated the way they should have been, we can talk it through with you. It’s confidential, and there’s no cost to find out where you stand.
- Is this normal? Recovery week by week
- My stitches smell, came apart or feel open (you are here)
- “Nobody told me how bad my tear was”
- “I can’t control wind after birth”
- I can’t hold it, or make it to the toilet in time
- Sex after a third or fourth degree tear
- Still can’t sit, months later
- Caesarean or vaginal birth next time?
- Could my tear have been prevented?
- “I feel broken, and no one understands”
- How much compensation for a third or fourth degree tear?
References
- Australian Commission on Safety and Quality in Health Care. Third and Fourth Degree Perineal Tears Clinical Care Standard. Sydney: ACSQHC, 2021. safetyandquality.gov.au
- Australian Commission on Safety and Quality in Health Care. Recovering from a third or fourth degree perineal tear (information for women). safetyandquality.gov.au
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Birth Trauma Roundtable Final Report. July 2026. ranzcog.edu.au
- Royal College of Obstetricians and Gynaecologists. The Management of Third- and Fourth-Degree Perineal Tears. Green-top Guideline No. 29, 2015 (published on the RANZCOG website). ranzcog.edu.au
- Queensland Clinical Guidelines. Perineal care. Guideline MN18.30. Queensland Health. health.qld.gov.au
- Royal Hospital for Women, South Eastern Sydney Local Health District. Third and fourth degree tears: repair and management. Clinical Business Rule, 2023. seslhd.health.nsw.gov.au
- Dudley LM, Kettle C, Ismail KMK. Secondary suturing compared to non-suturing for broken down perineal wounds following childbirth. Cochrane Database of Systematic Reviews, 2013. cochranelibrary.com
- Rogers v Whitaker (1992) 175 CLR 479; [1992] HCA 58.
- Civil Liability Act 2002 (NSW) s 5O.
- Limitation Act 1969 (NSW) s 50C.
Client stories in this article are composites drawn from many women’s experiences and have been changed so that no one can be identified. They do not describe any individual client.
Written by Dr Rosemary Listing, PhD (Law). Rosemary is a medical negligence lawyer and Of Counsel at Peter Evans & Associates. She has practised since 2013 and worked on many hundreds of claims, including for women injured during childbirth. Her doctoral research examined patterns of failure in medical negligence, and she is a Sessional Lecturer in Health Law at the University of Newcastle. She is responsible for all content published under her name.
Rosemary is not medically qualified. Clinical information in this article is drawn from, and checked against, the national Clinical Care Standard, RANZCOG publications and state clinical guidelines listed in the references. Legal information reflects the law as at the review date.
Last updated 27 October 2026. First published 27 October 2026. Next review April 2027.
Cite this article: Listing, R. (2026, October 27). “My Stitches Smell, Came Apart or Feel Open”: Wound Problems After a Third or Fourth Degree Tear. Reframe Legal. https://reframelegal.com/stitches-smell-came-apart-after-birth/
This article is general information only. It isn’t medical or legal advice about your situation, and reading it doesn’t create a lawyer and client relationship. If you are worried about your health, please see your doctor, midwife or hospital. If you are in crisis, call 000 or Lifeline on 13 11 14. Legal services are provided by Peter Evans & Associates.
