Congratulations on having welcomed your baby to world!
Childbirth is a beautiful thing, although sometimes it can result in a few ongoing issues, especially for the mum and one of those can be perineal tearing.
At the very end of your labour the skin and muscle layers in and around your vagina thin and stretch to allow your baby to be born and it is quite common for women to have some form of perineal or vaginal tearing at this time.
Midwives and doctors have developed a system of describing the types of tears according to the size of the tear and type of tissue involved; from a 1st degree tear to a 4th degree tear.
A 1st degree tear is a thin tear or graze of the perineal skin. No muscles are involved. It is possible that a small number of stitches may be required.
A 2nd degree tear includes skin and muscle tissue. Stitches are usually needed and it can take around two months or so to feel completely comfortable again.
An episiotomy is a cut made into your perineum to enlarge your vaginal opening. This is done to help your baby be born. An episiotomy involves the same muscle and tissue as a 2nd degree tear. However some episiotomies can extend further, and when this happens they might be described as a 3rd or even a 4th degree tear depending on their severity.
A 3rd degree tear is a tear or laceration through the perineal muscles and the muscle layer that surrounds the anal canal. This requires stitches and can take a similar time to a 2nd degree tear (two months or so), if not longer, before the wound is healed and the area comfortable.
A 4th degree tear goes through the anal sphincter all the way into the anal canal or rectum. Most women with this condition will have no ongoing problems, with the appropriate management (including good personal hygiene by you, diet, physiotherapy, pain medication and laxatives). However a small group of women may have ongoing problems with controlling the passing of urine, wind or faeces. This is called incontinence and will require ongoing clinical review or medical consultation.
Also, although more uncommon than a tear, a recto-vaginal fistula may develop. This is when a tubelike passage links the vagina and rectum. Symptoms of this include the passing of flatus and/or faeces through the vagina. It is very important that you tell your doctor if you have either of these symptoms as infection can result.
Third and fourth degree tears are an uncommon complication of child birth, which can affect a woman’s normal bowel, bladder and sexual functions short term and in some cases, permanently. Following the recommendations below is important to try and prevent any long term problems. The time span for recovery varies in accordance with individual circumstances.
Remember to relax and give yourself time to heal.
Can a third or fourth degree tear be prevented?
It is not possible to predict, or even prevent, these types of tears. There are some factors that may make a third or fourth degree tear more likely.
This is when:
Keep it clean and free from infection
Emptying your bowels
Exercises to help you recover
These are not strengthening exercises, but are important for early recovery and functional protection of sutures.
One to two weeks after you go home the Mater physiotherapist will contact you to see how you are recovering. They will also usually talk to you about coming to see a physiotherapist specialising in pelvic floor function, to check your progress and review your longer term strengthening program.
If you require further physiotherapy you will be referred to the Mater Health and Wellness Clinic which is located on level 2 of the Mater Private Clinic, 550 Stanley Street, South Brisbane. Further information can be obtained from wellness.mater.org.au or you can telephone directly on 07 3163 6000 (option 1, 2).
It is important to continue to look after yourself when you go home. We recommend that you don’t go home until your bowels have opened sufficiently and you are feeling well again. Your midwife/doctor will be able to advise you when you are ready and your doctor will prescribe any medication you will need upon discharge.
The importance of follow-up appointments
You will need to see your obstetrician six weeks after the birth of your baby for a check-up. This may include a vaginal examination. If you have any concerns about your recovery please see your obstetrician earlier.
If you have any concerns about your perineal tear, or your condition including persistent pain, please bring them to the attention of your midwife/doctor straight away.
Why is my perineum sore?
Exactly how much longer varies from person to person and also depends on how deep the tear is. With a 3rd or 4th degree tear there may be pain/discomfort for three months or longer while your body heals.
What can I do to relieve the pain?
What about my diet?
For the first few days, usually a low fibre diet and plenty of fluids is recommended to prevent any further damage caused from straining to pass a stool. Foods include white bread, refined pasta, rice and cornflakes, rice bubbles, egg, fish, cheese, meat and chicken (no skin), small amounts of soft, ripe skinless fruits and vegetables. After three days, eat a high fibre diet to assist passage of soft, easily expelled stool. We recommend wholemeal breads and cereals, brown pasta and rice and at least four serves of fruit and five serves of vegetables daily. Drink at least eight glasses of water daily, to decrease the risk of constipation.
When can I resume sexual relations?
Comfortable sexual activity can begin after your body has completely healed. This may happen as early as six weeks after the birth of your baby, however it may also take more than three months. A small number of women may experience ongoing discomfort during sexual intercourse. If this is the case it is important that you discuss this with your doctor, as sexual intercourse should not cause any discomfort in the perineal area once it has completely healed.
When can I go swimming?
When the bleeding has stopped and your stitches have completely healed.
What to do if I continue to have bowel symptoms and/or urinary incontinence?
Is there any other planned follow-up I should know about?
Yes. All women should be offered a planned follow-up at three months with their obstetrician. You will be offered further assessment and referred to a colorectal surgeon if needed.
What about future pregnancies and births?
If I have difficulties coping, who do I contact?
Always remember: relax and give yourself time to heal