Perineal Tears

image001 The thought of tearing the vaginal walls at child birth is one that scares many expectant mothers. Many women experience second degree perineal tears and these occur between the anus and vaginal opening affecting the surrounding muscles and skin. While this sounds like a very painful experience, many women hardly recognize the stitching that goes on after the tear mostly because it is swallowed up by all the labor pains. However, the real pain occurs after the stitching has occurred as the torn area heals. We give you some effective tips that will help you recover quickly from this uncomfortable experience.

What Are Perineal Tears?

There are different types of perineal tears that occur at childbirth and these are:

  • 1st degree tear. This is normally a thin tear that occurs on the perineal skin. The muscles are unaffected and only a couple of stitches will be required.
  • 2nd degree tear. This tear affects the skin and muscle tissue. Stitches will be required and the healing process will take a much longer time. In most cases, it takes about two months before the mother can feel comfortable again.
  • 3rd degree tear. This is tear/laceration extends from the perineal muscles to the muscle layer surrounding the anal canal. The recovery time could be similar to the 2nd degree tear or even longer depending on the extent of the tear.
  • 4th degree tear. This type of perineal tear is deeper as it goes through the anal sphincter to the anal canal. Most women who undergo such tears will not experience further problems if proper management is conducted. Management would include proper personal hygiene, a nutritious diet, physiotherapy, pain relieving medication and some laxatives. However, some women will experience problems controlling their urine and bowel movements or develop what is referred to as incontinence. In such a case, the patient will need to undergo clinical reviews and medical consultations frequently.

An episiotomy is a tear which is made to broaden your vaginal opening. The cut affects the same muscles and tissue affected in the 2nd tear. In some cases, the tear may be deeper and can be described as a 3rd or 4th degree tear. Such tears can affect the normal function of the bladder, normal bowel movements as well as sexual functions. While these are short term complications, in some cases they may be permanent complications. Both 3rd and 4th degree tear are rare.

Though also uncommon, a recto-vaginal fistula could develop. This condition involves the formation of tube-like passage linking the rectum and the vagina. Some symptoms of a fistula include passing feces through the vagina and it is important to seek medical attention if you develop this condition.

Who Are Likely to Have a Third- or Fourth-Degree Tear?

Here are some conditions where a third- or fourth-degree tear is inevitable:

  • During the first vaginal birth
  • Women who have previously experienced third and fourth degree tears at child birth
  • Assisted delivery, particularly if aids such as forceps are used
  • Women who have had an episiotomy especially in a previous birth
  • Women giving birth to large children
  • If the child is born face-up
  • Pushing for a long time during labor
  • A smaller distance between the vaginal opening and the anus

How to Treat Perineal Tears

If you undergo stitches following perineal tears, your doctor will first use a local anesthetic to numb the area. If you undergo an extensive tear, you will have to be injected with a pudendal nerve block which is an injection on the vaginal walls using a local anesthetic. The block is injected on the vaginal walls numbing the genital area completely. This allows your doctor to stitch up the area layer by layer. After the procedure, you will be required to apply ice packs for about 12 hours. You will also be given some pain medication.

How to Speed Up Your Recovery from Perineal Tears



Use cold packs

There are cold packs made for the perineum and luckily they can be used as menstrual pads, too. They are quite soothing and you can ask your doctor to provide some for you to take home as well.

Stay clean

Hygiene is important and the first thing you need to do is ensure that you take a bath daily, especially after bowel movements. You can acquire a sitz bath which will help you clean your vagina after bowel movements or a perineal irrigation bottle. Water not only cleans but also soothes the area as well. Also change your menstrual pad often.

Avoid straining

You will not have much bowel movement for a few days after birth, so do not force it. Eat more fiber rich foods and you could also request for a stool softener if necessary.

Donut pillow

Sitting may hurt, but you can ease the pain with a soft pillow. Donut pillows are quite cheap and make it more comfortable for you to sit down.

Wait on sex

It’s always important to wait until you are fully recovered and most doctors recommend a six-week wait period after a normal vaginal delivery. In the case of a perineal tear, you will have to wait until you are completely healed and this duration may be much longer. Failing to wait could lead to an infection and prolong your healing process.

How to Prevent Perineal Tears




A perineal massage can help as it stretches your perineum skin reducing your chances of tearing.

Take it slow

Taking it slow during labor gives your perineum time to stretch out and accommodate your baby, thus reducing your likelihood of tearing. Resist the urge to push until your body and the baby are ready.

Warm compresses

One study found that warm compresses especially in the pushing stage of labor can reduce your risk of having serious tears.

Look for help

It helps to work with a doctor who is experienced in helping women deliver without having perineal tears.

Accept it if necessary

Sometimes, perineal tears are inevitable. There is no sure way of avoiding tears especially in cases where the baby is in a difficult position, large or when your tissue is fragile.

You may want to learn more about how to prevent perineal tears. You can watch the video below: