During birth, vaginal tears are very common. Most deliveries cause some degree of tearing, though severe tears are quite rare.

What is a perineal tear?

The perineum is between the vagina and anus. A tear can happen at a vaginal delivery, and will happen spontaneously as the vagina and perineum stretch. Sometimes tears can happen inside the vagina, along the vaginal walls, or at other parts of the vulva or labia.

What types of tear are there?

Tears can be of different severity and are graded accordingly. The types of perineal tear include:

First-degree tear: A tear to the skin only. Although they are small and not dangerous, they can be painful and sting a lot. They usually heal quickly and without treatment, often not requiring treatment and are unlikely to cause long-term problems.

Second-degree tear: It is the most common type of tear. A tear into the muscle of the perineum. They usually require stitches. They are unlikely to cause long-term problems, but can be painful and swollen initially.

Third-degree tear: A tear that extends into the muscle that controls the anus (the anal sphincter) and which is the pelvic floor muscle.

Fourth-degree tear: This is the least common type of tear. It extends further into the internal anal sphincter lining, the anus or rectum.

A rectal buttonhole: This is a rare injury that occurs when the anal sphincter does not tear, but there is a hole between the back passage and the vagina. Wind and faeces may pass through the vagina instead of through the anus.

What can cause a tear?

Tears are more common in women having vaginal delivery for the first time. If the delivery is very long or extremely quick. It can also happen if the baby is large or delivers in a difficult position such as if their shoulder gets stuck (shoulder dystocia), or if they are born with their hand up by their head. The risk is also increased in cases where ventouse or forceps are used to assist the delivery. It’s not always possible to predict or avoid and a tear is not necessarily anyone’s fault

Are perineal tears common?

Up to 9 in 10 first-time mums who have a vaginal birth will have some sort of tear, graze or episiotomy. The Royal College of Obstetricians & Gynaecologists says that, for most women, these tears are minor and heal quickly.

Third- or fourth-degree tears can occur in 6 out of 100 births (6%) for first-time mothers and less than 2 in 100 births (2%) of births for women who have had a vaginal birth before.

What is an episiotomy?

An episiotomy is a cut made by the doctor or midwife into the perineum to create more space for your baby to deliver and is often done to prevent a more serious tear. It is usually done at an angle and will need stitches to repair.

How long will it take to heal?

It is normal to feel pain or soreness for 2 to 3 weeks after having any tear. The stitches may also irritate and it may sting when you pass urine. They may also feel a little itchy.

The skin part of the wound usually heals within a few weeks of giving birth.  If you have a third or fourth degree tear, this may take longer to heal and you may be given antibiotics to prevent infection in the area of the stitches. Stitches will dissolve on their own within 6 weeks.

What can I do while the tear heals

• Keeping the tears as clean and dry as possible is important. You can use a peri-bottle to keep yourself clean when passing urine and even pour water over the area while you pee, this can stop it from stinging. Pat yourself dry with toilet paper instead of wiping. Try to avoid constipation and straining.
• Ice packs over your underwear can help reduce swelling.
• Gentle rhythmic pelvic floor exercises, within pain limitations, help increase the blood flow to the area and promote healing.

What are the complications of a tear?

Pain, bleeding and infection are the immediate complications of tears. Signs of an infection will be a fever, pain that does not ease with medication and stitches that smell. In such cases you should go to your GP or healthcare provider.

Third- or fourth-degree tears, although less frequent, are commonly associated with increased risk of faecal and urinary incontinence, pain, and sexual dysfunction associated with these symptoms that can persist long after giving birth. Severe tears that affect the anal sphincters may cause symptoms of poor bowel control include leaking stool or not being able to hold in wind.

What treatment is available for symptoms of tears?

Your GP or healthcare provider will be able to offer some help and support. Specialist women’s health physiotherapy can help with symptoms of pain and incontinence. Once the scars have healed, physiotherapy may include scar tissue massage or other treatments such as therapeutic ultrasound which can help break down the scar tissue and reduce pain.  A full assessment will enable a physiotherapist to tailor treatment specifically to you needs.

If you would like support or help please get in touch…