What Is a Perineal Tear?
A perineal tear is a wound in your perineum. The perineum is the space between your vaginal opening and anus. It contains muscle and tissue. Perineal tears commonly occur during vaginal ÈËÆÞÖгöÊÓƵbirth.
Understanding Perineal Laceration Degrees
Experts classify perineal tears (lacerations) by how severe they are and the tissues they involve:
- First-degree perineal tears involve the skin of the vagina and perineum. They may or may not require stitches. These tears usually heal within a few weeks.
- Second-degree perineal tears involve some of the deeper perineal muscles and tissues. They usually require stitches and heal in about a month.
- Third-degree perineal tears extend into the muscles around the anus. These muscles are called the external and internal anal sphincters. They hold in gas and stool. These tears may require repair in an operating room.
- Fourth-degree perineal tears involve the anal sphincters and anal tissue. These are the most advanced type of obstetrical tear and often require repair in the operating room.
You have a higher risk of complications with third- or fourth-degree perineal tears. You may get infections or have problems with bowel or bladder control (fecal incontinence or urinary incontinence).
Perineal vs. Vaginal Tears
Vaginal tears are wounds in your vaginal tissues. Perineal tears often involve your vaginal tissue. But perineal tears also occur in the tissue or muscles between your vagina and anus.
Perineal tears during ÈËÆÞÖгöÊÓƵbirth almost always involve your vaginal tissue. You may hear the terms perineal tear and vaginal tear used interchangeably.
Perineal Tear Symptoms
Most people have pelvic floor soreness after a vaginal delivery. You can’t always tell whether this soreness relates to a perineal tear or if it’s general pain from ÈËÆÞÖгöÊÓƵbirth.
More severe third- and fourth-degree tears may cause other symptoms:
- Bleeding with bowel movements
- Difficulty passing bowel movements
- Difficulty sitting
- Discomfort in your rectum
- Discomfort with walking
- Stool or gas leakage
Perineal Tear Causes & Risk Factors
A perineal tear often happens because your baby’s head stretches your vagina and perineum during birth. Some factors increase your risk of a third- or fourth-degree tear:
- Having a baby larger than 8 pounds
- History of perineal tears with prior deliveries
- Maternal age over 30
- Prolonged pushing during labor
- Use of a vacuum or forceps during vaginal delivery
Perineal Tear Treatment
Your obstetrics provider repairs a perineal tear shortly after delivery. They use stitches to bring the tissues and muscles back together. These stitches dissolve over time. The obstetrics provider who delivered your baby usually treats first- or second-degree tears in the delivery room. You'll see your obstetrics provider for follow-up care during healing.
You may go to the operating room for a third- or fourth-degree tear. You may also receive antibiotics to prevent infection. You'll get a referral to the Utah Peripartum Pelvic Floor Wellness and Recovery After Delivery (UPWARD) Program for follow-up evaluation and treatment if you have a third- or fourth-degree tear.
Comfort Tips During Perineal Tear Recovery
You may use sitz baths to stay more comfortable while you heal from a perineal tear. You can either purchase a device that you place on the toilet seat or you can fill your bathtub with a few inches of warm water. Soak in the water for about 10–15 minutes, 2–3 times per day. Avoid adding any soaps or salts in the bathtub. Try to avoid using any soap or cleaning products on the tear while it heals.
Your obstetrics provider will also recommend several other ways to stay comfortable while healing:
- Take a stool softener or laxative to avoid constipation, if needed.
- Use a squirt bottle (peri bottle) to clean yourself after using the restroom.
- Wear special-made cold sanitary pads or layer ice or cold packs in your underwear beneath a sanitary pad.
Treatment for Perineal Tear Complications
About 1 in 4 people with third- or fourth-degree tears experience pelvic floor complications. Our UPWARD Program is dedicated to helping prevent and treat these complications. Your care in the UPWARD Program may include the following services and treatments:
- Education on possible risks of perineal tears
- Pelvic floor physical therapy to treat pelvic floor organ prolapse, incontinence, or pelvic pain
- Surgery to repair a reopened tear, treat a fistula (irregular tunnel between your anus and skin), or repair your sphincter
- Treatments to improve wound healing
How to Prevent Perineal Tears
Some studies show that applying warm compresses to your perineum may help prevent tearing. Stretching or massaging your perineum in your third trimester may also reduce your risk.
Why Choose ÈËÆÞÖгöÊÓƵ of Utah ÈËÆÞÖгöÊÓƵ?
Our obstetrics providers are highly trained in repairing all first- and second-degree perineal tears. However, all patients with third- and fourth-degree perineal tears are referred to the UPWARD Program for specialized care. The (UPWARD) Program is the only one of its kind in the Mountain West. We exclusively care for people with pelvic floor problems related to pregnancy and recent vaginal ÈËÆÞÖгöÊÓƵbirth.
The UPWARD Program team includes fellowship-trained urogynecologists, obstetrician-gynecologists with urogynecology training, and pelvic floor physical therapists. We discuss your symptoms and health in depth. We help you understand what’s happening in your body and what you can do about it. We aim to improve your quality of life and well-being with every treatment.
Refer a Patient to the UPWARD Program
Patients with third- or fourth-degree perineal tears will need a provider referral to be seen by a urogynecologist in the UPWARD Program. Your provider may make an online referral or call 801-581-2897.
Hear From Our Specialists
How to Care for a Tear After Baby
While it may sound downright scary, perineal lacerations, also known as vaginal tearing, can be very common, affecting 53-79% of women. The majority of lacerations are minor overall.