What is a perineal tear?
The perineum is the area between the vagina and anus. It stretches and thins out as baby’s head descends through the birth canal towards birth. The pressure of the baby’s head as mom pushes can result in a tear to the skin or muscles around the vagina, known as a perineal tear. Perineal tears are common, and occur in up to 85% of women after a vaginal birth (1).
There are 4 different degrees of perineal tears.
1st degree tear:
A 1st degree perineal tear is the most common and least severe tear. It involves only the skin around the vaginal opening and no muscular layers (1). 1st degree tears usually heal quickly on their own and will likely not require stitches. You might experience some mild burning with urination.
2nd degree tear:
A 2nd degree perineal tear is deeper and involves the skin and the muscles of the perineum (2). 2nd degree tears usually require stitches, which will dissolve on their own and don’t need to be removed by a doctor. It is normal to feel pain and soreness around the tear, especially when walking or sitting. 2nd degree tears typically heal within 2-3 weeks.
3rd degree tear:
A 3rd degree perineal tear is more extensive. It includes the skin, muscles of the perineum, and the muscles that control the anus (2). Some women experience painful intercourse or temporary fecal incontinence. You may feel pain for a month or longer.
4th degree tear:
A 4th degree perineal tear is the most severe. It extends through the muscles of the perineum into the lining of the anus or rectum. These types of tears are much less common, occurring in about 3 in 100 vaginal births. A 3rd or 4th degree tear might be repaired in the operating room with an anesthetic. You may experience painful intercourse and temporary incontinence of gas or feces. Unfortunately, healing from a deep tear like this can take months.
Will I tear again in a future delivery?
Having an episiotomy or perineal tear with one delivery does not necessarily mean that you will experience it again in a future delivery. Only between 5 and 7 women in 100 who had a 3rd or 4th degree tear will have have a similar tear in a future delivery (2).
How do I provide perineal care after a tear?
Perineal care tip: Ice packs
In the hospital, the nurses may make an icepack out of a hospital glove or they may fill a baby diaper with ice.
Ice packs help to decrease swelling and numb the tissues. Be careful not to place the ice pack directly on your skin. Apply the ice for 20 minutes, remove for 10, and then reapply throughout the first 24 hours (3).
Perineal care tip: Sitz bath
A sitz bath is a bath that covers the perineum with either warm or cool water. You can purchase a sitz bath, or fill up a clean bathtub with a few inches of water. Stay in the bath for about 20 minutes at a time.
Perineal care tip: Peri bottles
A peri bottle is a plastic squirt bottle that you’ll be given in the hospital. It allows you to clean the perineum by squirting water onto yourself rather than wiping with toilet paper. Fill it with warm water and clean the perineum after using the bathroom.
Perineal care tip: Kegel exercises
It’s a good idea to do Kegel exercises as soon as you can after giving birth. This will help increase circulation to the tear and promote healing. It will also help you to re-strengthen the muscles of the perineum.
Perineal tears are common, but are typically mild and heal quickly. If you have a more severe perineal tear, stay in close contact with your healthcare provider to answer any questions or concern that you might have during the healing process. Learn more about what you can expect during childbirth in one of Kopa Birth’s local or online childbirth classes!
Kopa Birth’s online birthing classes allow you to prepare for a natural hospital birth from the comfort of your own home, 24/7. Enroll today in our free online childbirth class and start preparing for your natural birth!
References:
(1) Feigenberg, T., Maor-Sagie, E., & Zivi, E. (2014). Using Adhesive Glue to Repair First Degree Perineal Tears: A Prospective Randomized Controlled Trial. BioMed Research International, Article ID 526590, 5 pages, 2014. doi:10.1155/2014/526590
(2) Royal Collge of Obstetricians & Gynaecologists. (2015). Third and Forth-degree Perineal Tears, Management. Greentop Guideline No. 29.
(3) Simkin, P. Whalley, J., Keppler, A., Durham, J., & Bolding, A. (2010). Pregnancy, childbirth, and the newborn: The complete guide. Minnetonka, MN: Meadowbrook Press, pg 336.
