A perineal tear is a laceration in the skin, muscles, and other soft tissues between the vaginal opening and the anus, occurring during childbirth as the baby passes via the birth canal.
These tears vary in severity, from minor skin lacerations to deep muscle tears involving the anal sphincter or rectum lining.
Types and Treatment of Perineal Tears
Perineal tears are classified into four degrees:
- First-degree: Small, skin-deep tears that may heal with stitches.
- Second-degree: Deeper tears affecting the perineal muscles, often requiring stitches.
- Third-degree: Tears extending through the perineal muscles to the anal sphincter, necessitating surgical repair.
- Fourth-degree: Severe tears affecting the lining of the anus or rectum, requiring surgical intervention.
Risk Factors and Prevention
Factors increasing the likelihood of perineal tears include:
- First-time childbirth
- Southeast Asian descent
- Previous third or fourth-degree tear
- Baby weighing over 4kg or in a posterior position
- Shoulder dystocia during birth
- Use of forceps or other instruments
Pregnant women can practice pelvic floor exercises and perineal massage for 35 weeks to reduce the risk of perineal tears. Discussing risk factors and preventive strategies with your doctor is also beneficial.
Healing and Recovery
Post-repair care includes pain relief, applying ice packs, and taking precautions to support healing, such as resting, avoiding high-impact activities, and maintaining hygiene.
Sex can be resumed once healing is complete and the mother feels ready, typically between 1 to 3 months postpartum.
Future vaginal births may still be possible, but it is essential under doctor guidance.
Postnatal Care and When to Seek Help
Most women are advised to have a postnatal check six weeks after their baby's birth.
Seek medical attention earlier if there are concerns about the healing process, such as:
- Developing a temperature
- Unusual smell or discharge from the tear
- Inflammation, swelling, or redness
- Persistent pain beyond 2-3 weeks
- Incontinence or pain during sex
Talk to your doctor about strategies to minimize perineal tears during childbirth.
