Severe Tear Patient Handout

Recovering from
perineal tears
Information for women
Facilitator: Jo McMullan, CMM

Version: 1.1 Review Date: May 2020 Page 1 of 12
You have been given this anus has torn or, even less
pamphlet because you have commonly, a 4th degree tear
resulting in complete tearing
had a 3rd or 4th degree tear.
through the soft tissues between the
The information in this
vagina and the anus.
pamphlet is designed to help
you recover as quickly as Different types of tears
possible. Midwives and doctors describe the
tears according to the size of the
We encourage you to read tear and type of tissue involved.
this pamphlet as soon after These range from a 1st degree tear
the birth as possible. Please to a 4th degree tear.
ask your Lead Maternity
The following diagram may be
Carer (LMC) if you have any
helpful for you to understand some
further questions. of the terms used to describe the
different degrees of tears that occur
Why do women tear? during child birth.
At the very end of your labour the
skin and muscle layers in and The perineum is the area between
around your vagina thins and the vaginal opening and the anus.
stretches to allow your baby to be
born. It is quite common for women
to have some form of perineal or
vaginal tearing.
These injuries (skin only or muscles

of the perineum as well as skin) are First degree tear
mostly insignificant and heal without A thin tear or graze of the skin. No
complications or long-term muscles are involved. It is possible
problems. that a small number of stitches may
be required.
Only a small proportion of women
may sustain a 3rd degree tear Second degree tear
where the sphincter around the Includes skin and muscle tissue.
Stitches are usually needed and it
Document Name: Severe Tear Patient Handout (MATPI063) Facilitator: Facilitator: Jo McMullan, CMM
can take around two months to feel wind or faeces. This is called
completely comfortable again. incontinence and will require
ongoing clinical care.
An episiotomy is a cut made from
your vagina into the perineum. This Also, although more uncommon
is done to give the baby more room than a tear, a recto-vaginal fistula
to be born. An episiotomy involves may develop. This is when a small
the same muscle and tissue as a channel forms between the vagina
2nd degree tear. However some and rectum. Symptoms of this
episiotomies can extend further, and include the passing of wind and/or
when this happens they might be faeces through the vagina. It is very
described as a 3rd or a 4th degree important that you tell your LMC or
tear depending on their severity. doctor if you have either of these
symptoms as infection can result.
Third degree tear
A tear or laceration through the Third and fourth degree tears are an
perineal muscles and the muscle uncommon complication of child
layer that surrounds the anal canal. birth, which can affect a woman’s
This requires stitches and can take normal bowel, bladder and sexual
a similar time to a second degree functions short term, and in some
tear (around two months), if not cases, permanently.
longer, before the wound is healed
and the area comfortable. Following the recommendations in
this pamphlet is important to try and
Fourth degree tear prevent any long term problems.
This goes through the anal The time span for recovery varies in
sphincter all the way into the anal accordance with individual
canal or rectum. Most women with circumstances. Relax and give
this condition will have no ongoing yourself time to heal.
problems, with the appropriate
management (including good
personal hygiene, diet,
physiotherapy, pain medication and
laxatives). However a small group of
women may have ongoing problems
with controlling the passing of urine,
Can a third & fourth a catheter might be inserted into the
degree tear be prevented? bladder and additional pain relief
given.
It is not possible to predict, or even
prevent, these types of tears. Sometimes, tears of the anal
Episiotomy makes more space for sphincter may be impossible to
the baby to be born, but it may not recognise at the time of the birth. If
prevent serious perineal tears. you suspect that you have a tear
There are some factors that may that has not been identified please
make a 3rd or 4th degree tear more talk to your LMC.
likely.
• You have an assisted birth Taking care of your
(forceps or ventouse)
• One of your baby’s shoulders
perineum
becomes stuck behind your Keep it clean and free from
pubic bone infection
• Personal hygiene is very
important. We recommend
Third or fourth degree tears are a
that you have at least one full
known complication of vaginal
shower and wash your
delivery and are not considered
perineal area three to four
substandard care.
times each day, especially
after toileting until the tear
Identification and heals.
treatment
If a third or fourth degree tear is • Change sanitary pads at least
suspected, a detailed examination every four to six hours to keep
of a woman’s perineum and anus the wound as clean as
possible
will be conducted by an experienced
clinician. The woman may be • Always pat the perineal area
transferred to an operating room for dry from the front to the back
stitching if needed. However, often after washing to avoid
the repair is possible without moving introducing germs from the
rectum into the vaginal area.
from the birthing suite.
• Do not use a hair dryer to dry
Around the time of the treatment and your perineum. This may
immediate recovery period, a woman delay healing or cause
is given intravenous fluids via a drip, burning to the genital area.
• Intravenous antibiotics are perineum. When feeding your
used immediately post- baby, shift your sitting position
and lie down occasionally to
operation and then oral
reduce the pain. The hospital
antibiotics are used for 5-7 midwives can help you get
days to help prevent wound used to feeding your baby
infection and wound while lying down.
breakdown.
• Lie down to rest for between
20–40 minutes every hour for
Keep comfortable the first two to four days as
• Apply ice packs to the perineal this will help the stitches to
area every couple of hours for heal.
the first 12–24 hours after
• You may find it comfortable to
birth. Your midwife will advise lie, on a flat bed, on your
you on this while you are in stomach with a pillow under
the hospital. You may find the your hips or on your side with
ice packs helpful for pain relief a pillow between your legs.
for a longer period (i.e. 24–48
• Avoid double leg movements,
hours).
“sit up” actions and lifting
heavy weights (including
picking up other children) as
this places extra strain on your
perineum.
• Get in and out of bed over on

your side as this reduces the
strain on your perineum (as
shown in picture).
• For 5-7 days take regular pain
relieving medications and
laxatives (as prescribed by
your LMC) to reduce the risk
of the wound splitting during
emptying of the bowel.
• Try to only stand and sit for

short periods of time as this
places strain on your
Emptying your bowels your bowel to make passing of
the bowel motion easier
• Support the perineum with

your hand while emptying your
bowels, laughing, coughing,
sneezing, etc.
• To assist with emptying of the

bowel, bulking and softening
agents such as kiwicrush or
Metamucil or Lactulose are
• For the first few days after usually recommended for
repair, a low fibre diet is several days after repair.
recommended to prevent any Make sure you drink a lot of
further damage due to water because this will assist
straining to pass a stool e.g. to reduce the likelihood of
white bread, refined pasta, constipation occurring
rice and cornflakes, rice
bubbles, egg, fish, cheese, • If you are prone to
meat and chicken (no skin), constipation, use bulking or
small amounts of soft, ripe softening agents up to six
skinless fruits and weeks after repair. Again,
vegetables.. After the 3rd day, discuss this with your midwife
a high fibre diet is or doctor first.
commenced. This will produce
a stool which is easier to Exercises to help you
expel.
recover
• Keep the stools soft and ask • Try to perform gentle pelvic
for help if the bowels have not floor exercises from day 1.
opened within 48 hours Gently squeeze the muscles
around the vagina and anus to
• Try not to strain when using increase the blood supply to
your bowels and use the the area and to promote
recommended defecation healing. These exercises will
position that is taught to you also help your pelvic floor
by the physiotherapist (see muscles maintain muscle tone
diagram included). The and control.
passage of hard stools can
disrupt repair and delay • Your physiotherapist will teach
healing. It may also help to you how to activate your
empty your bladder before muscles prior to moving and
lifting. This will help protect Going home
your perineum as it heals.
It’s important to continue to look
after yourself when you go home.
• Your physiotherapist will also
We recommend that you don’t go
teach you how to do gentle
home until your bowels have
pelvic floor pulses, to improve
opened sufficiently and you are
circulation and decrease
feeling well again. Your LMC will be
swelling and pain.
able to advise you when you are
ready and will prescribe any
These are not strengthening
medication you will need upon
exercises, but are important for
discharge.
early recovery and functional
protection of sutures.
After three days, eat a high fibre diet
to assist passage of soft, easily
You will be given an out-patient
expelled stool. We recommend
physiotherapy appointment for 4-6
wholemeal breads and cereals,
weeks.
brown pasta and rice and at least
four serves of fruit and five serves of
vegetables daily. Drink at least eight
glasses or 2-3 litres of water daily,
to decrease the risk of constipation.
Even if you didn’t have a 3rd or 4th

degree tear, your perineum would
still be bruised and tender after the
birth of your baby. Because your
perineum is a very tender site for a
cut or stitches, recovery can take
longer than elsewhere in your body.
Exactly how much longer varies

from person to person and also
depends on how deep the tear is.
With a 3rd or 4th degree tear there
may be pain/discomfort for three
months or longer while your body
heals.
The importance of follow-up Frequently asked
appointments
You will need to see an obstetrician
questions
at 6-8 weeks after the birth of your When can I resume sexual
baby for a check-up. This may
relations?
include a vaginal examination. If you
have any concerns about your Comfortable sexual activity can
recovery please see your begin after your body has
obstetrician earlier. completely healed. This may
happen as early as six weeks after
• If you are uncomfortable take the birth of your baby, however it
regular pain relief medication may also take more than three
as prescribed. . Talk to your months. A small number of women
LMC if you are unsure may experience ongoing discomfort
during sexual intercourse. If this is
• If you notice signs of infection the case it is important that you
such as a fever, wound discuss this with your doctor, as
breakdown or discharge in the sexual intercourse should not cause
perineal region, it is important any discomfort in the perineal area
you contact your midwife or once it has completely healed.
doctor that day
When can I go walking,
• If you have difficulty swimming, do yoga and/or
controlling the passing of
urine, please discuss this with pilates?
your midwife or doctor. If Short (10-20min), slow walks along
necessary they will refer you the flat are encouraged after the two
to a gynaecologist and/or weeks, but walking on uneven
urologist, a continence advisor terrain, up hills and exercises such
and/or Women’s Health as yoga, pilates and weight lifting
Physiotherapist. that may place stress on the
stitches should be delayed until you
If you have any concerns about your have been cleared by the
perineal tear, or your condition obstetrician. When the bleeding has
including persistent pain, please stopped and your stitches have
bring them to the attention of your completely healed you can go
LMC straight away. swimming.
What to do if I continue to Is there any other planned
have bowel symptoms and/or follow-up I should know
urinary incontinence? about?
• Within 6 weeks postpartum Stitches are checked by your LMC
contact your LMC; after 6 every few days within the first two
weeks contact your GP. weeks. A specialist clinic
appointment for a thorough check
• Where needed, the up is usually booked at around 6-8
obstetrician will refer you to a weeks post birth, or earlier, if
gynaecologist and/or urologist indicated. On-going plans will be
and/or Women’s Health made if concerns persist.
Physiotherapist.
What about future
How do I know if the pain I pregnancies and births?
am experiencing is normal or • All women will have the
if something else is wrong? opportunity to talk to their
• This is very variable, generally LMC / Obstetrician about how
after about a few days to a they wish their baby to be
week, the pain should begin to born and receive information
decrease, and by two weeks about the possible benefits
the level of pain medication and risks associated with
may be reduced. vaginal and caesarean births.
• If pain persists or increases • Future births will depend on

beyond three weeks and/or is how well you recover after the
accompanied by an offensive birth of this baby. If you are
discharge may indicate fully recovered; vaginal birth
infection. for future deliveries is
acceptable.
• Medical attention should be
sought for increasing pain in • However if you have some
stitches, offensive discharge, ongoing incontinence
or loss of bladder or bowel problems, especially with
control. controlling your bowel
motions, vaginal birth may additional treatment and
make this problem worse. support to manage these.
• There is some evidence to If I have difficulties coping,

suggest that episiotomies who do I contact?
(deliberate cut) away from the • You can speak with your LMC
anus might prevent future third or family doctor about any
and fourth degree tear and concerns you may have.
this may be recommended for
future vaginal births • If your injury was caused by
an instrumental delivery, such
Long term effects and as forceps or ventouse,
prognosis following a severe ensure that the doctor lodges
perineal tear an injury claim with the
• Most women make a good Accident Compensation
recovery within 12 months of Corporation (ACC). This will
delivery, especially if the tear ensure any future
is recognised and repaired at consultations and treatment
the time. While recovering, related to your injury is
some women may experience covered. It may also make
pain in the perineum, you eligible for home and
apprehension about having travel assistance during the
sex, a feeling of urgency to first few weeks of your
open their bowels or fears recovery.
about future pregnancies.
• Healthline is a free 24 hour
• Tears involving the anal phone service staffed by
sphincter can cause long term experienced registered nurses
problems such as bladder or who can provide you with
bowel dysfunctions, recto- health information and advice.
vaginal fistula, perineal pains There number is: 0800 611
or sexual dysfunction. If any 116.
of these problems should
arise, you will be referred for • Trauma And Birth Stress
(TABS) is a Charitable Trust
that serves as a support group
of mothers that have
experienced stressful and
traumatic pregnancies or
births.
Final advice
• Avoid constipation
• Aim for soft easy-to-pass
stools
• Remember the
physiotherapist’s advice
regarding defecation
positioning
• Always ensure that you have
good pain relief
• Do not take any medications
or suppositories via your
bottom, as you can aggravate
the tear or cause an infection
• Start exercises as advised by
your physiotherapist
• Keep your wound clean and
dry
• If you think your wound is
becoming infected see your
doctor
• Remember your follow-up
appointments
Always remember:
Relax and give yourself time to
heal.
Notes:
Contact Us
Maternity Assessment Unit (MAU), Hutt Hospital Ground floor,
Heretaunga Block, Hutt Hospital04 570 9282
Acknowledgements
This pamphlet is based on a similar booklet produced by Mater
Misericordiae Health Services Brisbane Limited 2014.

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Recovering from

Facilitator: Jo McMullan, CMM

These injuries (skin only or muscles

• Get in and out of bed over on

• Try to only stand and sit for

• Support the perineum with

• To assist with emptying of the

Even if you didn’t have a 3rd or 4th

Exactly how much longer varies

• If pain persists or increases • Future births will depend on

• There is some evidence to If I have difficulties coping,

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