4 Different Types of Perineal Tears

Discover the healing process for the different types of perineal tears that women may experience during vaginal birth. Learn about the symptoms, treatments, and possible complications that come with each type of tear.

Given that a baby’s head at term is roughly the size of a melon, it is not surprising that many women experience vaginal tearing during vaginal deliveries. Perineal tears, also known as perineal lacerations, occur between the vaginal opening and the anus. In comprehensive research, 85 percent of first-time parents suffered perineal tearing.

Perineal tears can range from small lacerations in the vaginal lining to extensive incisions that impair the anal sphincter. Fortunately, the most frequent cuts are not the most serious. Perineal tears and treatment are covered here.

First-Degree Perineal Tears

First-degree lacerations, the least severe sort of perineal rupture, are superficial. A certified nurse-midwife in Forest, Virginia, Katie Page, states, “The tear extends slightly into the vaginal lining.” Even though this does not involve muscle, it sometimes requires suturing.

However, no stitches are required most of the time, and healing is typically straightforward. Anticipate minor discomfort while sitting up, having a bowel movement, coughing, and sneezing; however, these symptoms should subside within a week.

Second-Degree Perineal Tears

Perineal lacerations of the second degree are the most prevalent type of birth injury. They affect the vaginal lining and deeper (submucosal) vaginal tissues. Severe tears require additional sutures and a lengthier recovery time. As with first-degree rips, you should anticipate discomfort when engaging in activities that increase downward pelvic pressure, such as coughing, sneezing, or defecating.

Third-Degree Perineal Tears

A third-degree vaginal laceration, described by Santa Monica, California-based OB-GYN Sherry Ross, M.D., involves damage to the vagina’s deeper layers and the anal sphincter’s muscular tissue.

“Your doctor will need to suture each layer separately, paying particular attention to the muscular layer that supports the sphincter.” You may require an anesthetic, and recovery time will be extended. Anticipate two to three weeks of agony, followed by several months of discomfort with sexual activity and bowel movements.

Fourth-Degree Perineal Tears

Perineal tears of the fourth degree encompass the aforementioned conditions and extend to the rectal lining. Dr. Ross states, “This is an extremely delicate and comprehensive repair involving numerous closure layers.” “Fortunately, this is the least common type of rip. Third- and fourth-degree tears typically occur when the baby’s shoulder becomes caught or when a vacuum or forceps are employed.”

Remember that extensive tears can lead to pelvic floor dysfunction, prolapse, and issues with urine and bowel motions.

How to Deal with Perineal Tears

Your recovery from a perineal rip will mostly rely on the severity of the injury. Full recovery often takes between four and six weeks; however, if you sustain a first- or second-degree tear, you will likely begin to feel better within a week or two.

Here are some suggestions for dealing with postpartum bleeding:

  • At the beginning of your recovery, bowel movements may be painful, so staying hydrated and avoiding constipation is important.
  • Employ a peri-bottle (a squirt bottle with a curved tip to target the areas to be washed) filled with warm water and pat dry gently with toilet paper.
  • Replace your pad frequently if you are bleeding to reduce the risk of infection.
  • Apply an ice pack that is wrapped in a cloth to the perineum to minimize swelling and pain.
  • When your doctor clears you for bathing, consider a warm sitz bath to assist your perineum healing; avoid harsh chemicals such as bath bombs, bath bubbles, and soaps.

Indicators of Infection

As long as you follow your doctor’s instructions to keep your perineum clean and dry, it is unlikely that your tear will become infected. But infections can occur, and when they do, they must be treated. Contact your doctor if you suffer a foul-smelling discharge, fever, or discomfort that worsens after taking pain medication.

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