As your baby’s head is born, the skin between the vagina and the anus (called the perineum) is stretched. For many women it will stretch and remain intact. For others it may stretch and tear.
Perineal tears are described in degrees, which tell us their size and effect:
- First-degree tears are small, skin-deep tears. These usually heal naturally.
- Second-degree tears are deeper and affect the muscle of the perineum. These usually require stitches.
- Third-degree tears involve the muscle that controls the anus (the anal sphincter). Stiches will be needed.
- Fourth-degree tears are the same as third-degree but extend into the lining of the anus. Stiches will be required.
Third- and fourth-degree tears happen for about 6 out of 100 (6%) of women giving birth for the first time and about 2 out of 100 (2%) of women who have given birth vaginally before.
These deeper tears will need repair in an operating theatre. You will be supported by healthcare professionals including physiotherapists after your recovery from a third- or fourth-degree tear.
Repair of Third- and Fourth-Degree Tears
If you have sustained a third- or fourth-degree tear you will be transferred to an operating theatre to repair it as soon as possible after your baby is born.
This procedure to repair your muscles will be pain free as you will be given a spinal or epidural anaesthetic. You will have stitches between your vagina and anus and also underneath your skin. The stitches will eventually soften and fall out by themselves.
You may need a drip in your arm to give you fluids until you feel ready to eat and drink. You are likely to need a catheter (tube) in your bladder to drain your wee. This is usually kept in until you are able to walk to the toilet, which should be a few hours later.
After the repair, you will be given antibiotics and pain relief, which you can still take if you are breastfeeding.
Aftercare
Once you are home it is important to take care of your stitches, which will reduce the risk of infection.
Top tips
- Keep the area clean – it is best to use only water at first and no harsh soaps.
- Wash or shower at least once a day and change your sanitary pads regularly.
- Wash your hands both before and after you go to the toilet or change your sanitary pads.
I Think my Stitches Are Infected, How Do I Know?
Signs of infection include:
- Red, swollen skin around the stitches
- Discharge, or pus from the wound
- Increase in pain, or tenderness at the wound
- A smell that isn’t normal for you
- A raised temperature
If you have any of these signs or symptoms, you should see your healthcare professional. You may require antibiotics to help it heal or, if you have been given antibiotics already, you may need your medicine changed.
Should I Feel Pain After The Wound Has Healed?
After having any tear, it is normal to feel pain or soreness for 2-3 weeks, particularly when walking or sitting.
The stitches can irritate as healing takes place, but this is normal. The skin part of the wound usually heals within a few weeks of birth, and after that you should feel much less raw and tender.
Weeing and Pooing
Having a wee can cause stinging. Pouring body-temperature water over the area when weeing can help. You can use a jug.
Having a poo should not affect your stitches. After your third- or fourth-degree tear is repaired, you will be given some laxatives for the first few days, so that you don’t get constipated and don’t need to strain to open your bowels.
Sometimes, the laxatives work so well that you may struggle to get to the toilet in time. This should improve and settle over the first few days.
It is important to eat well and drink plenty of water to help avoid constipation.
Try to drink at least 2 litres of water every day and eat a healthy balanced diet (for instance: fruit, vegetables, cereals, wholemeal bread and pasta).
Having An Easy Poo
It can be helpful to put your feet on a footstool to raise your knees above your hips while sitting on the toilet. This helps straighten out the bowels and makes pooing easier.
Try to relax and rest your elbows on your knees. Do not strain, as this weakens the pelvic floor.
Bulge out your tummy by taking big breathes into your belly. This will help you poo without straining. Straining weakens your pelvic floor and anal sphincter muscles, and you want to avoid this.
Gently push down from your back passage rather than holding your breath.
Most importantly, take your time and do not rush.
Your Pelvic Floor After Birth
It is important to do pelvic floor exercises as soon as you can after birth. Gentle pelvic floor exercises strengthen the muscles around the vagina and the anus, which should help improve bowel control.
You may feel that at first your pelvic floor muscles are not very strong. Sometimes after birth it can feel that you have very little sensation there. This usually improves with time and the more you are able to work your pelvic floor muscles, the quicker the recovery will be.
You can find out more about your pelvic floor after pregnancy here
Your Recovery – Getting Back to ‘Normal’
Everyone is different, and healing will be different for everyone. Your normal may look very different from someone else’s. Looking after a newborn baby and recovering from a third- or fourth-degree tear can be hard. You will need support from family and friends whilst your body gradually adjusts and gets better.
What to Expect
- 2-4 weeks after birth – it would be usual for the scar tissue where the tear is to feel uncomfortable.
- 4-6 weeks after birth – you should avoid strain or pressure on the anus and avoid high impact exercise or heavy lifting. After this, you can gradually increase your general activity.
Will I Have any Follow-On Appointments?
You will usually be offered an appointment with a healthcare professional approximately 6 weeks after you had your baby to make sure that you are recovering well.
At that appointment, you will be able to discuss any concerns and ask any questions you may have about the birth of your baby, any of your symptoms or any future pregnancies.
You may be given an appointment with a physiotherapist to help you strengthen your pelvic floor muscles. If you have not been given an appointment, you can book one by clicking on the button below or by calling this number: 03330 433966
When Can I Have Sex Again?
It’s common to be worried by the thought of having sex after birth, particularly if you have experienced a third- or fourth-degree tear. It will be when it feels right for you – usually once your stitches have healed and bleeding has stopped.
Remember to use a suitable method of contraception. It is possible to get pregnant very soon after giving birth, even if you are still bleeding, and even if you are breastfeeding.
Perineal massage – massaging the skin between the vagina and the anus – either on your own or with your partner, may help you feel more comfortable before you begin having sex again.
Sometimes, women who have recently had a baby may notice the vagina is drier than usual, this can be the case particularly if you are breastfeeding. You may wish to use an appropriate lubricant the first few times you have sex. If you are using condoms, you should use a water-soluble gel.
Sex may be a little uncomfortable and feel different at first, but the discomfort should not persist. If you can chat with your partner about sex and any anxieties either of you may have, it can help.
What Will happen If I Have Another Baby?
Many women go on to have a straightforward vaginal birth after a third- or fourth-degree tear, and do not experience a tear again.
If you do experience problems from the third- or fourth-degree tear, you may wish to consider a planned caesarean section. You will be able to discuss your options for future births at your follow-up appointment or early in your next pregnancy.
Your individual circumstances and preferences will always be taken into account so that you can make a decision that is right for you.
How to reduce your risk of perineal tearing
Your midwife can help you avoid a tear during labour when the baby’s head becomes visible. Your midwife may ask you to stop pushing and to pant or puff a couple of quick short breaths, blowing out through your mouth. This is so your baby’s head can emerge slowly and gently, giving the skin and muscles of the perineum (the space between the vagina and the anus) time to stretch without tearing.
The skin of the perineum usually stretches well, but it may tear, especially in women who are giving birth for the first time. The video below explains how to reduce the risk of perineal tearing during birth.
Support
MASIC exists to support women, challenge stigma and drive change.
The MASIC Foundation is the only multi-disciplinary UK charity to support women who have suffered severe injuries during childbirth known as OASI (Obstetric Anal Sphincter Injuries).
The charity is run by injured women and healthcare professionals who are committed to better detection and prevention of injury during childbirth.
More Information
Read Helen’s experience of a third-degree tear here:
Perineal tears during childbirth information poster