Perineal Tear During Childbirth: All You Need To Know

Childbirth requires immense body strength. One of the major issues faced by many women is a perineal tear. Let us find out what a perineal tear is, how you can prevent it, and take care of one.

What is a Perineal Tear During Childbirth?

The perineum is the region between your vagina and the anus. During vaginal deliveries, a perineal tear commonly happens. It is so common that almost 95% of mothers go through it.

This is because, during childbirth, the baby tries to push forward through the birth canal and towards the vaginal opening. The position of the baby is usually headfirst unless they are presenting as breech. Since the head of a baby is the size of a cantaloupe, this forward push results in a tear in the perineum.

Though you may not require a stitch always, most cases require dissolvable stitches to help the area heal faster. Women who are at an increased risk of a perineal tear are:

1. First-time mothers, as the perineum is rigid during the first delivery
2. Women pregnant with overweight babies
3. Women who have had prolonged labor
4. Assisted delivery with forceps or vacuum

How Long Do Perineal Tears Take To Heal?

This typically depends on how deep the tear is. Usually, if the perineal tear is a first-degree tear, then it will take 7-10 days, with minimal guidance. However, this increases with the severity of the tear.

If the tear is a third or fourth-degree tear, then it may take months before the mother can resume her normal activities.

It is advised to refrain from having sex if you have a perineal tear. If you have sex with a tear, then it can cause severe discomfort such as dryness, pain, and soreness in the pelvic floor.

Types of Perineal Tears

An important aspect to remember is that a perineal tear is not permanent damage to your body. However, in extremely rare cases will it lead to a prolonged issue. Consult your doctor once to understand this thoroughly.

First-Degree Tear

The least severe perineal tear that doesn’t require a stitch. This is a superficial tear as it is on the perineal skin, which is right at the vaginal opening and on the tissue right below the skin.

A first-degree tear heals within a week or 10 days. This can cause a burning sensation while you pee. You may experience pain while doing regular activities like having sex, bowel movements, walking, and coughing or sneezing.

Second-Degree Tear

A second-degree tear is the most common one. This perineal tear involves the skin and the muscle in the area between the vagina and the anus. It can sometimes go deep in the vagina as well. This tear will cause similar discomfort as a first-degree perineal tear. Activities that involve downward pressure can restrict your movement when you have this kind of tear. This will require stitches, and healing can extend up to a few weeks.

Third-Degree Tear

This degree of perineal tear goes deeper into the vagina and extends to the muscle around the anal sphincter. Because of its severity, anesthesia is required to stitch and repair it. The surgeon will have to stitch every affected tissue layer, one at a time.

The healing time of a third-degree perineal tear is longer than first and second-degree vaginal tears. It can delay up to a few months.

Extra care is required if you have a tear of this degree because your perineum is at its most vulnerable phase. There will be extreme discomfort when performing daily activities. A common complication of a third-degree perineal tear is fecal incontinence, where the stool can leak involuntarily as perineal muscles to include the anal sphincter is affected.

Fourth-Degree Tear

Third and fourth-degree perineal tears happen when the baby is either breeching or when an assisted delivery is required. A fourth-degree vaginal tear extends from the anal sphincter into the rectal mucosa or the rectal lining. As the cut is severely deep, it requires more specialized repair. The doctor has to repair several layers. Due to this, healing time will take a few months, with a probable disadvantage of pelvic floor dysfunction.

What Should You Do After Having a Perineal Tear?

There are a few home remedies that can speed up your recovery. However,  consult your doctor before opting for any of the following:

Ice Packs

Using ice packs on the perineal tear will help decrease the swelling and offer some relief to the affected area. Do not apply ice straight on the skin, cover the cubes with a cloth. Also, there are ready-made ice packs that can be kept in your pants. Do not ice your tear for more than 20 minutes as it can lead to nerve damage.

Maintaining Cleanliness

You need to remain clean and dry at all times. This will help prevent infection and promote recovery. Do not rub your perineal tear, and instead damp a clean dry cloth while drying the area. You can also use gauzes to do the same.

Stool Softeners

It is necessary to remain regular with your bowel movements or it can lead to constipation. While it may seem like you will break off your stitches while pooping, it won’t happen. Doctors usually prescribe stool softeners to make the process easy. You can also include enough fiber in your diet.

Sitz Bath

A sitz bath can include a tub with warm water in it. This will help soothe the pelvic floor. You can also use a hot water bag. Sitting in a sitz bath thrice a day for 20 minutes can aid in getting some relief.

Cushioning

There are doughnut-shaped cushions that can assist in sitting comfortably. This will also ensure that the tear is not rubbed against hard or rough surfaces.

Numbing

If you’re extremely uncomfortable, then your doctor can prescribe medicines that will help numb the perineal region altogether. These can come in the form of sprays and pads that do the job.

Changing Your Pad

You will be required to wear maxi pads post-delivery. It is important that you change them every four to six hours to avoid infection.

Rest

The most important part to remember is to rest. It may seem difficult with a new baby. But, resting time is your repairing time.

How Can You Prevent a Perineal Tear?

In the Philippines, it is a very common practice that your attending physician will do an episiotomy during vaginal deliver. It is a cut made in the perineum to assist the delivery of the baby. It is also done as it helps prevent third and fourth degree perineal tears.

While there are situations where you won’t have an option, here are a few tips that can possibly prevent a perineal tear in the first place:

1. Kegel exercises: These can strengthen your pelvic floor for childbirth, especially if it is your first baby.
2. Perineal massage: Starting at 34 weeks, perineal massage can help widen the birth canal by softening and stretching the perineum.
3. Regular checkups: Visiting your doctor during your pregnancy can help detect any underlying issue.
4. Warm perineal compresses: You can do this with a warm water bag or a warm cloth during the second stage of labor. This will increase the blood flow to your pelvic floor and consequently soften the rigid muscles.
5. Lubricating your perineum: During childbirth, if your perineum is smoothed out with oil, then it can help push the baby with a little more ease.

When Should You Consult Your doctor?

If you experience any of the following post-delivery, then talk to your doctor right away:

1. Foul smell from your vagina
2. Excruciating pain while urinating
3. Bowel leakage
4. Large blood clots
5. Intense pain in your pelvic floor

A mother’s body goes through many changes during pregnancy, and so it needs the proper care to get it back to normal after childbirth. A perineal tear is one of the many problems a mother faces during childbirth, and therefore we should know about it.

Learn more about Labor and Delivery here.