Perineal tear

Evidence  

https://www1.racgp.org.au/ajgp/2018/january-february/perineal-tears-a-review 

Ryan Goh   Daryl Goh   Hasthika Ellepola   

Fortunately, first-degree and second-degree perineal lacerations are minor and patients usually recover uneventfully. As third-degree and fourth-degree perineal tears are more extensive, there is an increased likelihood of residual defects resulting in ongoing symptoms that can have a significant impact on the woman’s quality of life. 

https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/labour-and-birth/perineal-status 

Perineal status refers to the state of the perineum after vaginal birth. Perineal status is categorised as intact, first-degree laceration, second degree laceration, third- or fourth-degree laceration, episiotomy or other type of perineal laceration, rupture or tear. An episiotomy is an incision of the perineum and vagina to enlarge the vulval orifice.  

Education 

What is a Perineal tear? 

A perineal tear is a deep cut of the skin, muscles and other soft tissues that separate the vaginal opening and the anus (back passage). Tears are usually graded by ‘degrees’; you may hear the terms first, second, third or fourth degree tear. Each tear is described below, including usual treatments. 

First and Second-degree tears 

First degree tears are small and skin deep and can heal without stitches.  

Second degree tears are deeper and may affect the muscles of the tiny patch of sensitive skin between your genitals (vaginal opening and anus) called the Perineum, which usually requires stitches.  

An episiotomy is a cut made by a doctor or midwife to make the vaginal opening larger to deliver the baby if needed. It is repaired with stitches after birth. 

Third or fourth degree perineal tears 

A third degree tear extends downwards from the vagina through the deeper muscles to the anal sphincter (the part that keeps the anal canal closed). If the tear extends further into the lining of the anus or rectum, it is known as a fourth degree tear.  

Injury to the anal sphincter during birth is thought to be the most important risk factor for faecal incontinence – the inability to control bowel movements, causing stools to leak unexpectedly. 

Your mental health 

Recovering from a perineal tear caused by birth or an episiotomy will mean different things for different people. If you are struggling with feelings after your birth, please know that help is available.  

A third and fourth degree tear has the potential for long-term or even lifelong impact on women’s wellbeing, including both physical and psychological challenges.  

It can impact the enjoyment of daily life and as well as mental wellbeing. It's important to seek medical support for the treatment of the condition and your mental health.  

If you are concerned about your symptoms or are finding it hard to manage, you should speak to your GP. In an emergency, you should call 000. 

You can also reach out to organisations such as PANDA. They have highly trained and caring counsellors and peer practitioners who can help you work through and support you in your birth trauma recovery journey. 

What is Birth Trauma?  

Birth Trauma Australia defines “birth-related trauma” as any injury or trauma, whether physical or psychological, sustained at any time in connection with all stages of the birth journey - from conception and pregnancy, through to labour and birth, and in postnatal care - and can affect the mother, birthing parents, partners and even health professionals. 

This can present as postnatal depression, postpartum post-traumatic stress disorder, or Obsessive-compulsive disorder. 

Birth Trauma Australia offer free resources to new parents, including evidence-based information on birth trauma recovery and healing. 

Empowerment  

It is normal to feel pain or soreness around the tear or cut for two to three weeks after giving birth, especially when walking or sitting. Passing urine may also cause stinging. You can continue to take pain relief when you go home, which will be prescribed by your care team. The skin stitches usually dissolve within three weeks, with the deeper stitches taking up to 3 months. Full healing can take up to 6-8 weeks.  

Many women go on to make a good recovery, particularly if the tear is recognised and repaired at the time of the birth. 

Useful Links 

Special thanks to Birth Trauma Australia (ABTA) for content sharing and providing support for families.  

https://birthtrauma.org.au/physical-birth-trauma/perineal-tear/ 

https://birthtrauma.org.au/physical-trauma/ 

 Australian Commission on Safety and Quality in Health Care  

https://www.safetyandquality.gov.au/standards/clinical-care-standards/third-and-fourth-degree-perineal-tears-clinical-care-standard 

Women’s Healthcare Australia (WHA) 

https://women.wcha.asn.au/collaborate/breakthrough-collaboratives/perineal-tears/ 

Pregnancy Birth and Baby 

https://www.pregnancybirthbaby.org.au/birth-trauma-emotional 

Centre of Perinatal Excellence (COPE) 

https://www.cope.org.au/ 

PANDA – Perinatal Anxiety & Depression Australia 

https://panda.org.au/ 

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