How to Cope with Perineal Tears during Delivery

Women go through a lot of pain during vaginal childbirth, especially if they haven’t taken pain relief measures. The fact that you are pushing a baby out of your vagina warrants the pain but also makes it worth it. Sometimes, however, other complications may arise for a woman that can leave her in pain for a few weeks after delivery as well. One of these is the perineal tear which happens when the baby’s head slides out of the vagina.

Vaginal tears are common, and most of the periurethral lacerations are minor tears and heal very fast. But, severe perineal tears may take much longer to heal.

What is a Perineal Laceration?

A perineal laceration is a tear in the perineal skin that is between the vagina and the anus. During delivery, as the baby’s head moves down to the vagina and the perineum, the thin skin usually stretches over the baby’s head, allowing it to pass. In case, the skin doesn’t stretch enough; a tear may occur in the perineum.

How common is tearing during Vaginal Birth?

Tearing during vaginal birth happens in as many as 90% of the cases. First-time mothers have a higher chance of experiencing a perineal tear, due to the lack of flexibility of the vaginal tissue. However, about 99% of these are minor tears and heal within a couple of days. More severe tears may take a few weeks to heal.

Who are Prone to Third or Fourth Degree Tear?

The risks of third or fourth-degree tear are high in women under the following conditions

• First vaginal delivery
• Baby is big
• Baby is in the posterior position during birth
• Long hours of pushing the baby
• Episiotomy (surgical cut at the opening of the vagina to aid childbirth during difficult labour) in the current or previous delivery
• Assisted delivery with the help of forceps

Causes of Vaginal Tearing

Some of the reasons or factors that may lead to vaginal tearing or increase the risk include:

• Your baby is big in size
• It is your first vaginal delivery
• You’re overweight
• You’re of Asian ethnicity
• Your baby is in a posterior position during delivery

Types of Tears during Childbirth

Based on the severity of the tear, there are four types of perineal tears.

• First-Degree Vaginal Tear

These are minor tears in the vaginal or the perineal skin and will heal within a week. They do not require stitches and will only cause some irritation or burning sensation while you urinate. You may be able to reduce this discomfort by gently pouring some warm water on your vulva during urination.

• Second-Degree Vaginal Tear

When the perineal muscles between the vagina and the anus tear, it is called a second-degree tear. The perineal muscles support the uterus, and the rectum and a tear in this region will require perineal tear stitches. It will take around two to three weeks after childbirth for the tear to heal. Spraying some warm water on the vulva during urination and using a pillow to support the vagina while sitting can give you some relief.

If you have second-degree tears, care should be taken to clean yourself softly after passing stool, so that the wound isn’t rubbed. Doctors may even prescribe stool softeners or pain relievers to reduce discomfort. You can also apply an ice pack to the region or wear a chilled witch hazel pad on your sanitary napkin to ease the pain.

• Third-Degree Vaginal Tear

A tear in the anal sphincter, a delicate muscle near the anus, constitutes a third-degree tear and may sometimes require being treated in the operating room. Recovery time for a third-degree tear may be a few months. You can try to relieve some of the pain by sitting on a padded ring or a pillow after delivery. Ice pack on the vagina or warm water on the vulva during urination can also help.

• Fourth-Degree Vaginal Tear

The fourth-degree vaginal tear is the most severe kind of tear and involves a tear in the muscles of the perineum, anal sphincter and the tissue that lines the rectum. This is treated in the operating room and usually takes several months for the wound to heal. Women with fourth-degree vaginal tears may experience pain while defecating and during sexual intercourse. Based on your condition and the wounds, your gynaecologist may refer you to a colorectal surgeon or an urogynecologist for further treatments.

Treatment

A perineal tear is often treated with surgical stitches. You will need stitches only if the tear is longer than an inch or 2 cm. Stitches may cause your perineal and vaginal region to feel tender and you may experience some burning sensation during urination.

How long do Perineal Tears take to heal?

A treated wound, in the case of first and second-degree tears, can heal within a week to 10 days, while the pain and discomfort may continue for a few more days after that. If you have suffered a more serious, third or fourth-degree tear, the healing process will take a few months to heal.

Tips for Recovering from a Third and Fourth-Degree Tear

Recovery from a third and fourth-degree tear can take a long time. To enable the process of recovery and avoid any infections, you will need to practice the following hygiene measures.

• Use lukewarm water to clean the vagina after urination. Use a squeeze bottle to gently spray the area with some water.
• Do not rub your anal area harshly while cleaning it after passing stool. Use soft paper wipes to clean the area.
• Replace your sanitary pads every four to six hours to prevent bacteria build-up and infections.
• Refrain from touching the wounded region as it may lead to infections.
• Don’t exert too much pressure during bowel movements to avoiding rupturing the wounds. Try consuming a lot of fluids and food rich in fibre for smooth passage of stool. You can also ask your doctor to prescribe some mild laxatives.

Suggestions to Help Ease the Pain

You can try a few simple steps to reduce the discomfort in the vaginal region:

• Apply ice packs on the area. You can use chilled witch hazel pads on your maternity napkins as well.
• You can use warm compressions or sit in a warm bath a few times a day to relieve the pain. You can also check with your doctor about the feasibility of using heat exposure lamps.
• In case of severe pain, numb the region with an anaesthetic prescribed by your doctor. Numbing ointments and pads are available for this purpose.
• Don’t strain the region by standing, sitting or walking for too long. Don’t engage in any activities that put extra stress on your body.
• Use ring pillows while you sit to avoid straining the region.

Prevention

Here are a few things that can be considered to reduce the risk of perineal tears during childbirth.

• Regular Exercise

A sedentary lifestyle can pose a risk of tears. It is advised that you incorporate a regular exercise regime.

It can help improve blood circulation to the vaginal tissues, and make them more flexible and increase elasticity. Pelvic floor exercises, also known as Kegel exercises, can also strengthen the pelvic muscles and help achieve a smoother delivery.

• Water Labour

Delivering as you sit in a warm bathtub can relax your muscles and lower the chances of tears.

• The Position Of Birth

When you give birth lying down or lying on your back with the legs up, it increases the pressure on the perineum. The positions that are least stressful for the perineum include lying on the side, standing on your hands and knees and leaning forward with support during sitting, kneeling or standing.

• Warm Compress

Applying a warm compress on the perineum when the baby starts crowning can increase blood flow to the region and reduce severe tearing.

• Avoid an Episiotomy

Episiotomies or the practice of surgically cutting the opening of the vagina can increase your risk of severe tears. This is because as the baby is pushed out, the cut can stretch out into a much larger tear.

When to consult a Doctor?

If you notice that your perineum appears red and swollen and is giving out an unpleasant odour, then you may have developed an infection. It is recommended that you consult a doctor immediately in such cases.

When can you resume having Sexual Intercourse?

You can resume intercourse once your wounds have healed completely. This can take six weeks to several months based on the severity of the wound. If you experience discomfort even after the wound is healed, don’t hesitate to contact your doctor.

When can you Resume Swimming?

You can begin swimming once your bleeding has stopped, and your stitches have healed completely.

What about Future Births?

If you have healed fully from the tear, your future vaginal birth shouldn’t pose the complication of a tear. However, there isn’t any evidence to suggest the ideal birthing method. In case you experience discomfort and bowel movement issues, a vaginal birth may complicate the process. You can raise this issue with your gynaecologist.

With proper care and rest, you will be able to recover from perineal tears within the given time. However, if you face any constant discomfort, ensure that you reach out to your doctor immediately.