Third and Fourth Degree Tears
What we know:
Unfortunately 6 in 100 (6%) women will experience a third or fourth degree tear during their first vaginal labour and less than 2 in 100 for a second vaginal birth. This kind of tear is also known as an obstetric anal sphincter injury (OASI). A third degree tear will extend down from the vagina to the perineum and anal sphincter and a fourth degree tear will extend into the back passage.
Both of these injuries will require surgery in an operating theatre as soon as possible after the birth of your baby. You will be given an anaesthetic in the form of a spinal or epidural but very occasionally the surgery may need to be carried out under general anaesthetic.
What happens after surgery?
You will be offered some of the following treatments as you start to recover:
• Antibiotics to prevent the risk of infection
• Painkillers such a paracetamol or ibruprofen
• Laxatives to help you open your bowels without risking damage to your stitches
• A drip to give you fluids until you feel ready to eat and drink
• A catheter for 12-24 hours to help you pass urine if you are unable to walk to the toilet
You will still be able to breastfeed your baby while receiving these treatments. You may also be offered a follow-up appointment with a physiotherapist.
How do I care for my wound?
• Avoid sitting or standing for long periods of time
• Keep the area clean at all times
• Change your sanitary pad regularly, at least every four hours
• Wear breathable materials and avoid tight clothing
• Drink plenty of water and eat a balanced diet to keep your bowels loose so you don’t have to strain when you go to the toilet
• Start doing pelvic floor exercises to start to strengthen the area again
• You could apply cold/ice packs wrapped in a cloth to the area for half an hour
• Take regular pain relief
• Your stitches will gradually dissolve but you may still be able to feel them up to 3 months after the birth.
Contact your midwife or GP if:
• You have a temperature or start to feel ill
• Your wound is throbbing or starts to swell
• Your stitches become more painful, or the wound starts to smell as this could be a sign of an infection
• Your stitches are coming apart
• You have problems controlling your urine or bowel movements
• You pass faeces through your urine
What are the long-term effects?
You will be given a checkup at 6-12 weeks and you must always tell your doctor if you have any concerns about the healing of your wound or any issues with your bladder or bowels. You may be offered an endoanal scan (anal muscle scan) and perineal nerve function test to check that the nerves damaged during birth are recovering. Avoid any strenuous activity or heavy lifting for 4-6 weeks.
A small number of women will experience difficulty in controlling their bowels or holding in wind. This is called anal incontinence. In very rare cases a fistula (hole) or rectal buttonhole may be left between your anus and vagina after the tear has healed. This will need to be repaired by further surgery as soon as possible.
There is no reason to suggest a straightforward vaginal birth will not be possible after a tear but speak to your obstetrician about your options. It is natural that you may feel apprehensive about going through the same experience again. If you are feeling abnormally anxious or have a low mood speak to your GP. Some women develop post-traumatic stress disorder (PTSD) after having a perineal tear.
When can I have sex?
Everyone is different and for many women the thought of having sex after having been through birth and surgery will be far from their minds. Wait until your stitches have healed and you have stopped bleeding. Discuss it with your partner and do what feels right for you both. You might experience some discomfort for the first few times but this should ease. If you are experiencing any pain, raise your concerns with your doctor.
It is possible to become pregnant very early on after having a baby so remember to use contraception.
Final thoughts:
Everyone will have a different recovery from a third or fourth degree tear but always consult a healthcare professional if you have any concerns.
Balancing your physical recovery with looking after your new baby will be hard work so make sure you have support from your family and friends in the first few weeks.
Many women go on to have a normal vaginal birth after a serious tear but if you are still struggling with the effects you may be able to have a planned c-section.
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