Pelvic Health Physiotherapy
Review due: 2025
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01592 648106
In the UK, a third- or fourth-degree tear occurs in about 3 in 100 women having a vaginal birth. It is more common with a first vaginal birth, occurring in 6 in 100 women, compared with 2 in 100 women who have previously had a vaginal birth.
Small, skin-deep tears are known as first degree tears and usually heal naturally. Tears that are deeper and affect the muscle of the perineum are known as second degree tears. These usually require stitches.
For some women the tear may be deeper. A third degree tear is one that extends downwards from the vagina and involves the muscle that controls the anus (the anal sphincter) and a fourth degree tear is one that extends downwards from the vagina and extends further into the lining of the anus or rectum.
6–8 in 10 women with a third- or fourth-degree tear will have no long-lasting complications after it has been repaired and given time to heal.
Why do they happen?
A tear is more likely to happen if:
- This is your first vaginal birth
- You are of South Asian origin
- Your second stage of labour is longer than expected
- You need forceps or a ventouse to help deliver your baby
- One of your baby’s shoulders becomes stuck
- You have a large baby (over 4kg or 8lbs 13oz)
- You have had a 3rd/4th degree tear before
How is it treated?
The tear will have been stitched using dissolvable stitches. You will have three different types of medication to help with healing:
- Pain killers – not codeine based as they can cause constipation.
- Antibiotics to reduce the risk of infection as the stitches are very close to the anus.
- Laxatives to make it easier and more comfortable to open your bowels.
How to take care of yourself
- It will be more comfortable to lie on your side with a pillow between your legs. Change position regularly and avoid sitting or standing for long periods of time. This lets the wound heal more quickly.
- Pace yourself and listen to your body. Rest when you need to and accept help from friends and family.
- Avoid heavy lifting.
- Keep the wound area clean. Baby wipes can be more comfortable than toilet paper for wiping after a bowel movement. You may want to use the shower to clean yourself after a bowel movement. Change your sanitary pads regularly.
- Drink 2-3 litres of fluid per day and eat a healthy diet including fruit, vegetables, cereals and wholemeal bread/pasta to avoid straining when opening your bowels.
- For the first few days after your third- or fourth-degree tear is repaired, control of your bowels may not be as good as before you had your baby. When emptying your bowels, it may be more comfortable to use a small step under your feet. Rest your forearms on your knees. Support the wound area with toilet paper held in your hand to make a bowel movement more comfortable.
- It is very important that you do pelvic floor exercises to help the area heal and keep good control of your bladder and bowels. These are explained in the booklet “Fit for the Future”, contained in the information pack given to you on the ward. Do the exercises whenever you are feeding your baby so you get into the habit of doing them often.
- You should wait to have sex until the bleeding has stopped and the tear has healed. This may take several weeks. After that you can have sex whenever you feel ready to do so. If you have difficulty having sex or it is painful, speak to your GP.
- If you have any other concerns speak to your GP at your 6 week check. You will be sent a follow up follow up appointment with a specialist nurse, usually 8 weeks after you have given birth. This is to make sure that everything has healed and that you have normal bladder and bowel control. If you are having problems like pain or leakage of urine or faeces, you may be referred to a specialist physiotherapist.
References
Care of a third- or fourth-degree tear that occurred during childbirth (also known as obstetric anal sphincter injury OASI) | RCOG
NHS Fife Urogynaecology Department Jun 2019
NHS Fife Midwifery Team Jun 2019
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