The perineum, the area between your vagina and anus, can often tear during delivery in order for your baby’s head to pass through the birth canal. If just the skin and some of the tissue under the skin is torn, this is known as either a 1st or 2nd degree tear. A woman with either of these types of tears may not even need stitches but could still experience pain or discomfort and have scarring.
A 3rd or 4th degree tear is present when the skin, underlying tissues, and part or all of the anal sphincter is torn. A woman with this type of tear may have anal incontinence meaning she has only partial or even no control over the passage of solid, liquid, or gas from the anus. Also, the tear may create pain with attempts at sexual activity. These problems can be embarrassing and make it difficult for you to continue with your everyday life. However, you are not alone.
Unfortunately, many women experience these problems after childbirth. The body takes time to heal, up to six weeks or longer if you had a 3rd or 4th degree tear. In general you should see daily improvement when you follow the ‘Vulvar and Perineal Care’ handout guidelines.
To help you in your recovery, follow the tips below. Remember that it is possible to return to your daily life without pain, to treat bladder and bowel incontinence, and resume a healthy, pleasurable sex life after childbirth.
OK, so I have a perineal tear. What can I do now?
- PRACTICE good perineal hygiene techniques. It is difficult for a perineal tear to heal due the normal post-partum discharge called lochia. Wearing a protective pad is common, and worn more often when urinary and/or fecal incontinence is present after delivery. You should be sure to use gentle cleaning techniques for your perineum in order to prevent it from becoming raw, and to keep the tear from reopening. Also, a tear can be reopened with wiping at the toilet, so pat the skin dry from front to back.
- DO pelvic floor exercises. Pelvic floor exercises (sometimes called Kegel’s) will help you regain the strength needed to stop the passage of solid, liquid, or gas from the urethra or anus. Also, these exercises will promote blood-flow and healing of the area. If you are experiencing any discomfort or pain with pelvic floor exercise, do not do them. Consult your health care provider.
- MASSAGE your perineum. You can perform massage yourself to promote healing and to prevent adhesions. See my article and educational handout on abdominal scar massage, the benefits and techniques apply to the perineum and vulvar area as well. These techniques are usually done 6 weeks after delivery.
- SEE a Women’s Health Physical Therapist. We strongly recommend you consult with a women’s health physical therapist after childbirth. The body has a lot of recovery to do after delivery. Many women don’t even know the consequences of 3rd or 4th degree tear for many weeks after childbirth. A women’s health physical therapist is specially trained in issues related to childbirth. They will evaluate you and let you know how to treat incontinence and perineal pain, assisting you in recovery from childbirth. To find a pelvic health physical therapist in the United States, visit Kathe’s Resources page.
For more information see the download ‘Vulvar and Perineal Care’ handout designed as a patient education tool.
This article was developed with Lindsy B. Campbell, SPT as part of an independent study project with the University of Washington, Department of Rehabilitation Medicine Division of Physical Therapy.
- Rathfisch, G. Effects of perineal trauma on postpartum sexual function. Journal of Advanced Nursing. 2010; 66(12), 2640-9.
- Groutz A, Hasson J, Wengier A, et al. Third- and fourth-degree perineal tears: prevalence and risk factors in the third millennium. Am J Obstet Gynecol 2011;204:347.e1-4.
- Starr JA, Drobnis EZ, Lenger S, Parrot J, Barrier B, Foster R. Outcomes of comprehensive nonsurgical approach to pelvic floor rehabilitation for urinary symptoms, defecatory dysfunction, and pelvic pain. Female Pelvic Med Reconstr Surg. 2013 Sep-Oct; 19(5):260-5.
- Wallace, K. Reviving Your Sex Life After Childbirth, Your Guide to Pain-Free and Pleasurable Sex after the Baby.
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