It can be helpful to be prepared for some of the more challenging facts about childbirth to ensure that you feel confident to handle these situations, should they arise. This article will review vaginal and perineal tears.
Vaginal and perineal tears
It is not uncommon for those who give birth vaginally to experience a tear. When the tear happens between the vagina and anus, this is called a perineal tear. These are classified as either 1st, 2nd, 3rd, or 4th degree tears. Tap here for a digital image of the difference between these tears.
It’s also possible to have small tears in other locations, within the vagina, on the outer or inner labia, or upwards near the urethra or clitoris. These are less common, and the care for them will be similar to a perineal tear.
1st and 2nd degree tears
A 1st degree tear impacts the perineal skin only whereas a second-degree tear impacts the skin and muscles of the perineum. In the case of 1st and 2nd degree tears, you may experience a stinging sensation or mild pain in the weeks after giving birth. In most cases, 2nd degree tears will require stitches.
You may experience vaginal and/or perineal soreness in the weeks after childbirth. You can expedite the healing process by applying ice packs for the first 24-48 hours, and avoid straining. Washing your private areas with warm water during and after you use the toilet may also help relieve some of the discomfort. Squirt bottles may help. Sitz baths are also a great option (more on this below)
Trouble with urination
In the days after birth you may feel a burning sensation and/or pain from lacerations around or close to the urethra. Childbirth can also affect the tissue around your urethra and bladder, which might mean you need to set reminders to pee.
Temporarily leaking urine is common for up to 2-3 months after delivery, and is more likely if you were experiencing leakage during pregnancy. You should call your healthcare provider if you feel you aren’t urinating enough or if you’re concerned about urine leakage or pain.
Obstetric anal sphincter injuries (OASIS)
3rd and 4th degree tears are considered obstetric anal sphincter injuries and require repair. The anal sphincters are the muscles that wrap around the anus and allow you to control gas and stools. Damage to them occurs in about 1-11% of deliveries and can be painful and slower to heal.
OASIS risk factors
There are pre-existing risk factors for OASIS such as giving birth for the first time, infant weight over 8.8 pounds, advanced maternal age, VBAC, and shorter height. These are generally factors you cannot control.
However, some controllable risk factors may be:
- Use of midline episiotomies
- Use of vacuum or forceps
- Oxytocin administration
- The baby is in occiput posterior position, meaning facing up while you’re on your back
There are things you and your OB provider can do before or during labor to limit your risk of having a severe tear, like perineal massage and applying warm compresses during labor.
Treatment options and recommendations
There are many treatment options for those who experience OASIS. A bowel regimen, including a fiber supplement and a stool softener, is strongly recommended for 3rd and 4th degree tears and sitz baths are recommended for everyone.
Sitz bath
A common way to soothe sore areas after birth is with a sitz bath. Sitz baths involve exposing your perineum to warm water, medication, or Epsom salt, depending on what your provider recommends. In general, doing this in a tub with a few inches of water is preferred. If you don’t have access to a tub, you can purchase (or your hospital may give you) a disposable sitz bath that attaches to your toilet. Disposable sitz baths are not as comfortable, and should only be used for a few minutes at a time.
If you have stitches from a tear, your recovery may be a bit more painful. There are things you can do to reduce discomfort like applying ice packs during the first 24-48 hours and keeping the area clean with squirt bottles and cotton soaked with witch hazel. You can also find pre-soaked witch hazel pads (usually marketed for hemorrhoid relief). Chill them in the refrigerator or freezer for a soothing cooling effect.
It can be scary to think about vaginal and perineal tears before you give birth, but keep in mind that OASIS are uncommon and should you experience one, there are trained healthcare providers — including obstetricians and urogynecologists — to guide you at every step. There are also designated postpartum clinics to treat women with obstetric trauma.
Reviewed by the Ovia Health Clinical Team
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Sources
- Jango¨ H, Langhoff-Roos J, Rosthøj S, et al. Modifiable risk factors of obstetric anal sphincter injury in primiparous women: a population based cohort study. Am J Obstet Gynecol 2014;210:59.e1-6.
- André K, Stuart A, Källén K. Obstetric anal sphincter injuries—Maternal, fetal and sociodemographic risk factors: A retrospective register-based study. Acta Obstet Gynecol Scand. 2022; 101: 1262-1268. doi: 10.1111/aogs.14425
