Perineal tear - origin, degrees & causes
Dr. Anja Loose-Roland
Updated on 02. November 2023
About 20 to 30 % of women suffer a perineal tear during the birth of their child. The high frequency shows that on average one quarter of women are affected by this problem. As the hormonal change due to the birth already means an inner turmoil for the mothers, the pain and discomfort caused by the perineal tear are an additional burden. With the right methods and aids, the problems of a perineal tear can be significantly reduced.
Perineal laceration Brief overview:
- Causes: Birth
- Symptoms: Pain
- Prevention: Perineal tear massage
- Treatment: Depending on the degree with ointment
Origin of a perineal tear?
The perineum is located between the external genitals and the anus. The skin there can tear due to heavy strain. The main cause in women is the birth of a child. When the child's head pushes through the vagina, overstretching can occur in this area.
What are the symptoms of a perineal tear?
Since a perineal tear happens during the expulsion phase, you will hardly notice it at first if the injury is minor. Only after birth will you feel pain, depending on the extent.
What do the different degrees mean?
A perineal tear can occur in different forms. The distinction is made according to the length and depth of the tear:
- Perineal tear grade 1: The skin is only torn superficially. The muscles are not affected.
- Perineal tear grade 2: The injury affects not only the skin but also the muscle. The sphincter muscle still functions.
- Perineal tear grade 3: The injury does not only affect the skin. The sphincter muscle is partially or completely damaged.
- Perineal tear grade 4: Not only the sphincter muscle but also the intestinal mucosa is affected.
Causes of perineal tear
Don't worry so much about a perineal tear in the run-up to the birth. Statistics show that you do not necessarily have to have a perineal tear. There are certain risk factors, but they do not necessarily result in a perineal tear.
What risk factors favour a perineal tear?
The following risk factors favour a perineal tear:
- Large child over 4000 g or large head circumference.
- Unfavourable position of the baby
- Very fast birth, where the skin has to stretch quickly
- Use of aids such as forceps or a suction cup
- Very firm connective tissue
Which is better, perineal tear or episiotomy?
With an episiotomy, the perineum is specifically incised during the pressing phase before it tears. The advantage of an episiotomy is the targeted incision, which makes it easier to control the severity. On the other hand, in many cases the severity of an episiotomy is low. The wound hurts less with a tear and heals better.
Treatment of perineal tear
The treatment of a perineal tear depends decisively on the degree of severity. First, the doctor will examine the size, location and formation. Then the treatment takes place.
How is a perineal tear treated?
A slight perineal tear of the 1st degree usually heals uncomplicatedly on its own. In the case of second-degree perineal tears, the doctor will decide whether a suture is necessary. Higher degrees of perineal tears are always sutured. This is usually done under local anaesthetic.
When are the stitches removed after a perineal tear?
Sutures that dissolve themselves are used to suture a perineal tear. Therefore, follow-up treatment is not necessary.
How long is the healing time for a perineal tear?
On average, a perineal tear takes 10 days for the scar to heal. It can take up to six weeks before you are completely free of symptoms. Complications are rare, but they can delay the healing process. If the injury is more severe or affects the muscle, it may take several months.
How does my perineal tear heal better?
To promote healing of a perineal tear, you can use several tools.
Cooling the scar is an important step to relieve the pressure. Cool packs or ice cubes can be used for this. A condom filled with water is particularly helpful. The narrow, elongated shape fits the suture area very well.
Hygiene is especially important for healing. To prevent germs from getting into the [scar\]\(/scar/), you should change the bandage regularly and wash or shower daily.
Sitz baths with healing and caring substances such as witch hazel and chamomile can promote healing. However, do not take sitz baths too often or for too long, otherwise the scar may soften.
At every opportunity, and especially after a sitz bath, you should walk around "bottomless", sit or lie down. The air helps the wound to heal faster. This can easily get lost in everyday life with a baby. However, you can create space for yourself by, for example, breastfeeding while lying down and always at a prepared place to cuddle.
What is the difference between perineal tear and vaginal tear?
Just like a perineal tear, a vaginal tear can also occur during childbirth. The vagina can tear in different places. A vaginal tear is more likely to occur during births with a suction cup or forceps. A vaginal tear is often observed together with a perineal tear.
Dealing with a perineal tear
A perineal tear is a wound that can affect you in the first period after birth. Even if the suture heals quickly and without complications, you should also take care. This is not always important with a baby in your everyday life. Remember, support in the postpartum period, whether from your partner or family or charitable organisations, is important. Make use of these possibilities yourself, for example, to avoid late consequences in the case of a 4th degree perineal tear.
Sitting, standing, walking with perineal tear?
How significantly a perineal tear affects you in your everyday life depends on the severity of the tear. Avoid putting unnecessary pressure on the scar by standing or walking for long periods or frequently. When sitting, it is very beneficial to put a small floating ring on your seat. This way you support yourself with your thighs and buttocks and the perineal area does not receive any pressure.
What helps if the perineal tear scar hurts?
Lie down regularly to relieve the [scar](). Do not spread your legs unnecessarily, for example when squatting or getting out of bed. If the general treatment options such as cooling and sitz baths do not help, you should consult your doctor. This is especially true if a yellowish discharge indicates inflammation.
How does defecation with perineal laceration work?
Bowel movements can cause pain after a perineal tear. Keep your stool soft by drinking plenty of fluids and eating light food. This will help you avoid heavy pushing and pressure the scar. If the diet is not enough, you can talk to your doctor about a light laxative. Clean yourself thoroughly with water after having a bowel movement. In addition, if you have a third or fourth degree perineal tear, you may have problems holding a bowel movement because of the injury to the sphincter muscle. In this case, you should talk to your doctor about whether perineal tear correction is necessary.
When can I have sex again after a perineal tear?
When you can have sex again after giving birth depends on how you feel. After the scar has healed and the postpartum flow has dried up, your own attitude to sexuality plays the decisive role. If you have a severe perineal tear, especially in combination with a vaginal tear, it is best to have your gynaecologist or midwife check the scar beforehand.
How can I avoid pain during sex after a perineal tear?
The suture of the perineal tear has slightly changed the shape of the vaginal entrance. This can cause pain during sexual intercourse. However, the tissue of the vagina is very elastic, which means that the problems quickly improve completely. At the same time, the fear of pain can also cause problems during sex. You should discuss the issue with your husband and not force anything together. If there is no improvement, talk to your gynaecologist about a possible correction of the suture.
How does the second birth after a perineal tear work?
Especially women who have already had a 4th degree perineal tear worry about the birth of their second child. If the scar has healed well, there is nothing to be said against giving birth without a perineal tear. However, you should find out what caused the severe tear. If it was a risk that could also occur during the next birth, you should talk to your midwife about it.
Avoiding a perineal tear?
Since a perineal tear makes the first time with the baby somewhat difficult, preventive methods can be resorted to. This applies to first-time mothers as well as to women who experience a second birth after a perineal tear.
How do I prepare for the birth?
Midwives often recommend that you prevent perineal tears with massage. You should start about six weeks before the delivery date to keep the perineum soft and elastic until delivery.
Which birth position will help me avoid a perineal tear?
There are several birth positions that reduce the risk of perineal tears. The quadruped position in particular is very gentle on the perineum.
Can a perineal tear itch?
Yes, itching can be a symptom of a perineal tear. Although itching does not always occur with every perineal tear, it can be a reaction to the healing of the tissue. The [itching]() can be caused by the healing process itself, the formation of scar tissue or the irritation of the sensitive skin around the perineum.
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