Perineal Tear (Vaginal Tear): Causes, Symptoms and Treatment

Overview

A vaginal tear or a perineal tear is an injury to the tissue around the vagina and rectum that can occur during childbirth. A woman may experience any of the four grades of tear. During delivery, an episiotomy is a procedure that may be used to widen the vaginal opening in a controlled way. 

This article covers everything about perineal tears, 2^nd-degree perineal tears, perineal tears not from childbirth and perineal tear not healing. 

What is a perineal tear?

A vaginal tear can occur during childbirth. Also called perineal laceration is a tear in the tissue around the vagina and perineum. The perineal area, also known as perineum, is the space between the vaginal opening and the anus.

During a normal vaginal delivery, the vagina’s skin prepares for childbirth by thinning itself out. This part of the female body is designed to stretch and allow the head and body of the baby to pass through without trauma. 

But, there are many reasons why a vaginal tear may occur. These reasons can include:

• A large baby
• A quick delivery where the skin hasn’t had time to stretch and thin
• Use of forceps during delivery

What are the degrees of perineal tears?

There are four degrees of perineal tear, and those are:

First-degree tear

This kind of perineal tear involves only the skin and the tissue directly beneath the perineum skin, which is the area between the vagina and the rectum. If the patient has a first-degree tear, they may experience some mild pain or stinging while urinating. These tears may generally not require stitches, although some do. They typically heal within a few weeks. 

Second-degree tear

The second-degree perineal tear is the most common type of tear that happens during childbirth. It is deeper than a first-degree tear and involves the skin and muscle of the perineum. It may also extend deep into the vagina. Usually, a second-degree tear needs stitches and may heal typically within a few weeks.  

Third-degree tear

This perineal tear extends to the muscle around the anus. The patient may need anaesthesia to stitch the tear in the operating room. A third-degree tear may generally take longer than a couple of weeks to heal. The patient can also experience complications like uncontrolled bowel movements and painful intercourse.  

Fourth-degree tear

Fourth-degree perineal tear is the most severe tear that extends through the muscles around the anus and into the mucous membrane which lines the rectum. Usually, this type of tear requires anaesthesia to be stitched in the operating room. The patient may also need a more specialized type of repair and the healing may take longer than some weeks. As with a third-degree tear, they may have complications such as uncontrolled bowel movements and painful intercourse.  

When to seek medical help?

Women should watch out for any signs of an infection when the tear heals. When women notice any of the following, they should immediately seek medical attention:

• A foul-smelling discharge
• A fever
• Constant pain even after medication

Request an appointment at Apollo Hospitals

What are the causes of a perineal tear?

A vaginal tear during childbirth may occur due to various reasons. A few factors that may cause a tear include:

• First delivery.
• Use of forceps or a vacuum during the delivery 
• The position of the baby is face-up during delivery
• A large baby, usually weighing more than 8 pounds
• If the woman had an episiotomy before

What Are Risk Factors for a Perineal Tear?

Many factors may increase the chances of a perineal tear, including: 

• Having the first baby
• Having a big baby
• Needing a vacuum or forceps to help with the delivery
• Being an older mother
• Breech presentation, which is when the baby is face up instead of face down when into the labour 
• Having a midline episiotomy that is a surgical cut in the middle of the vaginal opening toward the anus

What Are Potential Complications of a Perineal Tear?

A few potential complications linked to perineal tears include: 

• Vaginal Bleeding
• Delay in bonding with the baby because of the time it takes to repair the tear and the pain
• Infection
• Reopening of the tear
• Pain
• Urinary incontinence, which is when one can’t control urine
• Bowel incontinence
• Painful sex

What are the treatments for a perineal tear?

Treatment of a vaginal tear depends on the severity of the injury. In a first-degree tear, one may not need any stitches. In a second-, third- and fourth-degree tear, one may receive stitches to heal the injury. 

These stitches are dissolvable and heal within six weeks. In some of the most severe cases, the patient’s healthcare provider may need to repair the injury to the anal sphincter with the help of dissolvable stitches. One may feel discomfort in the weeks after delivery while the tears heal. There are some things that may help ease this discomfort. These tips work with each type of tear.

• Clean the area well after using the restroom 
• Gently pat dry with toilet paper instead of wiping
• Drink plenty of water to avoid constipation and use a stool softener

The expert may also give cooling pads to wear with the sanitary pad post-delivery. These can help relieve discomfort from the tears. 

What are the preventive methods?

Perhaps the most significant thing one can do to help reduce the risk of severe vaginal tears is to ask the expert to avoid performing an episiotomy unless medically necessary. It was previously thought that cutting the perineum would help prevent further muscle damage and allow for more controlled delivery of the baby’s head. 

While there are medical reasons for performing an episiotomy when the baby’s heart rate drops near delivery, it is no longer a routine procedure. 

Using a lubricant such as mineral oil or KY jelly in the vaginal canal as the baby is delivered has shown to help reduce tears . Applying moist, warm cloths to the perineum while pushing also helps.

Massaging the muscles of perineum while pushing may also lessen tears. Performing perineal massage during the weeks before delivery may or may not help. There is no evidence to display that the position of the delivery or the type of anaesthesia results in tearing. However, using a vacuum or forceps during delivery escalates the risk of a more severe tear. The reason for vacuum or forceps is to avoid cesarean delivery .

Conclusion

Vaginal tears are prevalent and usually heal completely within 6 weeks of delivery. The vagina can stretch and expand to accommodate the baby naturally, but occasionally rigors of childbirth take their toll. Women should talk to an expert about the best ways to avoid tears, and the best way to take care of the tear and genital area after delivery.

Frequently Asked Questions (FAQs)

How long does it take for a vaginal tear to heal?

Most women feel relief from the pain caused by a vaginal tear in about two weeks. If the tear requires stitches, they may dissolve within six weeks. One may not need to go back to the doctor to have the stitches removed or receive any additional treatment for the tear. 

Can a woman have a vaginal delivery in a second pregnancy if she had a vaginal tear previously?

In most cases, experiencing a tear during one delivery doesn’t signify it may tear again during a future delivery. Most small tears heal well and may not prevent from having future vaginal deliveries. 

If a woman has experienced a third- or fourth-degree tear in the past, she can be at risk of a tear during vaginal childbirth in the future. Typically, the risk is low, and the woman can have a vaginal delivery. In some cases, the healthcare provider may suggest a Cesarean section (C-section) delivery to prevent a tear.