4 Types of Perineal Tears

Some degree of tearing is common with vaginal birth. Learn about the four different degrees of perineal tears and how they heal.

woman in hospital bed giving birth
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Since a baby's head is about the size of a cantaloupe at term, it's no wonder many people experience vaginal tearing during vaginal childbirth. These lacerations (also known as perineal tears) happen in the perineum, which is the area between the vaginal opening and the anus. In one sweeping study, 85% of first-time birthing parents experienced some form of perineal tearing.

There are four degrees of perineal tears, and they can range from mild lacerations in the vaginal lining to deep cuts that affect the anal sphincter. Luckily, the most common lacerations aren't the most severe. Here's all you need to know about the types of perineal tears and how to heal them.

First-Degree Perineal Tears

As the least severe type of perineal tear, first-degree lacerations are superficial. "The tear is just into the lining of the vagina," says Katie Page, CNM, FACNM, a certified nurse-midwife in Forest, Virginia. "While this doesn't involve muscle, sometimes it does require a little suturing."

Most of the time, however, no stitches are needed, and recovery is relatively simple. Expect mild pain while sitting up, having a bowel movement, coughing, and sneezing—but these discomforts should go away in about a week.

Second-Degree Perineal Tears

Second-degree perineal tears are the most frequent type of childbirth laceration. They involve the vaginal lining and deeper (submucosal) tissues of the vagina. These tears require more stitches and a slightly longer recovery period. Like with first-degree tears, you should expect discomfort doing anything that causes an increase in downward pelvic pressure, such as coughing, sneezing, or having a bowel movement.

Third-Degree Perineal Tears

Third-degree tears go into the deeper layers of the vagina and the muscles that make up the anal sphincter, says Sherry Ross, M.D., an OB-GYN and women's health expert at Providence Saint John's Health Center in Santa Monica, California.

"Your doctor will need to sew each layer separately, with special attention to closing the muscle layer supporting the sphincter." You may need anesthesia, and recovery will take longer. Expect two to three weeks of pain, followed by several months of discomfort when having penetrative sex or a bowel movement.

Fourth-Degree Perineal Tears

Fourth-degree perineal tears encompass all of the above and extend right through to the rectal lining. "This is a very delicate and thorough repair that involves multiple closing layers," says Dr. Ross. "Thankfully, this is the least common tear experienced. Generally, third- and fourth-degree tears happen when the baby's shoulder gets stuck or when a vacuum or forceps are used."

Note that severe tears can lead to pelvic floor dysfunction, prolapse, and problems with urination and bowel movements.

How to Care for Perineal Tears

Your experience recovering from a perineal tear will depend largely on the degree of the tear. Complete recovery usually takes four to six weeks; however, you if experience a first- or second-degree tear, you'll likely begin to feel better after about a week or two.

Here are some tips on how to tend to your post-delivery tearing:

  • Stay hydrated and avoid constipation since bowel movements are likely to be painful in the beginning stages of recovery (some providers recommend the use of stool softeners in the early postpartum stage for this reason).
  • Use a peri-bottle (a squirt bottle with a curved tip to aim at the areas you need to wash) with warm water and gently pat dry with toilet paper.
  • If you're bleeding, replace your pad frequently to reduce the risk of infection.
  • Wrap an ice pack in a cloth and apply it to your perineum to reduce swelling and pain.
  • When your doctor clears you for taking baths, try a warm sitz bath to help soothe your healing perineum; avoid harsh chemicals like bath bombs, bath bubbles, and soaps.

Signs of Infection

As long as you follow the doctor's orders to keep your perineum clean and dry, your tear is unlikely to get infected. But infections can happen and when they do, it's important to have them treated. Call your doctor if you experience a foul-smelling discharge, fever, pain that worsens or does not stop even when you take pain medication.

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