What is perineal trauma?
Trauma of the perineum (area between the anus- back passage and the vulva – female genitals) is when a woman tears during childbirth. This is extremely common; as many as nine women experience this in childbirth.
What are the types of tears during childbirth?
Most tears occur in the perineum, the area between the vaginal opening and the anus (backpassage).
They may be:
- first degree tears – small, skin-deep tears which heal naturally
- Second degree tears – which are deeper tears affecting the muscle of the perineum as well as the skin. These usually require stitches.
Less than nine per cent of women may experience a more extensive tear.
This may be a:
- third degree tear extending downwards from the vaginal wall and perineum to the anal sphincter (the muscle that controls the anus).
- fourth degree tear extending to the anal canal as well as the rectum (further into the anus).
Please refer to patient information leaflet – ‘third and fourth degree tears during childbirth’ for more information.
What is the difference between an episiotomy and a tear?
An episiotomy is a cut made by a midwife or doctor, through the vaginal wall and perineum to make more space to deliver the baby. A tear happens as the baby stretches the vagina during birth spontaneously (by itself).
Healing will vary from person to person. The stitches may take up to three weeks to dissolve.
The stitches do not need to be removed however if they are feeling uncomfortable the midwife will check them for you and in some cases tension in the stitches can be relieved by removing knots or some external stitch material. It is important for the midwife to look at the stitched area (in surroundings you feel offer you enough privacy) to check that you are healing properly and do not have an infection. If you would rather not have your stitches checked then please ensure you ask the midwife what you should be aware of and check them yourself. Doing regular pelvic floor exercises helps the healing process by stimulating the blood supply and strengthening the muscles. If you are unsure of how to do these exercises ask the midwife, you may have the opportunity to see the obstetric physiotherapist.
The midwife or your GP can advise you individually on simple pain killers such as paracetamol, to help discomfort and that are safe to take if you are breast feeding.
Healing will be helped by keeping the area clean with daily baths or showers and frequent changes of sanitary towel (do not use Tampons).
Salt baths are not necessary as the amount of salt that would be required to be effective is significantly more than a mug full.
Do not use creams/talcum powder/or any scented products in hygiene process unless you have discussed the specific product with your midwife.
Opening your bowels
Avoid constipation by eating a high fibre diet and drink plenty of fluid, especially water. When opening your bowels you may find supporting your perineum with a clean maternity pad or wad of toilet tissue, may make you more comfortable. If you are having difficulty opening your bowels tell your midwife who will advise you about correcting the problem.
This will vary from woman to woman depending on the healing process and when you feel comfortable enough to be able to consider trying. It may be helpful to use a non perfumed lubricant jelly. If intercourse continues to be painful or if you feel ‘things aren’t right’ since you had your baby please see your GP.
How can I find out more information?
Please discuss any queries or concerns with your midwife or consultant during your appointment; alternatively if you need any more information please do not hesitate to contact the Maternity Pregnancy Assessment Unit to speak to a midwife.
Any personal information is kept confidential. There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.
In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service.
This leaflet can be made available in other languages and formats upon request