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Recovering from third and fourth degree perineal tears

At the very end of your labour the skin and muscles around your vagina thin and stretch to allow your baby to be born. It is quite common for women to have some form of perineal or vaginal tearing.

Third and fourth degree tears are an uncommon complication of childbirth that may affect your bowel, bladder and sexual function for varying amounts of time.

A third degree tear is a tear or laceration through the perineal muscles and the muscle layer that surrounds the anal canal. A fourth degree tear goes through the anal sphincter all the way to the anal canal or rectum. These tears require surgical repair and it can take approximately three months before the wound is healed and the area comfortable.

Following repair of a third or fourth degree tear, a small group of woman may have persistent problems with bladder or bowel control. This is called incontinence and will require medical review and further management.

Caring for your perineum

Keep your perineum clean and free from infection

  • Wash your perineal area several times a day and after each bowel motion.
  • Change your sanitary pads every four to six hours.
  • Always wipe (or pat) from front to back after going to the toilet.
  • Do not use a hairdryer to dry your perineum—this may delay healing or cause burning to the area.
  • Avoid the use of creams, ointments or powder.
  • Antibiotics may be prescribed by your doctor to prevent wound infection

Keep comfortable

  • Apply ice packs to the area every couple of hours for at least 24 to 48 hours.
  • Take regular pain relieving medication as prescribed by your doctor.
  • Lie down to rest for 20 to 40 minutes each hour as this will help the area to heal.
  • When feeding your baby shift your sitting position or feed lying down.
  • Get in and out of bed on your side as this reduces any strain to your perineum

Emptying your bowels

For the first few days a low fibre diet is recommended to prevent any further damage to your perineum due to straining to pass a bowel motion. At the same time you will be given a softening agent such as Lactulose to ensure soft bowel motions. Drink eight glasses of water per day.

Make sure you try not to strain when using your bowels and use the recommended defaecation position. The passage of hard stools can disrupt repair and delay healing. Support the perineum with your hand while emptying your bowels, laughing, coughing, etc.

After three days you will need to eat a high fibre diet to assist with the passage of soft, easily expelled bowel motions. If you are usually prone to constipation please talk to your doctor about appropriate management—using softening agents for up to six weeks after the repair may assist your recovery.

Postnatal exercises

Your physiotherapist will teach you how to do gentle pelvic floor contractions to assist healing, improve circulation and decrease swelling and pain. You will also learn how to use your muscles to protect your perineum before and as you move. This is important for early recovery and functional protection of sutures. We recommend you avoid excessively strong pelvic floor exercises for six weeks after the birth of your baby. Gradually increase the strength of contraction/length of hold/number of repetitions of your pelvic floor exercises over the first six weeks after the birth of your baby.

Going home

Your doctor will be able to advise you when you are ready for discharge so ensure that you discuss any concerns you may have at this time. It is also very important that you continue to look after your perineum when you go home.

Follow up care

It is important that you attend all your follow up appointments so that your recovery can be assessed.

One to two weeks

A Mater physiotherapist will contact you to ask you about your recovery.

Six weeks

Physiotherapy appointment—you will be given an appointment to see a physiotherapist, who specialises in pelvic floor function, to check your progress and review your longer-term strengthening program.

Check-up with your family doctor (GP)—please make an appointment to see your GP for a check-up six weeks after the birth of your baby, as part of your routine postnatal care. Contact your GP earlier if you have any concerns about your recovery.

Three months

You will receive a follow-up phone call from the postnatal clinic at three months. A face-to-face appointment will be arranged if:

  • any issues are identified by the physiotherapist during follow up
  • you would prefer a face-to-face appointment
  • your situation is not appropriate for phone follow up (e.g. you require an interpreter)
  • any issues are identified during the phone consultation.

Frequently asked questions

When can I resume sexual activity?

Comfortable sexual activity can begin after your body has completely healed which may take from six weeks to several months. If you experience ongoing discomfort during sexual intercourse it is important that you discuss this with your doctor.

When can I go swimming?

When your bleeding has stopped and your stitches have healed.

What about future births?

Advice about future births will depend on how well you recover from this one. If you are fully recovered there at the time of your next pregnancy there is little evidence to suggest the best way for your baby to be born. However if you have some ongoing incontinence problems, especially with your bowel, a vaginal birth may make this worse. When you are seen in the Perineal Clinic, (via a telephone call or face-to-face appointment), the doctor will discuss with you the most appropriate way for your next baby to be born, depending on your individual situation.

If you have any further questions about what happened this time, please ask to speak to your doctors prior to going home.

© 2017 Mater Misericordiae Ltd. ACN 096 708 922.

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430028
Last modified 18/3/2020.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 18/11/2016
For further translated health information, you can visit healthtranslations.vic.gov.au/ supported by the Victorian Department of Health and Human Services that offers a range of patient information in multiple languages.
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