Giving birth is an incredible journey, but we’re not going to lie, it can also be painful. Vaginal delivery can sometimes result in a perineal tear, which is a common but often uncomfortable experience for a new mother.

We will delve into what perineal tears are, their causes, healing time, pain management strategies, when to seek medical attention and tips for preventing a perineal tear from happening.

What is a perineal tear?

A perineal tear refers to a tear or laceration that occurs in the perineum, the area between the vagina and the anus, during childbirth.

These tears vary in severity, ranging from first-degree tears involving the skin to fourth-degree tears extending into the rectum.

While perineal tears are common, their healing process and discomfort can vary from woman to woman.

Types of perineal tears

1. First-degree tear: Involves the skin of the perineum, usually minor and requiring minimal intervention.

2. Second-degree tear: Extends beyond the skin and involves the underlying perineal muscles, may require sutures for proper healing.

3. Third-degree tear: Extends through the perineal muscles and the anal sphincter complex, requiring careful repair to ensure proper healing and restoration of muscle function.

4. Fourth-degree tear: The most severe type, extending through the perineal muscles, anal sphincter and rectal lining, necessitating meticulous repair.

What causes a perineal tear?

Perineal tears can be caused by various factors, including the size and position of the baby’s head during delivery, a rapid or prolonged delivery, the use of forceps or vacuum-assisted delivery, and limited flexibility of the perineal tissues.

Additionally, first-time mums and women giving birth to larger babies may be more susceptible to perineal tears.

Complications associated with perineal tears

While perineal tears are a common occurrence during childbirth, some complications may arise as a result:

• Pain and discomfort
• Infection

Perineal infections can occur after giving birth and require prompt attention for proper treatment. Here are some signs to watch for:

1. Increased pain or tenderness in the perineal area.
2. Redness, swelling or warmth around the perineum.
3. Pus-like discharge or abnormal odour from the perineal wound.
4. Fever or chills.
5. Difficulty or pain while urinating.
6. Worsening discomfort or delayed healing of the perineal tear or episiotomy site.

If you experience any of these symptoms, it is important to consult your healthcare provider for an evaluation and appropriate treatment to prevent further complications.

• Delayed healing
• Perineal or vaginal scarring
• Dyspareunia (painful intercourse)
• Faecal or urinary incontinence

How long until perineal tears heal?

The healing time for perineal tears depends on the severity of the tear and individual healing processes.

First-degree tears typically heal within a few weeks, while second-degree tears may take a few weeks to a couple of months.

Third- and fourth-degree tears require more time to heal, often up to several months.

If stitches are required to repair the tear, they will usually dissolve within six weeks.

During the healing period, it’s important to keep the area clean and dry, use a peri-bottle for gentle cleansing after using the bathroom and avoid constipation by staying hydrated and using a stool softener.

Women may experience some discomfort during this time, and it’s essential to watch for any signs of infection.

Perineal tear: Home remedies to manage the pain

Dealing with pain from perineal tears after childbirth can be challenging and leave you in tears (no pun intended).

However, there are several home remedies you can try to help manage the discomfort and promote healing.

Here are some tips that can aid in speeding up the recovery process.

1. Stay active

• Gentle exercises, like walking, can help improve blood circulation and promote healing.
• Pelvic floor exercises, such as Kegels, strengthen the perineal muscles and aid in recovery.

2. Follow a balanced diet

• Eat foods rich in fibre to prevent constipation, which can aggravate pain during bowel movements.
• Stay hydrated to promote healthy tissue healing and overall well-being.

3. Over-the-counter pain relief

• Over-the-counter pain medications, like acetaminophen or ibuprofen, can help manage pain. Always consult your healthcare provider before taking any medication.

4. Warm compresses

• Apply a warm compress to the perineal area to relieve pain and promote blood flow. Use a clean towel or a specially designed perineal ice pack.

5. Proper wound care

• Keep the perineal area clean and dry. Gently wash with warm water and mild soap, and pat dry afterwards.
• Change sanitary pads frequently to maintain hygiene and prevent infection.
• Avoid using scented products or wipes, as they can irritate the area.

Remember, every individual’s healing process is unique, and it’s essential to consult your healthcare provider for personalised advice and guidance.

When to call the doctor for perineal tear

It’s important to contact your healthcare provider if you experience severe pain, excessive bleeding, signs of infection (such as fever, increasing redness, or foul odour), or if you have difficulty urinating or having bowel movements.

Your healthcare provider can assess the tear, provide appropriate medical care and ensure proper healing.

ALSO READ: Worried about your first poop after giving birth? Here's what to do

Can you prevent perineal tears?

There is no surefire way to prevent perineal tears, but there are some strategies that might help reduce the risk:

1. Perineal self-massage: Perform perineal massage after 34 weeks of pregnancy to protect the perineum and reduce the risk of severe tears.
2. Pelvic floor muscle training: Strengthen your pelvic floor muscles during pregnancy to prepare for labour and lower the chances of third- or fourth-degree tears.
3. Controlled delivery: Slow down the rate at which the baby’s head and shoulders emerge with the guidance of your birth attendants to help prevent perineal injuries.
4. Perineal massage by healthcare professionals: Consider perineal massage performed by a healthcare professional during the second stage of labour to reduce the risk of severe tears (not recommended for everyone).
5. Follow midwife instructions: Listen carefully to your midwife’s guidance and follow their instructions for gentle delivery, which can contribute to a slower and more controlled birth.
6. Choose a home-like birth environment: Opt for giving birth at home or in a birth centre, where there is less medical intervention and the option to use water for pain relief and deliver in upright positions, decreasing the likelihood of perineal trauma.

Remember, while these strategies might help reduce the risk of perineal tears, there is no guaranteed way to prevent them entirely. Discuss these options with your healthcare provider for personalised advice and guidance.

This article was first published in theAsianparent.