It is very common to experience vaginal tears when giving birth. In most cases the tear cannot be prevented. Some tears are more serious than others, for example a tear that involves the anal sphincters (back passage).
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What is a third or fourth degree anal sphincter tear?
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A tear that extends to the anus (back passage) is called a third or fourth degree tear. A third degree tear involves partial or complete tearing of the back passage. A fourth degree tear involves tearing through the back passage to the bowel.
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It is important to know how to help these more serious tears/stitches heal.
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We recommend that you visit a the perineal clinic about three months after the birth of your baby.
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How is it treated?
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After the baby is born the tear is repaired using a special technique. Sometimes it is necessary to do this in the operating theatre.
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Immediately after this repair it is important to place ice packs (in a sanitary pad) over the stitches for 20 minutes every three to four hours, for two to three days.
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The doctor will recommend medications to prevent pain and constipation. Do not take any medication in suppository form via the back passage.
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The continence nurse/midwife in the postnatal ward will refer you to the physiotherapist, dietician, or medical specialist, depending on your needs.
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Generally you should:
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- avoid constipation (aim for a soft easily passed stool)
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- not have suppositories or medications via the back passage
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- have ice therapy for two to three days
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- commence pelvic floor exercises when comfort permits
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- take care of your personal hygiene.
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Remember to try and reduce any pressure on your pelvic floor. For example get out of bed from a side-ways position. When you pick up your baby, bend at the knees.
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Before leaving the hospital the continence nurse or midwife should discuss a follow up appointment with you. Follow up occurs at the Perineal Clinic (Wednesday afternoons) three months after the birth of your baby.
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Why do you need a follow up appointment?
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Most tears heal completely and there is normal bowel control. In a minority of cases there is altered function to the back passage. Some tests at the follow up appointment will check for this (e.g. ultra sound scan).
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The specialists will talk with you about how well your body has healed and discuss any concerns you have now and for the future.
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It is a good time to rasie any concerns or anxieties you have about your tear.
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A very small percentage of women need further advice from the colorectal specialist.
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Scan of anal muscle. Arrows pointing to area of injury from 10 o'clock to 2 o'clock
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At home
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The healing process takes about six weeks.
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During this time:
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- avoid constipation and heavy lifting e.g. children, shopping bags, washing baskets, high impact exercise, as you need to avoid any strain or pressure on the back passage
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- sexual intercourse should be avoided during the healing period.
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After four to six weeks gradually increase your general activity and pelvic floor exercises.
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Please see also, the fact sheets Pelvic floor exercises and Normal bowel function.
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Further information
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Midwife and Continence Advisor
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Urogynaecology Pelvic Floor Service
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Royal Women's Hospital
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Locked Bag 300
Grattan St & Flemington Rd, Parkville VIC 3052
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Tel: (03) 8345 2000
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Disclaimer
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The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
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Last updated Jan 2008
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