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HealthInfo Canterbury

Healing after a perineal tear

Why did I tear?

Often there is no clear reason for tearing. There is an increased risk for women who:

  • have their first vaginal birth
  • have a large baby
  • have a long pushing phase of their labour (over two hours)
  • have the baby's shoulder stuck behind the pubic bone (shoulder dystocia)
  • require forceps or ventouse (suction) birth
  • had labour induced.

What to expect after a third or fourth-degree perineal tear

Your tear will have been surgically repaired by an experienced doctor. Following your surgery, you will need to have a catheter (tube to your bladder) until your epidural or spinal anaesthetic wears off and sensation returns so you can feel the need to pass urine.

If you can't pass urine, or can pass only small amounts, have bladder pain, or feel your bladder is overfull, then let your midwife know.

The stitches used to repair your tear are dissolvable and do not need to be removed. Most will dissolve within six weeks, however some of the stitches can take a little longer and you may feel these as small lumps around your anus, or bottom. This is normal and will improve with time.

Medications

You may be given:

Perineal care

Using ice packs in the first 24 hours may help reduce your pain and swelling. Otherwise, keep the perineal area clean and dry. You should shower and bath as usual, and dry the area by gentle patting with a clean towel or disposable cloth.

After passing urine or a bowel motion, it's important to clean the area with a cloth and pat dry, rather than wipe.

Make sure you change your pads and wash your hands regularly to reduce the risk of infection.

How to avoid constipation following your tear

Aim to drink 2 litres (eight cups) of water every day, or 2.5 to 3 litres (nine to 10 cups) if breastfeeding. This includes fluids such as soup, milk, and hot drinks, but try to make at least half of your drinks water.

Try not to skip meals, and include plenty of fibre in your diet. You can do this by choosing a high-fibre breakfast cereal or wholegrain bread for breakfast, having two or more pieces of fruit a day, and having vegetables with dinner and lunch if possible. Also try to choose snacks such as wholegrain crackers, a bran muffin, fruit or popcorn.

Sitting in a correct position when passing a bowel motion is also important to minimise strain and increase efficiency. Try to:

You can support the area with stitches by holding a wad of toilet paper to it. And when finished lift your pelvic floor muscles a few times.

Pelvic floor muscle exercises

Your pelvic floor muscles form a sling underneath your pelvis and run from your pubic bone at the front of your pelvis to your tail bone at the back. They help to control bladder and bowel function and also support your pelvic organs. These muscles are often weakened in pregnancy and will have been further injured from your tear.

You can start exercising your pelvic floor muscles as soon as your catheter is removed. Exercising them early on will also help reduce pain and swelling and help you to heal.

Posture and exercise

What happens next?

During recovery, you may experience some mild pain or soreness in your perineum.

Tell your midwife or GP if:

Most women make a good recovery and can go on to have further vaginal births. If you have had a third or fourth-degree tear and you continue to have symptoms, you may be offered a caesarean delivery for your next baby.

Your follow-up appointment

Before you leave hospital, you will be seen by a physiotherapist. Your lead maternity carer – midwife or doctor – will check your perineum during their post-natal visits and check that you are healing properly. Your GP may also check at the six-week baby check that your perineum has healed. You will also be given a follow-up appointment to be seen in the Perineal Clinic at the hospital three months after your delivery.

If you need any further advice, or help with your pelvic floor exercises, please ask your lead maternity carer to refer you to the Physiotherapy Department at Christchurch Women's Hospital, phone (03) 364‑4908 or fax (03) 364‑4290.

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Written by Physiotherapy Services and Maternity Services, Christchurch Women's Hospital. Adapted by HealthInfo clinical advisers. Updated July 2016.

Sources

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Review key: HIPTE-54082