HealthInfo West Coast-Te Tai Poutini
Perineal tear
Tīhaetanga ā-tero
Your perineum is the area between your vagina and anus (back passage or bottom). Many women tear their perineum during childbirth.
- First-degree tears are small tears of just the skin and do not usually need stitches.
- Second-degree tears are deeper and affect the muscle as well as the skin and need stitches to be repaired.
- Third-degree tears involve tearing of the vaginal wall and the anal sphincter (the muscle that controls the back passage).
- Fourth-degree tears extend to the lining of the back passage, or anus.
Causes of perineal tears
Often there is no clear reason for tearing. There is an increased risk for women who:
- have their first vaginal birth
- have a long pushing phase of their labour (over 2 hours)
- need a forceps or ventouse (suction) birth
- have a large pēpi (baby)
- have the baby's shoulder stuck behind their pubic bone (shoulder dystocia)
- have labour induced.
Treating a perineal tear
If you have a second-degree perineal tear, your midwife or an obstetrician will stitch it soon after you have given birth. They will use dissolvable stitches, which your body will reabsorb in about 6 weeks.
Your midwife or LMC will give you more information about how to care for your wound. Most women do not have any long-term problems after a second-degree tear. This page is mainly aimed at women who have third- or fourth-degree tears.
If you have a third- or fourth-degree perineal tear, an experienced doctor will surgically repair it soon after you give birth.
After your surgery, you will need to have a catheter (tube to your bladder) until your epidural or spinal anaesthetic wears off and you can feel when you need to pass urine.
If you cannot pass urine, can only pass small amounts, have bladder pain or feel your bladder is overfull, tell your midwife.
The stitches used to repair your tear are dissolvable and do not need to be removed. Most will dissolve within 6 weeks, but some can take a little longer. You may feel these as small lumps around your anus, or bottom. This is normal and will get better with time.
Medications for a perineal tear
You may be given:
- antibiotics to reduce the risk of infection
- laxatives to make it easier and more comfortable to open your bowels (poo)
- pain-relief medicine.
Self-care for a perineal tear
You can help your healing by keeping your perineum area clean and dry. Cold packs can help with any pain.
Avoid constipation and start pelvic floor exercises. Be careful with lifting and exercise.
See Self-care after a perineal tear for more details.
Follow-up after a perineal tear
Your midwife, LMC or doctor will check your perineum during their postnatal visits and check that you are healing properly. If you have any concerns during their final visit, 4 to 6 weeks after birth, they will refer you to a physiotherapist.
If you have a grade 3 or 4 tear, your general practice team will also check you 6 months after birth. If there are any issues, they will refer you for review with a specialist (gynaecologist).
Preventing perineal tears
This information explains how to massage your perineum in the weeks leading up to your delivery to reduce the risk of it tearing.
On the next page: Self-care after a perineal tear
Written by HealthInfo clinical advisers. Last reviewed November 2024.
SourcesReview key: HIGIB-113323
