The area between the vagina and anus (perineum) can tear during birth. Here we talk about how to care for yourself and recover after a perineal tear.
What is a perineal tear?
The area between the vagina and anus (perineum) usually stretches well during childbirth but it might tear. Most often this happens in women who are giving birth vaginally for the first time. (RCOG, 2015)
Perineal tears are described in degrees that tell us their size and effect:
- First-degree tears are small, skin-deep tears. These usually heal naturally.
- Second-degree tears are deeper and affect the muscle of the perineum. These usually need to be repaired soon after birth using dissolvable stitches.
- Third-degree tears involve the muscle that controls the anus (the anal sphincter). Stiches will be needed.
- Fourth-degree tears are the same as third-degree but extend into the lining of the anus. Stiches will be required. (RCOG, 2015; NHS Choices, 2017)
The time it takes to recover from a perineal tear will depend to an extent on the degree of tear. Recovery from a more severe tear is likely to take longer.
Stitches usually start to dissolve within a few weeks to a month after giving birth but may take longer. (RCOG, 2015)
Following a perineal tear, there are steps you can take to help your body recover:
1. Rest when you can to promote healing
Rest is really important and will help your body heal from childbirth. It’s a good idea to rest whenever you can. You can also try the following:
- It can help to lay down and air your stitches – fresh air can help with healing. Take off your underwear and lay on a towel on your bed for 10 minutes or so a couple of times a day.
- Sleep when your baby does, to help your body rest and recover.
- Talk to your midwife, health visitor or GP about which activities you should avoid while you are healing. (NHS Choices, 2017)
2. Ways to help cope with pain
It’s common to feel some pain after childbirth, especially if you have had a severe tear but there are things you can do to feel more comfortable. Some of the following self-care suggestions might help to relieve pain:
- Put an ice pack wrapped in a towel or cloth onto the affected area.
- Some people say having a warm bath helps you relax and eases pain.
- Use a special doughnut-shaped inflatable cushion to help make sitting down more comfortable.
- Painkillers may also help bring relief:
- Paracetamol – is safe to use, even if you are breastfeeding.
- Ibuprofen – is safe to use if breastfeeding but ONLY IF your baby wasn’t premature (born before 37 weeks), was not a low birth weight and has no medical condition.
- Aspirin is NOT recommended if you are breastfeeding because it can pass to your baby via your breastmilk. (NHS Choices, 2017)
3. Help make toilet visits more comfortable
It can be uncomfortable going to the toilet while you are recovering from childbirth. It’s a good idea to:
- Eat healthily and stay hydrated – this will help prevent constipation.
- Use laxatives if passing stools is particularly painful.
- Pour warm water over your vagina while you wee to help relieve discomfort.
- Pour warm water over your vagina and perineum after going to the toilet, and always wipe from front to back to keep your stitches clean.
- To relieve pressure on the wound, hold a clean pad and press lightly against your stitches while you go for a poo. (RCOG, 2015; NHS Choices, 2017)
Other ways to aid childbirth recovery
- Restart your pelvic floor exercises as soon as you can after birth. They enhance blood circulation and aid the healing process. It will also help reduce pressure on the cut.
- Pelvic floor exercises involve squeezing the muscles around your vagina and anus like you’re trying to stop yourself from going to the loo. You can ask your midwife for more information about this and read our article about how to do these exercises.
- Some women say it can help to talk about your birth experience with close family or friends.
- If you are worried you aren’t healing or recovering well, talk to your midwife, health visitor or GP. (RCOG, 2015; NHS Choices, 2017)
Complications following a perineal tear
Occasionally, complications arise after having a perineal tear.
Infection – it’s important to keep an eye out for any signs of infection. This includes:
- red, swollen skin
- persistent pain
- a smell that isn't usual for you
- pus or liquid coming from the cut. (NHS Choices, 2017)
Tell your GP, midwife or health visitor as soon as you can, about any possible signs of infection. They can make sure you get treatment.
Scar tissue – for a few women scar tissue following a tear may cause problems. Excessive, raised or itchy scar tissue can sometimes form where a tear was. If your scar tissue is causing problems for you, talk to your GP.
Pain during sex – have sex when you are ready for it. In the weeks after having a baby, many women feel sore and tired.
There is no need to rush into sex. If sex hurts it won’t be pleasurable. And if you've had a tear, pain during sex is very common in the first few months.
Read our article about having sex after having a baby.
Having a tear can be a sensitive subject for some women. Yet it’s important to seek medical advice. If you don’t think your stitches are healing, you are concerned you may have an infection or are worried about your symptoms, seek medical advice.
This page was last reviewed in August 2018
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The Royal College of Obstetricians and Gynaecologists (RCOG) has an information hub for perineal tears and episiotomies in childbirth. You can find out more about the types of tears that can occur during childbirth, how to minimise your risk of deeper tearing, and what can be done to help your recovery if you do tear. It also covers what to do if you have any concerns about your recovery, helping you feel better informed when discussing any topics with a healthcare professional.
RCOG. (2015) Patient leaflet. A third of fourth degree tear during birth (also known as obstetiric anal sphincter injury – OASI). Available from: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-third--or-fourth-degree-tear-during-birth.pdf [Accessed 16th May 2017].
NHS Choices. (2017) Episiotomy and perineal tears. Available from: http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/episiotomy.aspx [Accessed 16th May 2017].
Beckmann M, Stock O. (2013) Antenatal perineal massage for reducing perineal trauma. Cochrane Database Syst Rev. (4):CD005123. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005123.pub3/abstract;jsessionid=CF32264FB13246A8540B877017B34E8C.f02t04 [Accessed 1st September 2018].
Frolich J, Kettle C. (2015) Perineal care. BMJ Clin Evid. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356152/ [Accessed 16th May 2017].
NICE. (2014) Intrapartum care for healthy women and babies. Available from: https://www.nice.org. uk/guidance/cg190 [Accessed 16th May 2017].
RCOG. (2015) The management of third- and fourth-degree perineal tears. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg-29.pdf [Accessed 16th May 2017].
RCOG. (2016) Patterns of maternity care in English NHS trusts 2013/14. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/research--audit/maternity-indicators-2013-14_report2.pdf [Accessed 16th May 2017].