Vaginal tears in childbirth

Vaginal tears are common during childbirth. They often happen when a baby’s head is coming through the vaginal opening. These tears usually are a result of the head being too large for the vagina to stretch around. Or the vagina doesn’t stretch easily. Vaginal tears also are called perineal lacerations or perineal tears.

Tears that involve only the skin around the vagina typically heal on their own within a few weeks. But some tears are more severe and need treatment. A member of your health care team examines you after your baby is born to see if you have a tear and, if so, whether it needs to be repaired.

First-degree tears are the least severe. They involve the skin between the vaginal opening and the rectum and the tissue directly beneath the skin. That area is called the perineum. First-degree tears also may happen around the tube that carries urine out of the body, called the urethra. First-degree tears usually cause some pain or stinging when you urinate. They may not require stitches, although some of them do. If a first-degree tear does need stitches, that repair typically can be done in the delivery room. These tears usually heal within several weeks.

Second-degree tears involve skin and muscle in the area between the vaginal opening and the rectum. These tears may go deeper into the vagina. Second-degree tears typically require stitches. That often can be done in the delivery room. Healing usually takes about 3 to 4 weeks.

Third-degree tears go into the muscle that surrounds the anus, called the anal sphincter. These tears sometimes need to be repaired in an operating room rather than in the delivery room. They typically take about 4 to 6 weeks to heal. If you have a third-degree tear, you may need to take antibiotic medicine to prevent an infection.

After a third-degree vaginal tear is repaired, some problems that can happen include infection, separation of the repaired tear, leaking stool — also called fecal incontinence — and leaking urine — also called urinary incontinence. If you notice any of these problems, contact a member of your health care team.

Fourth-degree vaginal tears are the most severe. They go through the anal sphincter and into the mucous membrane that lines the rectum. Fourth-degree tears usually need to be repaired in an operating room rather than in the delivery room. Sometimes they require more complex repair than stitches alone. Healing may take 4 to 6 week or more. If you have a fourth-degree tear, you may need to take antibiotic medicine to prevent an infection.

After a fourth-degree vaginal tear is repaired, some problems that can happen include infection, separation of the repaired area, leaking stool — also called fecal incontinence — and leaking urine — also called urinary incontinence. If you notice any of these problems, contact a member of your health care team.

To ease discomfort while you’re recovering:

• Sit on a pillow or padded ring.
• Cool the wound with an ice pack, or place a chilled witch hazel pad between a menstrual pad and the injured area.
• Use a squirt bottle to put warm water on the injured area as you urinate.
• Sit in a warm bath deep enough to cover just your buttocks and hips for five minutes. This is sometimes called a sitz bath. Some people find cool water more soothing than warm water.
• Take a pain reliever that you can buy without a prescription. If that’s not enough to ease the pain, ask a member of your health care team about getting a numbing spray or cream to use on the injured area.
• A stool softener or laxative to prevent constipation may ease pressure and pain in the injured area. But talk to a member of your health care team before you start taking this medicine.
• Wait to have sex until after your tear is fully healed.
• Don’t use a tampon or menstrual cup until after the tear has healed.

Most people have a medical checkup 2 to 3 weeks after a baby is born and another about six weeks after a baby is born. If you have a vaginal tear, a member of your health care team checks on your recovery during these appointments.

If more-serious health problems develop due to a vaginal tear, you may need to see a specialist, such as a urogynecologist or a colorectal surgeon.

Contact your health care team right away if you have any of the following symptoms. They could mean that you have an infection, a separation of the repaired tear or other problems related to a vaginal tear:

• Severe pain.
• Pain that gets worse.
• Pain that won’t go away.
• Fever.
• Leaking urine.
• Leaking stool.