What is the Perineum?

The perineum is the area between the vaginal opening and the anus. This area can sustain trauma during vaginal birth, either intentionally through an episiotomy or spontaneously as a perineal tear.

How common are perineal tears?

Around 85% of women experience some degree of perineal trauma following vaginal birth. Approximately 60% of these women require suturing.

Types of Perineal Tears

1st Degree: Superficial tear of vaginal tissue and/or perineal skin.
2nd Degree: Tear involves vaginal tissue, perineal skin, and muscles.
3rd Degree: Extends into anal sphincter muscles.
4th Degree: Extends through anal sphincter into anal mucosa.

Third and Fourth Degree Tears

About 3% of vaginal deliveries may result in 3rd or 4th degree tears. These tears cannot always be predicted. Risk factors include first vaginal delivery, large baby, occipito-posterior head position, induced labour, shoulder dystocia, and instrumental delivery (forceps or vacuum).

If not repaired properly, women can experience gas or stool incontinence and urgency. Most symptoms improve within 3 months; persistent issues may require further evaluation.

Suturing (Stitches)

1st degree tear: may heal naturally or require minimal suturing.
2nd degree tear or episiotomy: suturing of muscles and skin under local or regional anaesthesia.
3rd & 4th degree tears: complex repair under regional or general anaesthesia in operation theatre using absorbable sutures.

Aftercare

Regular painkillers for the first few days.
Avoid rectal suppositories and enemas, especially for 4th degree tears.
Maintain good personal hygiene; keep the perineal area clean and dry.
Sitz bath with warm water twice daily to ease pain and clean the wound.
Antibiotic course for one week to prevent infection.
Stool softeners for two weeks to avoid constipation and straining.