Perineal Tears and Perineal Tear Degrees: An Overview

Of the women who experience pregnancy and childbirth in their lives, most will suffer some sort of trauma to their perineum. Perineal tears can range from a small superficial tear to deep lacerations affecting pelvic floor muscles. Prevalence of perineal tears is almost 60% in women undergoing their first vaginal birth.

Perineal tears happen for many reasons: lack of elasticity in the perineal muscles, overstretching of the perineum without properly softening the muscles, bad management of normal labor, and more.

 

Degrees of perineal tears

Perineal tears fall into four classifications associated with different levels of discomfort or complications. In most cases, perineal tears are moderate and not associated with any serious health complications.

 

Moderate perineal tears

One U.S. study found that first and second-degree perineal tears are the most common complications for vaginal deliveries in the United States.
 
First-degree perineal tears

First degree perineal tears involve the tearing of the superficial surface of the skin lining which is torn during birth. The vaginal lining is disturbed, but no muscles are damaged. The healing of a first-degree perineal tear is straightforward. There is no need for any stitches due to minimal damage to the vagina usually heals naturally within days after childbirth. A woman with a first-degree tear might feel slight discomfort while sneezing or during bowel movements until healing is complete.

Second-degree perineal tears

Second degree perineal tears is associated with damage to the vaginal lining in addition to deep tissue structures such as the submucosal tissues of the vagina. Second-degree perineal tearing usually requires stitches. The recovery process may take a few weeks and includes discomfort in urinating, bowel movements, and sneezing. 

 

Severe perineal tears

Third- and fourth-degree perineal tears are considered severe. According to the Royal College of Obstetricians and Gynecologists in the U.K., this level of tearing occurs in about 3 of 100 women delivering a baby vaginally. Prevalence is three times more common with a first vaginal birth (occurring in 6 out of 100 women compared with 2 in 100 women who have had already had a vaginal childbirth). Data shows that 60–80% of cases are asymptomatic 1 year after childbirth.

Third-degree perineal tears

Third-degree perineal tears are deep and can a woman’s anal sphincter. Stitches and local anesthesia are part of treatment. The recovery process of 3rd degree perineal tears takes longer with pain persisting for weeks to month after childbirth. An extended period of discomfort persists during intercourse, at bowel movements, and when sitting.

Fourth-degree perineal tears

Fouth degree perineal tears are the most significant type perineal injury. It starts from the anal sphincter and extends up to the rectum or anal canal lining. Recovery may take a few months. Woman with 4th degree perineal tears may suffer from fecal incontinence, fecal urgency, pain during intercourse, chronic perineal pain, and fistula formation.

To learn more about the consequences of fourth-degree perineal tears, read:
This Is What It’s Really Like to Have a 4th Degree Tear in Childbirth

 

Reducing the chances of perineal tears during childbirth

Like the rest of childbirth, the type of perineal tear you may endure is mostly unpredictable. But there are a few things you can do to try to prevent tearing during childbirth or to reduce their severity:

Perineal massage in the weeks before labor

Various techniques might help prevent perineal tears, but numerous research studies have reported that perineal massage is the most effective prevention, especially for third- and fourth-degree tears. Perineal massage can be done once or twice a day, and it should be started from the 35th week of pregnancy.

Read: The ultimate guide to perineal massage

Wet warm towels during labor

The other effective technique for preventing perineal tears is the use of a warm wet towel during childbirth to relax the perineal muscles. The warm wet towel must be gently rubbed and also placed over the perineal lining, where it can soften the skin, increasing its flexibility so that it stretches more easily.

Perineal massage during labor

In their latest 2018 guidelines, the World Health Organization (WHO) supports performing a perineal massage during labor to reduce the chances of tearing. During labor, perineal massage is usually done by the midwife by inserting two fingers into the vagina, pressing downwards towards the rectum and moving the fingers side to side at the same time.

Read more about perineal massage during labor

Considering the prevalence of perineal tears, the dire consequences of severe tears, and the ease with which massage can make a difference, it’s worth becoming informed about this simple, proven, and time-honored technique.

March 28, 2021