During vaginal childbirth, the body undergoes significant stretching, and it is common for some degree of tearing to occur in the perineum, the area between the vagina and the anus. Tears vary in severity, from minor skin abrasions to more extensive injuries involving muscle. While many tears are superficial and heal readily, some can be more complex, extending deeper into surrounding tissues. This article focuses on third-degree tears, a type of perineal injury that involves muscles important for bowel control.
Understanding 3rd Degree Tears
A third-degree tear is a perineal laceration that extends through the skin and vaginal tissues, affecting the muscles of the anal sphincter complex. This muscle group, which includes both the external and internal anal sphincters, plays a role in controlling bowel movements and gas. Such tears are classified as third-degree injuries.
These tears are further sub-classified based on how much of the anal sphincter is involved. A 3a tear affects less than 50% of the external anal sphincter, while a 3b tear involves more than 50%. A 3c tear extends through both the external and internal anal sphincters. Third-degree tears occur in about 3 out of every 100 vaginal births.
The Repair Process and Stitches
Repairing a third-degree tear typically occurs soon after delivery, often in the delivery room or an operating room, depending on the tear’s complexity and the need for optimal lighting and equipment. An obstetrician or surgeon performs the repair under appropriate anesthesia, which may include an epidural, spinal anesthesia, or local anesthetic. The goal is to meticulously reconstruct the torn tissues and muscles to restore their function and anatomy.
The repair involves a layered approach, rather than a fixed number of stitches. The surgeon first identifies and carefully brings together the torn ends of the anal sphincter muscles using fine, dissolvable sutures. This internal layer of stitching is crucial for restoring muscle integrity and preventing long-term issues with bowel control. Subsequent layers of stitches are then placed to repair the vaginal mucosa, the perineal muscles, and finally, the perineal skin.
All stitches are absorbable or dissolvable, naturally breaking down within several weeks, usually six. This eliminates the need for removal appointments. The precise number of stitches varies significantly based on the tear’s length, depth, and specific involvement of muscle layers, emphasizing that it is a tailored surgical reconstruction rather than a standardized count.
Post-Repair Care and Healing
After a third-degree tear repair, managing pain and promoting proper healing are important aspects of recovery. Pain relief can be achieved through various methods, including ice packs applied to the perineum for 20-30 minutes every few hours, and prescribed pain medication. Gentle hygiene practices are also recommended, such as using a peri bottle with warm water to rinse the area after urination or bowel movements, and patting the area dry instead of wiping vigorously. Regular changing of sanitary pads, at least every three to four hours, helps maintain cleanliness and reduce infection risk.
Bowel care is a significant focus to prevent straining, which could put pressure on the healing stitches. Healthcare providers often recommend stool softeners and dietary adjustments to ensure soft bowel movements. It is advised to avoid constipation and heavy lifting during the initial healing period. Pelvic floor exercises, started gently a day or two after birth, can help stimulate blood flow to the area and support healing, gradually increasing in intensity as comfort allows. Soreness may persist for four to six weeks.
Potential Complications and Long-Term Outlook
While most women heal well after a third-degree tear repair, complications can arise. These may include wound infection, which can present as increased pain, redness, foul-smelling discharge, or fever. Occasionally, the repaired wound may break down, requiring further medical attention. Some women experience persistent pain, including pain during intercourse, known as dyspareunia.
Less commonly, issues with bowel control can occur, such as difficulty controlling gas or accidental leakage of stool (fecal incontinence). If any of these symptoms develop or persist, seeking medical advice is important. Most women make a full recovery without severe long-term problems. For future pregnancies, a vaginal birth is often recommended, though the risk of a repeat third- or fourth-degree tear is slightly higher.