By Alison Heyerdahl

Childbirth is often described as a marathon rather than a sprint.  It is an endurance event that results in the miracle of a baby.  As a mother, you are so overwhelmed with joy, gratitude, and relief that your baby has finally arrived, you often only notice the aftermath of this process much later on.  Perineal tears are a common occurrence during childbirth.  

What are perineal tears?

Around 9 out of 10 first-time mothers will experience some sort of perineal tear, graze, or episiotomy.  The perineum is the space between the anus and the vagina.  It often tears when the baby’s head is too big to fit through the vagina, or the vagina cannot easily stretch around the baby’s head.  Sometimes your midwife or doctor will suggest an episiotomy before your baby has moved down through the vaginal passage.  An episiotomy is a small incision to make the opening of the vagina a bit wider to accommodate the baby’s head, though they have become far less common in recent years as research has proven they’re often not necessary. 

Types of perineal tears

• First-degree tears: These are minor tears or grazes that affect only the skin of the perineum, vagina, or labia.  First-degree tears generally heal on their own and don’t require any medical intervention.

• Second-degree tears: These tears extend slightly into the perineal muscle.  They often require stitches under a local anesthetic performed by your doctor or midwife.  While they often heal with no problem, they can be very painful.

• Third- and fourth-degree tears: These tears are slightly more serious.  They are often the result of a more traumatic birth but only affect 3.5 out of 100 women.  These tears extend into the muscle of the anus and can affect your ability to control your bowel.  These cases require more serious surgery in an operating room.  

How to care for your perineal tear

• Good hygiene:  If you have experienced a first or second-degree tear, you need only use water to keep the area clean.  Shower or bathe once a day and be sure to change your sanitary pads regularly.  This will help prevent infection.  If you’ve had stitches, you may notice bits of stitches in your sanitary pads.  This is completely normal if your midwife or doctor has used dissolving stitches.

• Sit on a padded donut (or ring) or cushion:  This helps to relieve the pressure on your perineal area and thereby reduce the pain.

• Pour body-temperature water onto your perineal area while urinating.  This will reduce the stinging sensation while urinating.

• Bowel movements:  Bowel movements should not disrupt your healing process.  However, you must ensure that you do not strain during a bowel movement.   Raise your feet on a small footstool, place your elbows on your knees and take deep, relaxing breaths to expel your stool.  You may consider asking your healthcare provider for a laxative to prevent constipation.

• Correct diet and water intake:  Always drink plenty of water (around eight 8-ounce glasses of water per day), and ensure that you eat food with plenty of fiber to keep your bowel movements soft and regular.  High carbohydrate, low fiber diets tend to cause constipation, which can be very painful for a perineal tear.

How long should it take for my perineum to heal?

It is normal to experience a bit of pain and tenderness around the perineal area after giving birth.  Pain can be exacerbated by sitting or walking, but will often subside within a matter of weeks.  First-degree grazes or minor tears usually heal within a week or two after birth, while fourth-degree tears can take up to three weeks to fully resolve.  Healing can be prolonged if an infection occurs at the wound site or if you re-injure the perineum with a difficult bowel movement.  

Follow-up care

Be sure to attend all follow-up appointments with your healthcare provider.  Your doctor or midwife will immediately be able to tell you if your healing is progressing positively.  If you have any concerns or excess pain in the perineal area that lasts longer than expected, be sure to contact your healthcare provider immediately. 

Conclusion

Perineal tears are a common occurrence during childbirth.  It’s important to take good care of your perineal wound, including practicing good hygiene, preventing constipation, eating a healthy diet, drinking plenty of water, and taking steps to ease your pain.  Perineal tears heal within a matter of weeks provided you don’t re-injure the area or succumb to infection, and you should always attend all follow-up appointments to ensure healing is progressing well.