Perineal Tear

Definition - What does Perineal Tear mean?

A perineal tear is a tear in the woman’s perineum (the diamond-shaped area between the vagina and the anus) incurred during a vaginal delivery either spontaneously or during episiotomy. A perineal tear is distinct from an episiotomy which is a surgical incision made in the skin of the perineum to aid vaginal delivery. Doctors routinely used episiotomy in the past, but not anymore, owing to the risk of several complications, in particular, serious perineal tears.

FertilitySmarts explains Perineal Tear

Vaginal delivery puts tremendous pressure on the perineum, which must stretch to fit the baby's head. A baby’s head is relatively large in comparison to the size of the birth canal, putting the perineal soft tissues at risk of trauma during childbirth. The passage of the head causes the soft tissues to overstretch and eventually tear. During delivery, perineal tears are more likely to occur in women:

  • Giving birth to a baby weighing more than 3500 grams
  • Requiring instrumental (forceps or suction) delivery
  • Having a baby inside the uterus with the head in the face-forward position
  • Giving birth for the first time

Other than tearing spontaneously, the perineal soft tissues may also weaken and tear after an episiotomy — otherwise done in an effort to prevent the soft tissues from tearing. Studies show that women with a prior episiotomy have a fourfold increased risk of perineal trauma during a second vaginal birth, most likely due to a weaker or distorted scar tissue.

The Royal College of Obstetricians and Gynecologists classifies perineal tears into four degrees depending on the depth and extent of injury:

  • First-degree tear: Injury to perineal skin and/or vaginal lining.
  • Second-degree tear: Involves the skin and perineal muscles but spare the small muscular rings around the anus (called external and internal anal sphincters) that narrow to prevent any poop leakage. A classical episiotomy procedure cuts the skin and muscle and the resulting tear thus fits into this category. This cut/tear requires stitches that - in uncomplicated cases - take about two to three weeks to heal. The pain associated with these types of tears usually lasts for a few weeks.
  • Third-degree tear: Injury to perineum involving the anal sphincter. Further subdivided into:
    • 1. Grade 3a tear: The tear involves less than 50% of the external anal sphincter.
    • 2. Grade 3b tear: More than 50% of the thickness torn.
    • 3. Grade 3c tear: Both anal sphincters are torn.
  • Fourth-degree tear: Injury to perineum involving the anal sphincter and extending into the lining of the anal canal as well as vaginal lining. Women with third-and fourth-degree tears are likely to experience discomfort for a longer period.

The deeper a perineal tear, the greater is the likelihood for long-term complications. Massage and warm compresses may help minimize the chances of serious perineal trauma (third- and fourth-degree tears).

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