The perineum is the area of tissue between your anus and vagina. When you deliver a baby vaginally, it’s possible for this area to tear. Some tears are tiny and can heal on their own without stitches, while others may require suturing.
Board-certified OB/GYN Kelly Morales, MD, FACOG, and our team at Willow OB/GYN in San Antonio, Texas, know that the idea of a perineal tear can be scary — and sometimes more uncomfortable than the tear itself.
Knowing what to expect as you recover from this common childbirth injury can help. Here’s a closer look at perineal tears and how you can care for yourself as you recover.
Perineal tears are one of the most common vaginal injuries that can occur when you deliver your baby. As your body gets ready for childbirth, the skin near your vagina thins so that it can stretch to deliver your baby.
But in some cases, the skin doesn’t become flexible enough to accommodate your baby’s head. When this happens, the tissues around your vagina can tear. This is more likely if:
To avoid a tear, some doctors may make a surgical cut, called an episiotomy, which makes the opening of the vagina larger.
Not all perineal tears are the same. Like burns, perineal tears are rated by degree based on how severe they are:
Your recovery from a perineal tear depends on how severe your tear is and whether it required stitches. Here’s a look at what you can expect depending on the degree of tear.
Generally, women with first-degree perineal tears heal quickly and have minimal discomfort. Most of the time, these tears don’t require stitches.
You might notice some mild stinging or pain when you urinate. You can ease this discomfort by drinking plenty of water and using a peri-bottle (squirt bottle for your perineum) to clean the area with warm water after you use the restroom.
Most women with first-degree tears feel better in a week or two, though full healing after childbirth takes about 4-6 weeks.
If you have a second-degree perineal tear, you can expect a similar recovery as women with first-degree tears. You’ll probably have stitches and will need to use a peri-bottle to keep the area clean after urinating and moving your bowels.
You might also have some perineal swelling. In addition to staying hydrated and doing your best to avoid becoming constipated, which can make going to the bathroom more painful on your perineum, you can use an ice pack to help minimize pain and/or swelling.
Like first-degree tears, you should feel better after about two weeks and fully recovered after about a month.
Third- and fourth-degree perineal tears extend into the muscles around your anus and your rectal lining.
Closing these tears is a more involved process and requires each layer of the tear to be stitched separately. This leads to more side effects and a longer recovery.
If you have a third- or fourth-degree perineal tear, it can make going to the bathroom after childbirth more difficult and may cause you to leak stool. Some women find the pain or discomfort the injury causes make it difficult to move around.
You can take pain-relieving medicines, like acetaminophen. And Dr. Morales most likely will prescribe antibiotics to reduce your risk of infection. She may also recommend a stool softener or laxative to keep you more comfortable.
Since your muscles are affected by these more severe perineal tears, you may also benefit from physical therapy as you recover. Every woman is different, so Dr. Morales makes personalized recommendations to help you recover fully, which typically takes about six weeks.
Are you worried about perineal tears or want more details about what to expect as you recover? Talk to Dr. Morales by scheduling an appointment at Willow OB/GYN in San Antonio, Texas.