(Perineal Lacerations; Tears, Vaginal)
Vaginal tears are rips in the skin and muscle above or near the vaginal opening. Tears most commonly occur in the perineum. The perineum is the region between the anus and the opening of the vagina. There are four degrees of vaginal tears:
- First and second degree tears—most easily repaired
- Third and fourth degree tears—require more complex repairs since they are larger, deeper, and involve muscle tissue
This serious condition is not common. When it occurs, it is usually during vaginal birth]]> .
Vaginal tears may be caused by any of the following:
- The baby’s head is too large to easily fit though the vaginal opening.
- The baby is in a breech]]> position and is coming down the birth canal feet first or buttocks first.
- Labor has happened too quickly, and the perineum has not had time to stretch slowly.
- The mother is unable to control her pushing.
If you are a very small woman carrying a very large baby, your doctor will be aware of this risk before you deliver your baby. She will be able to help you.
Tell your doctor if you have any of these risk factors:
- Having a very large baby
- Having a very small frame, particularly in the pelvic area
- Having a baby for the first time
- Having had the condition before
There are usually no symptoms of vaginal tears. A sign might be may be increased bleeding from the vagina.
Your doctor will be with you during labor and will see any tearing if it happens. The seriousness will be based on the size of the tears and what muscles are affected. If the doctor thinks you may tear, she may recommend an episiotomy]]> . This is a surgical incision of the perineum. An episiotomy will make the vaginal opening temporarily larger so that the baby does not tear the vagina or its surrounding muscles.
Talk with your doctor about the best treatment plan for you. Treatment options:
First degree tears are superficial. They often do not require stitches and will heal naturally. Second degree tears are deeper into the tissues, require a few stitches, and then heal well afterward. Third degree tears involve the rectal muscles, and fourth degree tears enter into the rectum. These tears require more time and stitches to repair. In rare cases of abnormal healing, additional surgery is sometimes needed to repair significant tears.
Stitches to Repair Third Degree Tear
Other treatments that can be used at home to lessen the pain of the stitches include :
- Nonsteroidal anti-inflammatory drugs (eg, ibuprofen]]> )—Doctors usually recommend ibuprofen for any pain following stitches. If the pain continues even with the ibuprofen, contact your doctor.
- Warm baths—Sitting in a warm bath that only covers hips and buttocks can sometimes help; this is sometimes called a sitz bath.
- Ice or witch hazel pads—Ice wrapped in a cloth or chilled witch hazel pads applied to the area are sometimes used to dull the pain.
If you are diagnosed with vaginal tears, follow your doctor's instructions .
To help reduce your chance of getting vaginal tears, take the following steps:
- Perineal massage—You or your partner can begin to massage the perineum with fingers and a lubricating jelly, like K-Y Jelly, when you are 34 weeks pregnant. After that, it should be done every day. This action will soften and smooth the skin and may help it to stretch more easily during labor.
- Kegel exercises]]> —Contract and hold the muscles of your pelvic floor. These are the same muscles you use to stop the flow of urine. Practice contracting, holding, and slowly releasing these muscles to strengthen them.
- Practice good nutrition—Healthy skin stretches more easily.
- A slow second stage of labor—Controlled pushing allows the perineum to stretch slowly.
The American College of Obstetricians and Gynecologists
Women's Health Matters
Benefits and risks of episiotomy: a review of the English–language literature since 1980. Gentlebirth.org website. Available at: http://www.gentlebirth.org/format/woolley.html . Accessed August 9, 2005.
Episiotomy: a cut you may not need. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?id=HO00064 . Accessed August 9, 2005.
Managing complications in pregnancy and childbirth: repair of vaginal and perineal tears. World Health Organization website. Available at: http://www.who.int/reproductive-health/impac/Procedures/Repair_vaginal_P83_P90.html . Published 2003. Accessed July 11, 2008.
Repair of obstetric perineal lacerations. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20031015/1585.html . Accessed August 9, 2005.
Last reviewed February 2009 by ]]>Ganson Purcell Jr., MD, FACOG, FACPE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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