Pregnancy and childbirth transform your body in so many ways—from stretch marks to larger breasts and broadened hips to hormonal changes. Other changes that aren't as commonly talked about are perineal lacerations, also known as vaginal tearing. While it sounds downright scary, these type of injuries can be very common, affecting 53-79% of women, with the majority of lacerations being minor overall.
"Many women aren't aware of perineal lacerations until it's happening to them,” says Jolyn Hill, MD, director of surgical operations-gynecology at University of Utah Health. “The good news is the vast majority of cases are non-severe and this condition is highly treatable.”
What Is a Perineal Laceration?
Perineal lacerations occur when the baby emerges from the vaginal opening. The severity of the wound is measured in four degrees:
First-degree laceration: The least severe of all, this superficial tear occurs in the skin and tissue of the perineum (the area between the vagina and anus).
Second-degree laceration: This is a slightly deeper tear that involves the skin and muscle of the perineum and may extend into the vagina.
Third-degree laceration: This level of tear goes into the muscle that surrounds the anus (the anal sphincter).
Fourth-degree laceration: The most severe—and thankfully rare—tear extends from the vagina and perineum through the anal sphincter and into the rectum.
How Are These Tears Repaired?
A lot happens in the delivery room—including some stitchwork. Patients with less severe tears will get stitched up with dissolvable sutures after delivery. Recovery time typically takes six to 12 weeks. Third- and fourth-degree tears can also be repaired but could take longer to heal and may require wound care and possibly even surgery.
During the recovery process, Hill advises women to listen to their bodies and to watch for warning signs of infection, which include fever and chills, smelly discharge, inability to sit, and lasting pain.
"Most women do just fine after delivery," Hill says. "But women with third- and fourth-degree lacerations should see their doctors within a couple of weeks to make sure there's no signs of infection."
How Can I Prevent This From Happening?
As with the many lessons of early parenthood, some things just can't be controlled. Perineal lacerations can happen to anyone, no matter the amount of Kegels and Lamaze exercises you do in a day.
"This is just not something you could predict with a crystal ball," Hill says. "A first-time mother could push out a 10-pound baby with forceps without tearing, while a second-time mother delivering a six-pound baby could get a third-degree tear.”
There are, however, some risk factors to keep in mind, which include a first birth, a previous perineal laceration, a large baby, and the use of forceps or a vacuum to assist vaginal delivery.
Prior to delivery, Hill advises expecting mothers to speak with their doctors about their risks and delivery options.
"It’s so important to have a conversation with your doctor and take part in the decision-making process.” Hill says. “Everybody is on their own personal journey, so it's important for women to have that sense of agency and validation.”
How Can I Ease the Pain?
Self-care is key when it comes to healing and pain management. Here are a few things you can do on your road to recovery:
- Take a stool softener or laxative to avoid constipation—which can lead to pain from straining.
- Soak the affected regions in a sitz bath with warm water to reduce pain and swelling.
- Use a handheld water bottle with a spray nozzle (perineal wash bottle) to gently spray water over the wound while peeing to reduce stinging and keep wounds clean.
- Take some over-the-counter anti-inflammatory medications to alleviate the pain.
As for daily activities, Hill advises patients to avoid swimming until the wound heals and to rethink any activity that could derail their progress.
"Listen to your body and use common sense when considering certain activities,” Hill says. “Your body has been through this whirlwind of changes, so be patient and know that it takes time.”