• Reference Number: HEY-489/2023
• Departments: Maternity Services
• Last Updated: 25 January 2023

Introduction

This leaflet has been produced to give you general information about your perineal tear.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor or midwife, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of your healthcare team caring for you.

What is a perineal tear or episiotomy?

As your baby is being delivered a tear can occur. A tear involves the skin and muscle of the perineum which is the area between your vagina and back passage (anus). A tear can also occur inside your vagina and in the labia (lips of the vagina).

An episiotomy is a cut made through the vagina wall and the perineum to allow more space for delivery of your baby. Before the procedure can take place a doctor or midwife will talk you through the procedure and they will need to gain your permission to undertake the procedure (gain your consent).

Why do I have a tear or episiotomy?

As the baby is born it stretches the skin and muscle on the inside and outside of the vagina, and it is common for women to sustain a tear at this time during the birth (9 women in 10 will have some type of tear).

How will I find out if I have a tear?

After the birth of your baby the doctor or midwife will check to see if you have a tear, or look at the episiotomy. They will then let you know what type of tear it is (see below) and if it needs suturing (requires stitches) or not. This will prevent bleeding and help you heal properly. The doctor or midwife will discuss this with you.

There are different types of perineal tears (we refer to them as degrees):

• First degree: A superficial tear of just the vaginal tissue and/or perineal skin.
• Second degree: Involves the vaginal tissue, perineal skin and perineal muscles.
• Third degree: A tear in the vaginal tissue, perineal skin, and perineal muscles that extends into the anal sphincter (the muscle that surrounds the anus).
• Fourth-degree: Tear goes through the anal sphincter and the tissue underneath it (anus/rectum – the lowermost part of the bowel).
• Labial Tears: Tear in the lips of the vagina.

How is the tear repaired?

This usually takes place in the room where you gave birth or in theatre.

• An episiotomy requires suturing (stitching).
• A first degree tear may require suturing or may be left to heal naturally.
• Labia tear may require suturing under the effect of a local anaesthetic.
• A second degree tear requires suturing of the muscles and the skin under a local anaesthetic.
• Third and fourth degree tears are usually repaired in theatre under a more effective anaesthetic such as spinal, epidural or general anaesthetic to prevent bleeding and help you heal properly.

All of the above will be repaired with dissolvable sutures so they do not need to be removed. They start to dissolve in 10 -14 days as the perineum should have healed by this time. Some sutures can take up to 6 -12 weeks to completely dissolve.

Care for your wound or painful perineum?

The staff will ask to inspect your tear / episiotomy on the ward, and when you return home.  We would strongly advise that you consent to this review, as the Midwife will look for signs of healing or infection.

Below are some important points to remember:

• Avoid standing or sitting for long periods.
• Wear breathable materials, like cotton and disposable briefs, and avoid tight clothing.
• Begin doing your pelvic floor exercises as soon as you can after the birth this will increase the blood supply and help with healing.
• Drink plenty of water at least eight glasses a day, to dilute your urine.
• Ensure you are comfortable when sitting to feed your baby, you may find it more comfortable feeding on your side.

To help with discomfort:

• You can use cold/ice packs. Do not apply directly onto the skin always wrap in a cloth/flannel and apply for 30 minutes every so often throughout the first few days.
• Take regular pain relief medication for the first two to three days if required. Paracetamol and ibuprofen are both safe while breast feeding but make sure you read and understand the label.
• You may find it helpful to pour body temperature warm water over your perineum during and after passing urine, to help reduce the stinging or use a shower head or bidet.

It is important to keep this area clean:

• Wash your hands before as well as after using the toilet.
• Wash your perineum after every visit to the toilet.
• Just pat/wipe the area dry with toilet paper. Always wipe, front to back to avoid contamination from your back passage.
• Change your sanitary towel regularly, at least every four hours. Ensure it is secured in place so it does not move around and cause further irritation.
• Use plain water to clean this area, you can have a bath or shower as usual and you may find this soothing. You do not need to add anything special to your bath to help with healing.

Having your bowels open:

• When having your bowels open hold a clean sanitary towel against your perineum/stiches to protect them and to stop you feeling that your stiches will split.
• To avoid putting strain on your wound, eat a high fibre diet (fruit, vegetables and brown bread) and remember to drink plenty of water.
• If you are unable to open your bowels obtain some medicine to soften your stools.

Can there be any complications or risks?

If you have any of the following, speak to a health care professional:

• If you start to feel unwell or have a temperature.
• You have a smelly discharge.
• Your stitches are coming apart and the tear is not healing.
• The area starts to throb or starts to swell.
• You have problems controlling your urine or you can not control your back passage.

When can I have sex?

It is best to resume sex after your stiches have healed and your bleeding has stopped but there is no right or wrong time. For some people it is within a few weeks but for others it can be when they feel ready.

Things to think about:

• Do not forget you can become pregnant the first time you have sex after the birth of your baby, it is advised you use contraception.
• Make sure you talk to your partner about resuming sex and when you start, start gently.
• You may find it helpful to use a lubricating jelly.
• You may feel some discomfort for the first few times whether you had stitches or not.
• It will feel different following the birth of a baby.
• Different positions may make it more comfortable.
• If the pain continues discuss this with your doctor.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Community Midwives on telephone number: (01482) 382658.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.