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For some women, less than 3 in 100 (3%), the tear may be more extensive. This may be:
Could anything have been done to prevent it?
A third or fourth degree tear cannot be prevented in most situations because it cannot be anticipated. Factors associated with an increased chance of a third degree tear include adopting a lithotomy position of the delivery, forceps delivery and delivery on a birth stool. Research has shown that, although an episiotomy makes more space for the baby to be born, it does not prevent a third or fourth degree tear from occurring.
You could consider perineal massage during pregnancy in order to reduce the possibility/severity of a perineal tear. Please click here for more information.
What happens after birth?
If your obstetrician or midwife suspects a third or fourth degree tear you will have a detailed examination of your perineum and anus. The obstetrician will confirm the extent of the tear and provide you with information about surgical repair and treatment. You will need an anaesthetic. This is usually an epidural or a spinal on rare occasions this may be a general anaesthetic. The obstetrician will then suture (stitch) the damaged anal sphincter and the tear in an operating theatre. This will be performed soon after the birth of your baby.
What treatment will I be offered after surgical repair?
When you leave theatre you will have a drip in your arm and a catheter (tube) in your bladder. The drip will give you fluids until you are able to eat and drink and the catheter in your bladder will collect urine until you feel able to walk to the toilet.
None of the treatments offered will prevent you from breastfeeding.
What can I do to speed up healing of the tear?
Signs of infection – what to look out for
The following can all be signs of an infection. Be aware of your perineum and if you start to experience any of the following, let your midwife of GP know so that appropriate treatment can be given:
What are the long-term effects of a third- or fourth-degree tear?
Most women make a good recovery, particularly if the tear is recognised and repaired at the time. During the first month some women may experience all of the below:
Very rarely, you may develop a fistula (hole) between your anus and vagina after the tear has healed. This can be repaired by further surgery.
Contact your midwife or GP if:
A follow-up appointment at the hospital (3 months after you have given birth) is automatically arranged for all women who have experienced a 3a, 3b, 3c or 4th degree tear, in addition to this if you are experiencing problems with your bowel function following any type of tear please inform your GP who will arrange a referral to be made.
At the appointment you will see a uro-gynaecologist. You will be asked questions specifically about your bladder and bowel function, and an endoanal ultrasound may be required. If there are any complications, you may be referred to the physiotherapist or the colorectal surgeons.
This appointment offers you the opportunity to discuss any concerns that you may have, such as sexual intercourse.
Can I have a vaginal birth in the future?
Most women will be recommened to plan a vaginal delivery after a previous third- or fourth- degree tear. This advice will be based on a number of factors which your obstetrician will discuss with you at your follow-up appointment or early in your next pregnancy.
If your tear has healed completely and you do not have any symptoms, then you should be able to have a vaginal birth. However, if you continue to experience symptoms from the third- or fourth-degree tear, you may want to consider a caesarean delivery.
I am experiencing pain and problems with my bowels, what should i do?
If you find you are suffering from perineal pain or bowel problems (such as bowel incontinence, bleeding/pain when opening your bowels) please discuss this with your community midwife. If they have discharged you from their care, you will need to see your GP.
What is normal bowel function?
Please complete a short questionnaire at 3 months postnatal (from the birth) to understand when symptoms may be outside of the normal.