I had a bad vaginal tear in my last pregnancy…

Small tears in the vagina or perineum are common during birth.  Most tears can be repaired easily with a few stitches and will heal very well.  However, some women have more serious tearing.

Following a serious tear, a number of women will experience long-term side effects.  Bad tears also have implications for the next birth.  It’s important to discuss this with an experienced obstetrician.  I previously spent 3 years helping to co-ordinate a specialised perineal trauma follow-up clinic in Sydney, so this is an area of special interest for me.

What’s the perineum?

The perineum is the area between the vagina and anus.  It is made up of muscle, skin and other tissues.  Usually, when women talk about having a bad vaginal tear, the perineum was also involved.

Perineum - Dr Colin Walsh

Types of tears

A tear in the perineum is graded from 1st degree through to 4th degree, depending on how bad it is.

  • 1st degree tears involve the skin and 2nd degree tears involve the skin plus the perineal muscles.  These tears are common and can be repaired fairly easily.  The majority of women with 1st and 2nd degree tears will recover well, with no long-term problems.
  • 3rd degree tears extend from the vagina into, or through, the anal sphincter (the circle of muscle around the anus).
  • 4th degree tears go through the sphincter and all the way into the anus.

Why is the anal sphincter important?

The anal sphincter gives you control over your bowels.  If it is damaged, you can become incontinent, meaning you leak faeces or wind.  If the anal sphincter is torn, it has to be stitched back together and then protected from over-stretching and infection while it heals.  It’s very common to experience pain, a feeling of urgency, and leaking of wind or faeces while the sphincter is healing.  The good news is that 60-80% of women will fully recover within 12 months.  However, this still leaves a significant number of women with long-term symptoms that can affect their quality of life.

How common are 3rd and 4th degree tears?

Overall, 3rd and 4th degree tears occur in around 3-4% of vaginal births.

Am I at higher risk for my next birth?

Yes, slightly.  Women with a previous 3rd degree tear have approximately double the risk of another 3rd degree tear with their next baby.  However, even doubling the risk means that 90%+ of women with a previous 3rd degree tear will have a very straight-forward delivery requiring minimal stitches in their next pregnancy.

What additional treatment do you recommend in the next pregnancy?

Usually, no extra treatment is required during the next pregnancy.  It may be helpful to organise specialised testing of the sphincter muscle if this has not previously been performed.

The main decision relates to the mode of delivery for the next baby – in other words, vaginal delivery versus caesarean section.  In general, caesarean section is reserved for women with a very complex 3rd degree tear or who have persistent problems with bowel control since their last baby.  Vaginal delivery is the better option for most women with a previous 3rd degree tear.  Ultimately, your individual circumstances and preferences will help make the decision.