It can be helpful to be prepared for some of the more challenging symptoms associated with childbirth, to ensure that you feel confident to handle these situations should they arise. This article will review vaginal and perineal tears.
Vaginal and perineal tears
It is not uncommon for those who give birth vaginally to experience a tear, which are classified as either 1st, 2nd, 3rd, or 4th degree tears. Tap here for a digital image of the difference between these tears.
1st and 2nd degree tears
A 1st degree tear impacts the perineal skin only whereas a second-degree tear impacts the skin and muscles of the perineum — as well as the vagina in most cases. In the case of 1st and 2nd degree tears, you may experience a stinging sensation or mild pain in the weeks after giving birth. In most cases, 2nd degree tears will require stitches.
You may experience vaginal and/or perineal soreness in the weeks after childbirth. You can expedite the healing process by applying ice packs and sitting carefully on soft cushions. Washing your private areas with warm water during and after you use the toilet may also help relieve some of the discomfort. Squirt bottles may help. Sitz baths are also a great option (more on this below)
Trouble with urination
In the days after birth you may feel a burning sensation and/or pain from lacerations around or close to the urethra. Childbirth can also affect the tissue around your urethra and bladder, which might mean you’re peeing too much or not enough. Look for signs of urinary tract infections, specifically pain during urination or unusually frequent trips to the bathroom.
Leaking urine is common for up to 3 months after delivery, so doing kegels to tighten your pelvic muscles is always a good idea. You should call your healthcare provider if you feel you aren’t urinating enough or if you’re concerned about urine leakage.
Obstetric anal sphincter injuries (OASIS)
3rd and 4th degree tears are considered obstetric anal sphincter injuries and require repair. The anal sphincters are the muscles that wrap around the anus and allow you to control gas and BM. Damage to them occurs in about 1-11% of deliveries and can be painful.
OASIS risk factors
There are pre-existing risk factors for OASIS such as giving birth for the first time, infant weight over 8.8 pounds, Asian ethnicity, family history, and a perineum length of less than 2.5 cm.
During labor, chances of OASIS increase when:
- Labor is induced or augmented
- An epidural is used
- The baby is in occiput posterior position, meaning facing up while you’re on your back
- If pushing lasts for longer than 60 minutes
But the highest predictors of OASIS are midline episiotomies and deliveries in which a vacuum, forceps or another device is used.
There are things you and your provider can do to limit your risk of having a severe tear, like perineal massage (tap here to learn how to do it) and applying warm compresses during labor.
Treatment options and recommendations
There are many treatment options for those who experience OASIS. A bowel regimen, including a fiber supplement and a stool softener, is strongly recommended for 3rd and 4th degree tears and sitz baths are recommended for everyone.
A common way to soothe private parts after birth is with a sitz bath. You can either take a sitz bath in a bathtub or use a sitz bath bowl. Sitz baths involve exposing your perineum to warm water, medication or salt may also be added depending on what your provider recommends. You can find more information on how to take a sitz bath here.
If you have stitches from a tear, your recovery will be a bit more painful. There are things you can do to reduce discomfort like applying ice packs and keeping the area clean with squirt bottles and cotton soaked with witch hazel. You can also find pre-soaked witch hazel pads (usually marketed for hemorrhoid relief). Chill them in the refrigerator or freezer for a soothing cooling effect.
It can be scary to think about vaginal and perineal tears before you give birth, but keep in mind that OASIS are uncommon and should you experience one, there are trained healthcare providers — including obstetricians and urogynecologists — to guide you at every step. There are also designated postpartum clinics to treat women with obstetric trauma.
This content was reviewed by Dr. Lisa Hickman and Dr. Katie Propst. Dr. Hickman runs the Childbirth Pelvic Floor Disorders Clinic at The Ohio State University Wexner Medical Center. Dr. Propst runs the Postpartum Care Clinic at Cleveland Clinic.
- By Lisa Hickman, MD, and Beri Ridgeway, MD. “Why Ob/Gyns Should Care About OASIS.” Cleveland Clinic. Cleveland Clinic. May 31, 2018. https://consultqd.clevelandclinic.org/why-ob-gyns-should-care-about-oasis/.
- “Vaginal Tears in Childbirth.” Mayo Clinic. Mayo Clinic. October 11, 2019. https://www.mayoclinic.org/healthy-lifestyle/labor-and-delivery/multimedia/vaginal-tears/sls-20077129?s=2.