Congratulations! You just had your baby and you’re riding that birth high… and then you deliver your placenta and your care provider is checking for tears and you find out you have a 3rd or 4th degree tear. Ouch.
Let’s talk a little bit about vaginal tears in general. A vaginal tear (also called a perineal tear or laceration) occurs in childbirth when a baby’s head is coming out of the vaginal opening and is either too big, or the vaginal tissue doesn’t stretch easily, causing a vaginal tear.
Tears are rated in degrees of severity from 1 to 4. A first degree tear only involves the perineal skin. A second degree tear involves the skin and the muscles of the perineum and may extend deep into the muscles of the vagina. A 3rd degree tear involves the muscles around the anal sphincter. And a 4th degree tear is the most severe and the tear extends through the anal sphincter and into the rectum.
3rd and 4th degree tears need to be repaired by an obstetrician and may also be repaired under anesthesia in an operating room.
So once your tear is repaired properly what can you expect? How can you get comfortable? I actually had a 4th degree tear with my first baby, and a 3rd degree tear with my second baby, so I feel like I have some wisdom to share with you all. First of all, your bottom is going to be uncomfortable and swollen. Take your pain meds regularly. Especially your NSAIDs (ibuprofen or advil) as their job is to help control inflammation.
Try changing positions frequently. Sitting up in one position can be painful as there is a lot of pressure on your vagina. Leaning back, side-lying, even standing up can really help with your comfort.
Take your stool softeners. The very last thing you want to do is be straining with a bowel movement and putting any extra strain on those stitches down below. Continue to take those stool softeners for a few weeks, just to give everything a good chance to heal without putting any additional strain on your stitches.
Taking a small bath with epsom salts can really help with healing, and keeping everything clean. Just fill up your bath tub with warm water, just enough water to get up to your hips and sit for at least 5 minutes. Use your peri-bottle when you go pee the rest of the time, just to help keep everything clean and free from infection.
Ice pads, tea bag pads or “padiscles” are all great ways to help provide comfort to healing perineum. Ice pads are just normal pads that you get wet with water, and then place them in the freezer and use them as needed. Ice can help decrease inflammation, and it feels nice to help relieve some of that swelling. Padsicles are pads made out of 1 tbsp of aloe vera, 4 tbsp witch hazel and lavender (steep 1 cup of lavender tea for 20-30 min) and then mix everything together and place mixture on each pad until wet, but not soaked and place in the freezer to help soothe your bottom after that painful tear. Tea bag pads are normal black tea bags that you just get wet under warm tap water and place them on your pad and the tannins in the tea are said to have healing properties. Personally, I found alternating between ice pads and warm tea pads quite nice, as sometimes you don’t always want to have ice on your bottom.
Pelvic Floor Physiotherapy is a must after these tears. I think that pelvic floor physio should be done after all childbirth, but especially if you are recovering from a severe tear. Pelvic Floor Physio’s are really the experts in making sure you are healing your body from your deep core out, and can help make sure that you are engaging all your muscles appropriately and can help prevent urinary or bowel incontinence.
Some discomfort is normal, but if you are experiencing severe pain, having issues with fecal incontinence or painful sexual intercourse, please speak with your healthcare provider as there may be a more serious complication.
I’d love to know what worked well for you with your perineal tear recovery, or what didn’t work well. Remember your local mama coach is here to help you with any newborn concerns that you may have.