Perineal Tear Repair

What is a Perineal Tear?

The perineum is the area between the vagina and the opening of the anus. A tear in the perineum area may occur when the skin does not stretch during childbirth. Majority of women experience perineum tear when the baby needs more space to be born. Tears can occur around the vaginal area, labia, inside the vagina and anus. Episiotomy is when a doctor or midwife makes a deliberate cut in the perineum to provide extra space for delivery. It is common is first-time vaginal delivery and in emergency situations, when the baby is in distress. This is not recommended or required during most childbirths.

Perineal Tear Repair in Delhi

After childbirth, the perineum may need stitching depending on the severity of tears. Small tears do not require stitches and may heal naturally. Perineal tears are repaired in women with larger tears or those with episiotomy cuts. Stitches hold the muscles and skin together and also prevent further bleeding. Dissolvable stitches are used that do not require removal. These will dissolve in ten days and will six to seven weeks to completely disappear. The patient will experience pain and difficulty in passing urine and bowel movements but will improve after a few days. A patient should regularly examine the stitches to ensure healing. Consult a surgeon if you notice a smell, leakage or swelling in the perineal area along with extreme pain as it may be a sign of infection.

Types of Perineal Tears

Perineal tears are classified into four types depending on size, deepness and areas involved:

• First-degree tears are skin deep and don’t usually require stitches. They heal naturally.
• Second-degree tears are deeper into perineal muscles. These will require stitches and will take two to three weeks to heal.
• Third-degree tears involve muscle and skin around perineum and anus.
• Fourth-degree tears are more severe than the third degree and include tears inside the anus.

Common risk factors for perineal tears are long hours of pushing, a posterior position of the baby, assisted delivery (using forceps), large baby, first vaginal delivery, Asian ethnicity, induced labor, the second stage of labor and previous instances of a third- or fourth-degree tear.

Women with third- and fourth-degree tears can experience pain while defecating and during sexual intercourse. A urogynecologist needs to assess those with severe wounds as colorectal surgery may be required in some patients.

Recovering from Perineal Tears

• Following hygiene instructions.
• Keep perineum area clean to avoid infection.
• Use warm water to clean the perineum after every visit to the toilet.
• Do not rub the perineal area while washing, wipe it gently with soft paper tissues.
• Change your sanitary pads frequently to reduce the risk of infections.
• Don’t use too much pressure during bowel movements.
• Avoid constipation. Your physician will prescribe stool softeners and laxatives. Try to consume more fluids and food that is rich in fiber.
• Exercises to strengthen pelvic floor muscles can help in healing. Women should start these exercises soon after the childbirth in addition to physiotherapy.
• Your physician will schedule a follow-up appointment six weeks after the childbirth. He will also assess recovery and wound healing and discuss further management if needed.

How to Ease Pain?

• Use ice packs on the affected area for comfort. Make sure that ice pack is not in direct contact with the skin.
• Your physician will prescribe painkillers to help with the pain and swelling.
• Use Local anesthetic cream or spray for severe pain.
• Take a warm bath with aromatherapy oil to ease the pain.
• Avoid physical activities that will stress your body.

When to Contact a Physician?

• If your pain is becoming unmanageable.
• If you have a fever that does not go away.
• If your stitches are not healing or if they have a smelly discharge.
• If you cannot control your bowel and there is a constant need to visit the toilet.
• If you have other concerns related to recovery and management.

Suggestions for Future Delivery

Women who heal completely from third- and fourth-degree tears may give birth vaginally, but there is a higher chance of a perineal tear. If perineal tears are not healed completely then the physician may choose to do a cesarean section to reduce the risk of future problems.

Perineal Tear can be repaired with the help of Plastic surgery by an expert and senior plastic surgeon, Dr. Kaushik specializes in Genital surgeries and can help you with Perineal Tear Repair Surgery here in Delhi. Schedule a consultation with him right now.