Obstetric Vaginal Tears

What are Vaginal Tears?

The skin between the vagina and anus is made to stretch during labor.  But very often this tissue tears during delivery. The area may need to be repaired using stitches that dissolve. There are four main types of vaginal tears:

• First degree: vaginal skin only
• Second degree: vagina, perineal skin and underlying perineal muscle
• Third degree: vagina, perineal skin, perineal muscle, and anal sphincter muscle
• Fourth degree: vagina, perineal skin, perineal muscle, anal sphincter muscle, and the rectum

First and second-degree tears are more common. Third and fourth-degree tears are more severe and referred to as obstetric anal sphincter injuries (OASIS). Most tears are repaired in the delivery room. Sometimes the tear is repaired in the operating room.

What Should I Expect After the Repair of my Vaginal Tear?

The stitches used to repair the tear will dissolve with time. You do not need to see your doctor for stitch removal.  Your doctor may want to see you before your postpartum visit. This is to make sure you are healing well, especially if you had an OASIS.

Vaginal bleeding, mild itching, and soreness is expected. To help with healing, your doctor may recommend:

• Prescription pain medication other than Tylenol® or Motrin®
• Sitz bath or use of a peri-bottle to clean the area with warm water after using the bathroom
• Stool softeners or laxatives to reduce pressure on the healing area
• Nothing in the vagina for a time to allow healing

What Problems May Happen?

Some women have trouble healing or develop new problems after a vaginal tear.

• Trouble emptying your bladder completely
• Blood collection in the area around the wound
• Infection
• The stitches come apart
• An opening between the rectum and vagina

When Should I Call the OB/GYN Doctor?

Call right away if you have any of these problems:

• Increased vaginal or perineal pain
• Foul smelling discharge from the vagina or perineum
• Gas coming from your vagina
• Stool coming from your vagina

What Should I Expect After an (OASIS) Repair?

Most women heal well from this type of tear. Some women have trouble with wound healing after an OASIS. Damage to the anal sphincter muscle may affect your ability to control gas and stool after the repair or later in life. Your doctor will give you special instructions to take care of the wound. They will tell you things to look out for during wound healing.

It is important to follow these steps to help wound healing:

• Keep the area clean and dry
• Avoid cleaning with soaps. Do not douche.
• Use a laxative such as Miralax® to keep the stool soft. Do not strain.
• Avoid heavy lifting or strenuous activity
• Avoid tight-fitting clothing
• See your doctor 1-2 weeks after discharge
• Follow up with specialist, if recommended
  • A Urogynecologist specializes in the management of OASIS healing and complications

How Will This Problem Affect Future Pregnancies?

Since most women heal well from vaginal tears, a vaginal birth is possible for future pregnancies. You may not tear with future pregnancies, or the tear may not be as severe.

If you had a severe tear that did not heal well or had more trouble after the repair, please talk to your OB/GYN. A c-section may be a better option for you.

Ways to reduce your risk of vaginal tears in future pregnancies include:

• Avoid the use of a vacuum or forceps to help with vaginal delivery, if possible
• Have a slow and controlled vaginal birth to allow the perineum to stretch
• Apply a warm compress to the perineum during labor

If you have any questions, be sure to talk to your OB/GYN. Ask for a referral to a specialist if you are not healing well or develop urinary or bowel symptoms.