Perineal tear Tīhaetanga ā-tero

Your perineum (the area between your vagina and anus) can tear when it stretches during birth. 

There is an increased risk for women who:

• are having their first vaginal birth
• have a long pushing phase of their labour (over 2 hours)
• need a forceps or ventouse (suction) birth
• have a large pēpi
• have the baby's shoulder stuck behind their pubic bone (shoulder dystocia)
• have an induced labour.

Perineal tears are described by how severe they are.

• First degree tears are small tears of just the skin and do not usually need stitches.
• Second degree tears are deeper and affect the muscle as well as the skin and need stitches to be repaired. These are the most common type of tear.
• Third degree tears involve tearing of the vaginal wall and the anal sphincter (the muscle that controls the back passage). This type of tear is rare.
• Fourth degree tears extend to the lining of the back passage, or anus. This is very rare.

An episiotomy is when your midwife or doctor makes a small cut in your perineum to make it easier for your pēpi to be born. 

An episiotomy may be offered if: 

• your pēpi is in distress (not getting enough oxygen)
• you are in distress and this is slowing the birth
• your baby's shoulder is stuck behind your pubic bone (shoulder dystocia)
• you are at risk of third or fourth degree tears.

You will be asked whether you consent to having an episiotomy before it is done.

Self care after this procedure is similar to a perineal tear. 

Second degree tears

If you have a second degree perineal tear, your midwife or an obstetrician will stitch it soon after you have given birth. They will use dissolvable stitches, which your body will reabsorb in about 6 weeks.

Your midwife or doctor will give you advice on how to care for your wound. 

Third or fourth degree tears

If you have a third or fourth degree perineal tear, a doctor will surgically repair it soon after you give birth.

If you have not already had an epidural, you will be given this or a spinal anaesthetic before the surgery.

After your surgery, you will need to have a catheter (tube to drain your bladder) until your anaesthetic wears off and you can feel when you need to wee.

Tell your midwife if you find you:

• cannot wee
• can only do small amounts
• have bladder pain
• feel your bladder is overfull.

The stitches used to repair your tear are dissolvable and do not need to be removed. Most will dissolve within 6 weeks, but some can take a little longer. You may feel these as small lumps around your anus. This is normal and will get better with time.

Medications for a perineal tear

If you have a second, third or fourth degree tear, you may be given:

• antibiotics to reduce the risk of infection
• laxatives to make it easier and more comfortable to poo
• pain-relief medicine.

Pain relief

Use ice packs for the first 24 hours to help reduce your pain and swelling. Hold an ice pack wrapped in a cloth to the area for 5 to 10 minutes every 4 to 5 hours. Perineal-shaped ice packs can be bought online or from a pharmacy. 

Hygiene

Keep your perineal area clean and dry. You should shower and bath as usual and dry the area by gentle patting with a clean towel or disposable cloth.

After doing a wee or poo, it is important to clean the area with a damp cloth and pat it dry, rather than wipe.

Make sure you change your pads and wash your hands regularly to reduce the risk of infection.

Avoiding constipation

It is important you try to avoid constipation (hard poos) after a perineal tear. Straining too much to poo can cause problems with your wound.

If you are breastfeeding, aim to drink at least 2.5 litres (10 cups) of fluid every day. Otherwise, aim for 2 litres (8 cups). This includes fluids such as soup, milk and hot drinks, but try to make at least half of your drinks water.

Have regular meals and snacks and include plenty of fibre-rich foods.

Fibre and fluids for healthy bowels

Correct way to sit on a toilet to poo

It is also important to sit properly when pooing, so you do not need to strain as much. Try to:

• have your knees higher than your hips, either by raising your heels or using a low footstool
• lean forwards from your hips, keeping your lower back curved (like in the picture)
• keep your knees apart, and rest your forearms on your knees
• make your waist wide and gently bulge your tummy forward as you work with the urge to go — do not strain.

You can support the area with stitches by holding a wad of toilet paper to it. When you have finished, lift your pelvic floor muscles a few times.

Exercise and posture

Your pelvic floor muscles run from your pubic bone at the front of your pelvis to your tail bone at the back. They help to control your bladder and bowel and support your pelvic organs. Pregnancy often makes these muscles weak, and they will be injured by your tear.

Start exercising your pelvic floor muscles as soon as you can. Exercising them early on will help reduce your pain and swelling and help you to heal.

Pelvic floor exercises

There are several other things you can do to help your healing, including:

• avoiding sitting and standing for long periods, especially in the first few days — lying on your side is a good position to rest in
• avoiding lifting anything heavier than your baby for at least the first 2 weeks
• gradually returning to low-impact exercise
• avoiding any exercise or activity that involves jarring, jumping or straining for at least 6 weeks.

You should stick to low-impact exercise and do not run for at least 3 to 6 months after having a third or fourth degree tear.

If you need any further advice or help with your pelvic floor exercises, ask your midwife or doctor to refer you to a physiotherapist.

Getting more help

While you recover, you may have some mild pain or soreness in your perineum.

Tell your midwife or doctor if:

• your stitches become more painful or smell bad
• you feel a need to rush to the toilet or cannot control your wee, poo or farting
• your perineum is still sore or tender after the stitches have dissolved.

If you are having difficulty with bladder or bowel control or having sex, ask your midwife or healthcare provider to refer you to a physiotherapist.

Find a physiotherapist — HealthPointexternal link

Most perineal tears or episiotomy cuts will fully heal in 4 to 6 weeks. 

Your midwife or doctor will check your perineum during their postnatal visits and check that you are healing properly. If you have any concerns during their final visit, 4 to 6 weeks after birth, they will refer you to a physiotherapist.

If you have a third or fourth degree tear, your usual healthcare provider will also check you 6 months after birth. If there are any issues, they will refer you for review with a specialist (gynaecologist).

The Accident Compensation Corporation (ACC) is a government agency that helps pay for treatment if you are injured in an accident.

If you have an injury while giving birth on or after 1 October 2022, ACC may be able to help with your recovery.

Injuries we cover — ACCexternal link

You can reduce your risk of tearing during the birth of your pēpi by massaging your perineum in the weeks leading up to your due date.  
Perineal massage