Preventing and Caring for Vaginal Tears

Are you scared of getting a tear down there? You’re not alone. Many women are anxious about the possibility of tearing during vaginal deliveries. While it’s true that any tearing is no fun, the good news is that most tears are minor and heal quickly. While tearing is normal and can be treated, severe tears can significantly affect your pelvic floor muscle function. Pelvic floor physiotherapy can help reduce the risk of vaginal tearing during birth and speed up the healing process. This article will discuss the various type of perineal tears, how pelvic physiotherapy can help your birth preparation and postpartum recovery, and some home remedies to speed up the healing.

What is a perineal tear?

The perineum is the area between the vagina and anus. A perineal tear occurs when the skin and tissues of the perineum are injured during vaginal birth. 

Vaginal tearing is most common in new moms but also can happen:

  • during a quick labour
  • with delivering a big baby
  • when the baby’s head isn’t well-positioned.
  • depending on the baby’s position–especially when babies are facing upwards or in cases where the baby’s shoulders are too broad.

What are the different kinds of vaginal tearing?

There are four different degrees of laceration, each based on the severity of the tear:

First-degree tears

These are the most common and most superficial wounds. They are often small and heal on their own. They only involve the perineal skin and don’t go all the way into the rectum. First-degree tears usually heal within a few weeks.

Second-degree tears

These tears are deeper and go through the skin and muscles around the vagina. They may involve the perineal muscles, which support the pelvic floor. Second-degree tears often need to be repaired with tiny stitches. These usually heal within a few weeks, but some women may experience long-term discomfort.

Third-degree tears 

These are the most severe type of vaginal tear, but thankfully, it is not as common as the others. They extend from the vagina through the perineal muscles and may involve the anal sphincter muscle (the muscle that controls bowel movements). Third-degree tears often need to be repaired with more stitches. This type of vaginal tear can cause pain, discomfort, and a few weeks to months of healing time.

Fourth-degree tears

Fourth-degree vaginal tears or fourth-degree perineal tears are rare but can cause a lot of pain for many months. Because the depth of these vaginal tears goes through muscle and tissue from your vagina to the muscles around your anus, these severe perineal traumas can lead to bowel incontinence.

How can you prevent perineal tearing?

There is no way to guarantee that a vaginal tear won’t happen to you when you’re giving birth. Still, there are several things you can do to lessen the likelihood of it happening:

Get ready to push gently  

When you feel the urge to push, give birth slowly and gently instead of bearing down. This gives the tissue around your vagina opening enough time to stretch to create room for the baby without putting too much pressure on the perineum.

Use warm compress 

A warm compress applied to the perineum can help relax the tissues around the vagina and make them more elastic.  This, in turn, can help reduce severe perineal trauma.

Change positions 

It is recommended that mothers give birth on their side or all fours instead of lying flat on their back. This takes the pressure off your perineum. You can also try using a birth stool or squatting to open up the pelvis and give the baby more room to come out.

Perineal massage

Perineal massage is a technique that can help stretch the tissues around the vagina. It is often done during the last few weeks of pregnancy, but it can also be done during labour. Research studies have supported perineal massage to decrease the risk of severe perineal laceration during vaginal delivery, especially during the first vaginal birth. 

How can physiotherapy help with birth preparation and postpartum recovery?

If you’re pregnant and want to reduce your risk of perineal tearing during birth, working with a pelvic floor physiotherapist can be an effective way to prepare. Pelvic floor physiotherapy can help you learn how to connect with your pelvic floor muscles correctly,  which can help you relax during birth and reduce perineal laceration.

During your first visit, your pelvic physiotherapist will evaluate your pelvic health and possible risk factors. Depending on your health and physical condition, appropriate exercises and self-care techniques will be prescribed to prepare your pelvic floor and surrounding muscles for vaginal birth. 

At InvigoPhysio, you’ll receive custom care to help prepare for your birth, including:

  • different exercises to balance the muscles in your pelvis and create room for your baby
  • birth positioning strategies at different stages of labour that are appropriate for your body and support your pre-existing injuries such as disc herniation, knee pain
  • pelvic floor exercises to minimize vaginal tearing

Our birth prep program at InvigoPhysio also includes learning how to do the perineal massage safely with minimal pain under the guidance of your pelvic floor physiotherapist. You will also learn how to push effectively to avoid the Valvasa maneuver, leading to more severe perineal trauma.

In addition to helping you prepare for birth, pelvic floor physiotherapy can aid your postpartum recovery. After delivery, your pelvic floor muscles will be weak after being stretched out. This can lead to incontinence, pain during sex, and other problems. 

After a vaginal birth, what kind of treatment can be done for vaginal tears?

If you experience a vaginal tear, don’t worry—they can heal. In most cases, tears will heal on their own within a few weeks with the help of at-home care. 

You may need stitches for more severe tears that go through the muscle tissue and affect the anal sphincter. These types of tears usually heal within six weeks. 

In some cases, you may need surgery to repair the damage. This is more likely if you have a severe tear that goes through both layers of the vaginal wall or into your rectum. 

It is essential to remember that due to individual differences in skin and health conditions, the rate of healing is different from person to person.

At-home perineal care includes:

Rest

Getting plenty of rest is essential to allow your body to heal. Avoid scheduling activities that have the potential to be stressful. You can alleviate perineal pain by sleeping on your side and avoiding prolonged periods of standing or sitting.

Cold packs

Apply ice packs to the area for 20 minutes, several times a day. Place a piece of thin fabric between the ice and your skin to protect it. Alternatively, you can use a padsicle (frozen postpartum pads). 

Keep the area clean and avoid infection

Spray your perineum with warm water using a small Peri bottle before and after urination. Use gauze pads or wipes with your sanitary pads and change pads at least every four to six hours. Pat the area gently, rather than rubbing it and keep it as dry as possible. If you can, keep the site well-ventilated to help it heal more rapidly.

Start bowel movements as soon as possible

Although it may be painful, passing stool will help prevent constipation, which can make tear healing more difficult. It is common to have your first bowel movement 2 to 4 days after vaginal delivery. It is only natural to be concerned that you will tear your stitches when you have your first bowel movement after giving birth. The answer is that would be very unlikely to happen. 

Immediately postpartum, you might also find that your bowel motions are not as regular as before. This happens rather often. Make it a goal to avoid constipation and straining whenever possible. Stool softener, staying hydrated, taking fibre-rich foods, using a squatty potty and breathing during a bowel movement are all excellent strategies you can try.

Start your pelvic floor exercises

Continue doing your prescribed pelvic floor exercises as soon as possible after delivery, even if you can’t feel yourself doing them. These exercises can help promote circulation and speed up the healing process. Activating the pelvic floor also helps prevent or reduce incontinence. 

Use a sitz baths

Warm sitz baths consisting of 8 to 10 centimetres of water, or enough to cover the perineum, should be taken three times a day for 15 to 20 minutes each time, as well as after bowel movements. The region should then be blotted dry. Please continue to do this for as long as it continues to hurt. 

How can you relieve the pain associated with a vaginal tear?

When it comes to vaginal tears, the agony is real and especially in severe vaginal tears; nevertheless, there are specific ways to seek relief from the discomfort:

  • Ice is your friend
  • Take a warm sitz bath
  • Use analgesics and anesthetic agents: Your doctor may suggest using an anesthetic to numb the region.
  • Use cushions: You might find that sitting more comfortably with one of the donut- or ring-shaped pillows or rings explicitly designed for people who suffer from hemorrhoids. If you suffered from hemorrhoids throughout your pregnancy and are still healing from the condition, you can alleviate the discomfort of both conditions using the donut.

What complications can arise from a torn vaginal tissue?

Although most vaginal tears heal without any complication, some might experience the following:

Infection

The area where the tear occurred is susceptible to infection. Infections after birth are much more common in women with episiotomy or third-degree tears. If you experience a fever, chills, an increase in your perineal pain or foul-smelling discharge, please get in touch with your care provider immediately as these could be signs of infection. 

Excessive bleeding

If you are soaking more than one sanitary pad in an hour, or if you see large clots of blood, please contact your doctor.

Foul-smelling discharge

This could be a sign of an infection and should be reported to your doctor immediately. 

Scarring

Severe tears can result in scar tissue build-up and nerve sensitivity, leading to persistent pain in the area with sitting or walking and painful intercourse. Your pelvic physiotherapist can assess the mobility and quality of the scar tissue and provide you with specific massage techniques to eliminate the pain.

Urinary Incontinence

You may experience urinary incontinence if the muscles surrounding these organs are damaged during the tearing. If you already saw a pelvic physiotherapist during pregnancy and were given pelvic floor exercises, start doing them 2 to 3 days after birth to improve muscle strength and reduce incontinence. 

Anal incontinence

Anal sphincter injuries can result in losing control of your bowels. This is uncommon but can happen. If you have any concerns about this, speak to your pelvic physiotherapist, as there are exercises you can do to resolve this issue.

Pain during sex

You may experience discomfort or pain during sexual intercourse if there are significant scarring and pelvic floor dysfunction. There are no reasons to return to sexual activity, especially if it causes discomfort. Your pelvic physiotherapist can assess the area and give you suggestions to make sex more comfortable.

What can you do to improve the process of healing after vaginal delivery?

There are things that you can do at home to aid in the healing process:

  • It is best to avoid using a hairdryer in the area at all costs, even in the coolest possible setting. Dust and hair particles can be blown off by the hairdryer, become lodged in the wound, and develop an infection. Try using a clean towel to pat it dry instead.
  • Wear loose, comfortable clothing: avoid anything tight that can put pressure on your perineum or tear stitches. Cotton and other textiles that are breathable should be the focus of your wardrobe.
  • Perineal massage: Once the wound is healed, you can start massaging the perineal area with a water-based lubricant or natural oil such as olive oil. The goal is to reduce scar tissue adhesions and decrease pain in the area.
  • You should wait at least six weeks before engaging in intense exercise or lifting large objects.
  • Do your pelvic floor exercises only if these were given to you by your pelvic physiotherapist, as Kegel is not always good for you. Gentle pelvic floor activation increases blood flow to the area, which speeds up the healing process. Performing exercises targeted at the affected area will also help strengthen the muscles around the vaginal opening and the anus, which should help ease any difficulty managing your bowel movements.

Vaginal tearing is common during birth, but some steps can be taken to prevent or reduce it. If you do experience tearing, there are things that you can do at home to speed up the healing process. If the tear is severe, you may need professional help to recover fully. While caring for your newborn baby, it can be easy to put your health on the back burner, but it’s important to make time to ensure you are healing properly. If you are still on the fence about seeing a pelvic physiotherapist postpartum, here’s why every mom should get their pelvic floor checked.

We understand that the first pelvic floor visit can seem daunting. Check out what your first assessment with InvigoPhysio could look like, and learn about your options for virtual physiotherapy

Book your appointment now if you’re ready to get support on your motherhood journey!

Still have questions about vaginal tearing and the benefits of pelvic floor physiotherapy with InvigoPhysio? We’re happy to connect with you! Send us an email at trang@invigophysio.com.

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