Why do 4th degree tears happen

Fistulas and severe tissue damage are not automatic side effects of fourth-degree tears, but they do happen sometimes, as was the case for Nicki and Chey. Since then, both have had reparative surgeries: a sphincteroplasty and perineoplasty for Nicki, and a fistula repair and sphincteroplasty for Chey. Though they were long and painful processes, they have improved their fecal incontinence. But I still need to see a pelvic health physiotherapist because I continue to experience frequent urinary incontinence.

No one wants to experience a fourth-degree tear, but if it happens to you, the best thing you can do is educate yourself and push for proper diagnosis and care.

If your doctor is unfamiliar with fourth-degree tears and how to treat them, you could end up with long-term difficulties that require additional surgery. It made me feel very alone. This article was originally published online in May Photo: iStockphoto. The four degrees of tearing There are four types of tearing that can occur during a vaginal birth: First degree The least severe type of tear, it involves the skin around the vagina and entering the perineum.

Second degree The next level of tear builds off a first-degree tear but also affects the perineal muscle. Third degree A third-degree tear extends even further, into the anal sphincter, which is the muscle that controls the anus. Fourth degree The most severe type, a fourth-degree tear passes through the anal sphincter and into the mucous membrane that lines the rectum, known as the rectal mucosa.

Fourth-degree tears: How often do they happen? Potential symptoms of fourth-degree tears Pain, including pain during intercourse, and urinary incontinence are common side effects of any vaginal delivery, especially in the first four to six weeks. Healing from a fourth-degree tear The six-month period after childbirth is key to a good recovery. Manage your pain Your doctor will likely recommend pain medicines, including ibuprofen Advil , naproxen Aleve and acetaminophen Tylenol , or a morphine derivative if required, but never codeine.

Do pelvic health physiotherapy One of the most important ways to improve recovery is to work with a pelvic health physiotherapist, says Giesbrecht. Follow up with a healthcare practitioner Attend your follow-up appointments as scheduled and be sure to report any issues, including fecal incontinence, as soon as they arise.

Joseph Communications uses cookies for personalization, to customize its online advertisements, and for other purposes. Learn more or change your cookie preferences. You may be able to feel some of the stitches, especially those around the anus muscle, for up to 3 months. After having any tear, you are likely to experience pain or soreness for 4—6 weeks after giving birth, particularly when walking or sitting.

The stitches can irritate as healing takes place, but this is normal. Passing urine can cause stinging — pouring water over the area when urinating can help. If you are worried about the way your wound is healing or if you notice any bleeding from the tear, any smell or any increase in pain, you should see your healthcare professional.

This might be a sign of infection and you may need some antibiotics to help it heal. Opening your bowels should not affect your stitches. For the first few days after your third- or fourth-degree tear is repaired, control of your bowels may not be as good as before you had your baby.

It is important to eat well and drink plenty of water to help avoid constipation. You should drink at least 2 litres of water every day and eat a healthy balanced diet for instance fruit, vegetables, cereals and wholemeal bread. When opening your bowels, the best position to sit in is with your feet on a stool to raise your knees above your hips see silhouette image.

This helps straighten out your bowels. Try to relax and rest your elbows on your knees. Bulge out your tummy by taking big abdominal breaths — this will help to expel your faeces without straining. Take your time and do not rush. It is important to do pelvic floor exercises as soon as you can after birth. This strengthens the muscles around the vagina and anus and helps healing. Your pelvic floor muscles will not be very strong straight after giving birth. Image 3 shows a side view of your pelvic floor muscles.

Image 3: Side view and anatomy of the pelvic floor. You may feel that initially you have very little sensation in your pelvic floor, but this should improve the more you do your exercises. If the sensation does not improve, you may need further treatment such as physiotherapy, particularly if you experience any bladder or bowel incontinence.

Physiotherapy will include teaching you how to correctly squeeze and strengthen your anal sphincter muscles to help reduce incontinence. Anal incontinence is when you have problems controlling your bowels. Symptoms include sudden, uncontrollable urges to open your bowels and not being able to control passing wind.

You may also soil yourself or leak faeces. Most third- or fourth-degree tears heal completely, but some women may experience these symptoms. It is important to talk about any concerns you have. Women with anal incontinence will be referred to a specialist team for treatment, which may include physiotherapy or surgery. If you have had a third- or fourth-degree tear, you should avoid strenuous activity or heavy lifting for weeks. After weeks, you can gradually increase your general activity.

Looking after a newborn baby and recovering from an operation for a perineal tear can be hard. If you have any further questions about what happened this time, please ask to speak to your doctors prior to going home. Please note: we will endeavour to respond to your enquiry within five 5 business days. Follow us on. Recovering from third and fourth degree perineal tears At the very end of your labour the skin and muscles around your vagina thin and stretch to allow your baby to be born.

Caring for your perineum Keep your perineum clean and free from infection Wash your perineal area several times a day and after each bowel motion.

Change your sanitary pads every four to six hours. Always wipe or pat from front to back after going to the toilet. Do not use a hairdryer to dry your perineum—this may delay healing or cause burning to the area. Avoid the use of creams, ointments or powder. Antibiotics may be prescribed by your doctor to prevent wound infection Keep comfortable Apply ice packs to the area every couple of hours for at least 24 to 48 hours. Take regular pain relieving medication as prescribed by your doctor.

Lie down to rest for 20 to 40 minutes each hour as this will help the area to heal. When feeding your baby shift your sitting position or feed lying down. Get in and out of bed on your side as this reduces any strain to your perineum Emptying your bowels For the first few days a low fibre diet is recommended to prevent any further damage to your perineum due to straining to pass a bowel motion.

Postnatal exercises Your physiotherapist will teach you how to do gentle pelvic floor contractions to assist healing, improve circulation and decrease swelling and pain.

Going home Your doctor will be able to advise you when you are ready for discharge so ensure that you discuss any concerns you may have at this time.

Follow up care It is important that you attend all your follow up appointments so that your recovery can be assessed. One to two weeks A Mater physiotherapist will contact you to ask you about your recovery.

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