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The Different Degrees of Perineal Tears



During childbirth, the perineum – the area located between the vagina and the anus – can become lacerated. These injuries are classified as first, second, third, and fourth degree perineal tears. Fourth degree perineal tears are the most severe.


First Degree Tear


A first degree tear damages the skin around the vaginal opening. These are usually superficial and can generally heal without stitches. A first degree tear is fairly common during childbirth and usually causes the least amount of harm to the patient. Healing typically takes a few weeks and the woman may experience discomfort during sexual intercourse and urination for a short time.


Second Degree Perineal Tear


Second degree tears are more severe, as the resulting injury can damage the area between the vaginal area and the anus. In this situation, the perineal muscles can tear resulting in some discomfort. Because this is a deeper tear than a first degree, it requires stitching, following which recovery time is generally a few weeks. Similar to a first degree tear, this injury can cause some discomfort (stinging, burning) during urination and sexual intercourse.


The muscles are usually stitched back together to promote proper healing and to avoid further damage. A healthcare professional should be able to notice the tear, but if the tear is not treated properly, it can lead to additional problems including infection.


Third Degree Perineal Tears


A third degree tear receives immediate stitching due to its severe nature. At this point, the tear has reached through to the muscles of the anus, meaning it is possible for faeces to move through the rectum without the patient being able to control it. It can take months for a third degree perineal tear to heal after the initial repair, and the woman can experience a significant amount of discomfort and pain until the healing process is complete.


Fourth Degree Perineal Tears


The most damaging and severe of the four, the fourth degree tear impacts the perineal muscles, the rectal tissue and the anal sphincter. Fourth degree injuries can affect the patient’s bladder, sexual and bowel functions. This is usually temporary but, in rare cases, can be, permanent. It is important that the appropriate care is provided for this injury, as a lack of caution can cause further harm.


It can take some time until the woman can resume daily activities comfortably, usually around three months in some cases. The full recovery period for a fourth degree perineal tear, however, is usually around a year. During this time she may experience pain and discomfort around the perineum area, as well as a feeling of urgency to open the bowels.


Third and fourth degree tears are fairly uncommon in comparison to first and second degree tears. However, they are far more serious and can have a significant effect on the woman’s daily routine because of the level of damage caused. Because the tear extends into the anus as well as the rectal area, problems can include incontinence of faeces and/or gas due to the lack of muscle control. Urinating or having a bowel movement can also prove to be painful.


Successful claims for compensation for perineal tears


At Gadsby Wicks, we have successfully handled many medical negligence claims concerning different types of gynaecological injury, including perineal tears. Please see here for a selection of case studies.


Gadsby Wicks Can Help With Your Claim

Have you (or a loved one) experienced a perineal tear or other gynaecological injury? Do you think it may have happened as a result of medical negligence? Gadsby Wicks may be able to help you make a claim for compensation. Please call us on freephone 0800 321 3112 and speak to one of our medically qualified advisers. Alternatively, please complete our online enquiry form. and we will contact you.