Childbirth Injuries - perineal tearing

Childbirth injuries (including 3rd or 4th degree tears) can result in pain and muscle weakness which takes time to recover from.

While some women recovery quickly from their delivery, others find that they have quite significant discomfort and changes in function.

If you have had a third or fourth degree tear repair, you are at an increased risk of symptoms such to bowel incontinence.

With good physiotherapy management the chance of these problems occurring can be significantly reduced.

What causes childbirth injuries?

There are a number of known factors which increase the chance of deep perineal tearing or pelvic floor damage during delivery. These include:

• Instrumental Delivery (forceps or ventouse/vacuum)

• Large Baby (especially birthweight >4kg)

• Prolonged second stage of labour (especially more than 2 hours active ‘pushing’)

• Asian ethnicity

• Large infant head circumference,

• Shoulder dystocia of the baby (shoulder stuck behind mother’s pubic bone)

• Having a previous severe perineal tear (you have an increased chance of tearing again)

• Occipito-posterior position of the baby (back of baby’s head against mother’s spine)

What are the signs and symptoms?

If you experienced a third or fourth degree tear you may experience:

• Excessive pain when attempting to sit

• Excessive swelling/ bruising in the perineal area

• Pain/ Apprehension when passing urine or bowel motions

• Pain when returning to sex

• Decreased sensation to empty the bladder

• Urinary (bladder) or faecal (bowel) incontinence

• Urinary or faecal urgency

What can be done to help me?

A comprehensive assessment of your pelvic floor muscles and symptoms can be performed to determine the most appropriate forms of treatment.

Treatment options include:

• Pelvic Floor muscles strengthening

• Pelvic Floor muscle relaxation

• Perineal/ scar massage/ desensitization

• Education about good bladder and bowel habits

• Education about appropriate and safe return to exercise

It is not uncommon for women who have experienced a sever childbirth injury to suffer from the effects of birth trauma. If this is you, we encourage you to speak up and seek support from your healthcare team and we can also recommend the Australasian Birth Trauma Association as a great support network to connect with.