Perineal tear

Nicole Wendler holds a PhD in biology in the field of oncology and immunology. As a medical editor, author and proofreader, she works for various publishers, for whom she presents complex and extensive medical issues in a simple, concise and logical manner.

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The perineal tear is a common birth injury. The area between the back of the vagina and the anus is affected. Having a large child or giving birth quickly can cause the skin to become unable to withstand the excessive stretching and tear. Read everything you need to know about the perineal tear here.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. O70

Perineal tear: description

The dam lies between the vagina and the anus. During childbirth, the skin and muscles in this area are heavily stressed. The stretch is particularly strong when the child's head passes through the birth canal during the expulsion phase. Sometimes the tissue reaches its limits - a perineal tear is the result.In addition to the perineum, other regions can also tear during childbirth, such as the vaginal membrane, labia, cervix or clitoris.

A perineal tear is divided into different degrees of severity:

First degree perineal tear: The skin on the perineum is only superficially torn. The muscles are not affected.
2nd degree perineal tear: The injury affects the skin and muscles, the sphincter is still intact.
3rd degree perineal tear: the sphincter is partially or completely torn.
4th degree perineal tear: the sphincter muscle and intestinal mucosa are affected.

Perineum cut

Sometimes the doctor specifically enlarges the pelvic outlet with a perineal incision (episiotomy). If this incision is not large enough, the perineal tear can also occur during childbirth.

Perineal tear: symptoms

A tear in the perineum manifests itself through pain and bleeding. Many women often do not notice the symptoms themselves because of epidural anesthesia (PDA) or a reduced sensitivity to pain after the birth trauma. A detailed examination by the midwife or gynecologist is necessary here.

Perineal tear: causes and risk factors

It is impossible to predict whether or not the perineum will tear during delivery. However, the danger exists above all in the case of a very large child, an unfavorable child position, a rapid birth with a short opening period and inadequate perineal protection. A perineal tear often occurs during surgical vaginal birth, i.e. when mechanical aids are used (forceps or vacuum delivery).

Perineal tear: examinations and diagnosis

Immediately after the birth, the gynecologist carefully examines the mother's vagina and perineum. If there is a perineal tear, he will accurately assess the location and extent of the injury. Among other things, the following questions need to be clarified:

Where is the crack located?
Is it just the skin torn?
Are the perineum muscles also injured?
Is the sphincter affected?
How far is the intestine involved in the perineal tear?

Perineal tear: treatment

Smaller cracks in the skin heal on their own and do not have to be sewn. First and second degree perineal tears are usually straightforward. They are sutured with self-dissolving sutures - so no sutures have to be pulled later. Women without epidural anesthesia will be given a local anesthetic before sewing begins. Depending on the extent of the injury, pain, swelling, a feeling of tightness and discomfort while sitting can persist for a while. Going to the loo is quite uncomfortable in the first few days and weeks and often causes the wound to burn.

Third and fourth degree perineal tears are more problematic. It is important here to restore the sphincter muscle and intestine. In the case of a pronounced and complicated perineal tear, treatment under general anesthesia is sometimes advisable. After the muscles and intestines have been surgically treated, the doctor sutures the perineum in layers. After the wound has healed, it often takes a few weeks to months for the sphincter to function completely normally again. Abscesses, fistulas or permanent incontinence occur extremely rarely even after a high-grade perineal tear.