Postnatal physiotherapy

What to do if you have had a tear during birth

This video is for women who have had tears or stitches at delivery. It covers information to help with your recovery and advice for women who have had a third or fourth degree tear. 
Up to ninety percent of women may tear during childbirth. This is as the baby stretches through the vagina. The perineum is the area where most women will tear. This is the part of skin between the entrance of the vagina and the back passage.
Some women will have had an episiotomy this is a cut into the skin in the perineum which will help to allow the baby to be born.  
Tears go from a first to fourth degree. A first degree tear is a small graze into the area which will not normally require stitches. A second degree tear goes into the muscle in the perineum and into the skin, this will normally require some stitches. Up to six percent of women will have a third or fourth degree tear. These tears go deeper into the muscle. A third-degree tear goes into the muscle surrounding the back passage and a fourth degree tear extends further past the back passage.
After having a tear or an episiotomy it is normal to feel pain for a few days to weeks. This should continue to improve over time. If your stitches become more painful, you experience some increase in discharge or an offensive smell you may have an infection, please speak to your GP or your midwife. 
Some women will have less control of their bladder or bowel following delivery, if this happens please ask your midwife to refer you to physiotherapy. To reduce the risk of infection and aid with the healing and recovery, it is very important to:  keep the area clean, have a bath or shower at least once a day, change your pads every two to three hours and always make sure you wash your hands before and after doing this. Change position regularly, if you stay in one position for too long the area will become achey. 
You may need to take some medication to help with the pain, speak to your midwife about this. You can use ice to help with the swelling, you can use either an ice or a gel pack wrapped in a clean protective layer and place it over the area for up to 10 minutes at a time. Please make sure you check the skin regularly as ice can burn. Avoid wearing tight clothing and use cotton knickers. Eat a healthy balanced diet with plenty of fruit and vegetables and aim to drink up to 2 to 3 litres of fluid a day, ideally water.
Avoid straining when you open your bowels. Some women may find it more comfortable to use tissue on their hand to support the stitches when emptying their bowels.
Pelvic floor muscle exercises will help with the healing. Once you feel comfortable you can start these following the delivery.  Please do not do these exercises if you still have a catheter in your bladder. The pelvic floor muscles sits at the bottom of the pelvis. They go from the pubic bone at the front to the tailbone at the lower part of the spine. These muscles are very important especially when you’ve recently had a baby. The muscles prevent bladder and bowel leakage and they help to support the pelvic organs including the bladder, the vagina and the back passage. 
There are two pelvic floor exercises to do, start these exercises in a comfortable position either lying or sitting. As they get easier progress or doing them in a standing position. Do not do them on the toilet.
The first exercise is a quick squeeze. Tighten around your back passage as they are trying to stop yourself from passing wind and squeeze around the front passage and the vagina as they are trying to stop yourself from passing urine. Hold this muscle for a second and then relax. Try and repeat this up to 10 times. The second exercise is holding the muscle. Again squeeze around back passage and front passage hold for up to 10 seconds and relax. Repeat this up to 10 times. Both these exercises should be done three to four times a day, and it is important to continue with them for the rest of your life.
Most women will make a good recovery after having a third or fourth degree tear. Follow all the advice in this video. You will also have been given medication on the ward. This is to help avoid any infection, prevent you straining when you open your bowels and to help with the pain relief. 
All women who have had a third or fourth degree tear will be referred to physiotherapy. Women will also receive an appointment to see the doctors in perineal clinic at ten to twelve weeks following the delivery. This appointment is to check your recovery and to see if you are having any problems with your bladder or bowels. It is also an opportunity for you to discuss the birth in more detail with the doctors. You will be contacted by letter by the physiotherapy department. This is to check if you’re having any problems with your bladder, bowel or perineum. Please contact your physiotherapist if: you are having any problems controlling your bladder or bowel, you need to rush to get to the toilet, you feel like you are not fully emptying your bladder or bowel, or if you have any other concerns. You will be given advice and if necessary an appointment can be made with the physiotherapy team.