Expert advice Q&A
 What happens postnatally with a 3rd degree tear?
 Most women having their first baby suffer some trauma to the tissues of the vagina, perineum or labia. The perineum is the area between the vaginal opening and the anus (or back passage). Midwives and doctors describe perineal tears in the following way. A first degree tear is a small tear, maybe 1.00-1.5 cm long, involving only the skin covering the perineum. This type of tear generally heals well without the use of stitches. A second degree tear is a larger tear that involves the vaginal wall and the underlying muscles as well as the skin. Second degree tears heal best if they are sutured. An episiotomy is the surgical equivalent of a second degree tear. A third degree tear this is a second degree tear that reaches to the muscle ring surrounding the anus. Sometimes a third degree tear can follow an episiotomy, when the original cut extends further to involve the anal sphincter (or muscle). Although a third degree can happen during a normal vaginal birth, they more often follow an assisted delivery (forceps or ventouse). A third degree tear should ideally be repaired in an operating theatre by a senior doctor. If the woman has an epidural working, then this will be topped up to keep her pain-free. Alternatively, she will be offered a spinal anaesthetic. Following the repair, the woman will be given tablets to relieve pain, and regular laxatives to make sure she does not become constipated whilst the wound is healing. She may also be given a course of antibiotics. Provided the tear is repaired by an expert, third degree tears generally heal well and incontinence of the bowel (faeces or wind) is prevented. This said, maybe 25-50 per cent of women do have bowel problems following a third degree tear. It may be several months before these become obvious. For this reason, many obstetricians follow up women with third degree tears after 6-12 months. If the problem is very severe and does not resolve with time, the woman should be referred to a bowel surgeon who may then offer a further repair operation. If bowel function is normal this suggests that the wound has healed well. Even so, there may be areas of tightness, perhaps closer to the vagina, that cause discomfort. If the tear was complicated, there may be considerable scarring of the perineum, and this may take several months to reduce and soften. Some women find that regular massage with almond or olive oil (as may be done during pregnancy) helps solve this sort of problem. Others find that only time helps. Plenty of lubrication during intercourse can make a real difference, too.
Answer provided by Hannah Hulme Hunter
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