Written by Dr.M.D.Mazumdar, MD
The perineum is the region between the vaginal opening and the anus. The perineum may get injured when there is overstretching or rapid stretching during the delivery of the baby.
Tears are more common in women in their first childbirth since the perineum is quite firm and cannot stretch adequately. While an episiotomy can prevent major perineal tears to some extent, tears can still occur even after or with an episiotomy.
Very often, after an episiotomy has been done, a tear can occur at its apex, extending it upwards and to various depths in the mucosa and muscle.
An inelastic perineum due to the presence of a scar can also lead to a perineal tear. Some of the causes of overstretching of the perineum leading to perineal tear are:
There are four degrees of perineal tear, depending on the extent of the tear. The third degree perineal tear is further subdivided into three subcategories.
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Prevention is the best management. The second stage of labour should be properly conducted. An episiotomy should be performed wherever deemed necessary to prevent tear of the perineum.
If it is not repaired, the opening to the vagina will gape. The muscles may be able to heal back together on their own to some extent, but not completely and some amount of vaginal gaping will always remain. An inserted tampon may not remain in place and may slip out.
A torn sphincter does not heal itself because the torn ends are usually far apart from each other after the muscle fibers retract. So, a surgical repair under anesthesia may become necessary, especially in a 3C third degree perineal tear.
Repair of this type of perineal tear must be done under anesthesia in an operating theater with adequate sterilasation. If not done properly, the tear may not heal completely and leave a hole (fistula) between the vagina and rectum with consequent leaking of feces from the vagina.
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