Perineal Tears: What They Are and How to Recover from One

Perineal tears are usually repaired after delivery. However, it’s important to take care of the injury afterward. What are their implications? Why do they occur? We tell you all about them here!
Perineal Tears: What They Are and How to Recover from One

Last update: 25 February, 2021

Perineal tears usually concern pregnant women when they’re close to their due date. It’s an injury that occurs in the skin and muscles of the perineum when a woman gives birth.

The perineum is the area between the anus and the genitals. In the case of women, it’s the space between the vagina and the anus. It’s quite sensitive and consists of numerous muscles. Also, the anal sphincter is found there.

Perineal tears affect almost 2% of women who give birth. This can have several consequences, from simple pain to a sphincter involvement that causes fecal incontinence.

Due to its importance, in this article, we’ll explain everything you need to know about perineal tears, what they consist of, and what you can do to recover if you suffer one after giving birth.

What are perineal tears?

As we mentioned above, the perineum is the area between the opening of the vagina and the anus. It consists of a series of muscles and their respective fascia and skin. Also, the anal sphincter, which controls bowel movements, is there.

During labor, this area is under a lot of tension. This is because, to deliver a baby through the vagina, all these tissues need to stretch to allow them to pass through the vaginal opening.

Sometimes, this strain is too excessive and the tissues can’t withstand it. Thus, they become injured. This is how a perineal tear occurs. It’s relatively common during childbirth. However, obstetric techniques have reduced its incidence.

A woman in labor.
A perineal tear occurs due to the strain the muscles in the area suffer during childbirth. It’s common when the baby is bigger than normal.

The causes of perineal tears

Firstly, a perineal tear can be caused when the baby is being born. This occurs when the baby is bigger than normal or when the delivery isn’t properly controlled. It isn’t very common nowadays.

Another cause is the use of certain instruments to assist delivery, such as forceps or spatulas. In fact, it can even result from an episiotomy. It’s a technique that consists of making a surgical cut to the perineum to make room for the baby and then suturing it.

This article may interest you: What Is Labor Induction and How Is it Done?

Types of perineal tears

Perineal tears can be classified into different types or degrees based on their severity. This, in turn, depends on the extent of the damage that occurs. Here are the degrees:

  • First-degree perineal tear. Only the skin of the perineum is affected; it’s the most superficial.
  • Second-degree. It involves the skin and muscles of the perineum.
  • Third-degree. The tear is more severe and affects the muscle that surrounds the anus (anal sphincter).
  • Fourth-degree tears are the most severe. The entire perineum and its muscles are affected. In fact, the mucous membrane of the rectum and the internal sphincter of the anus can be damaged.

The first two degrees don’t usually lead to long-term complications. However, third-degree or fourth-degree tears usually cause fetal incontinence and inability to control flatulence. This is due to the involvement of the anal sphincter.

A woman in labor in pain.
Perineal tears are classified into different degrees. Third-degree or fourth-degree tears are the most serious, as they can cause fecal incontinence.


When this injury occurs, a medical professional proceeds to repair the tissues after birth. Firstly, they suture the tears that occurred. All the damage needs to be repaired.

Also, aftercare is essential. Medical professionals usually prescribe antibiotics to prevent possible infections. They also recommend patients watch their diet so that when they defecate the area doesn’t become further damaged.

For this purpose, patients need to drink enough water and eat a diet rich in fiber for a time. This way, their stool will be softer and they’ll avoid constipation. Many studies indicate that pelvic floor exercises can help the muscles in this area recover.


Although perineal tears are relatively common during childbirth, with adequate obstetric control, they don’t have to occur.

However, if one does occur, medical professionals usually fix it right away and will also give the patient the best recommendations based on their case.

It might interest you...
Treatment of Postpartum Urinary Retention
Step To Health
Read it in Step To Health
Treatment of Postpartum Urinary Retention

The most common cause of postpartum urinary retention is the lack of pelvic floor relaxation. In this article, discover the treatment for this cond...

  • Frohlich J, Kettle C. Perineal care. BMJ Clin Evid. 2015;2015:1401. Published 2015 Mar 10.
  • Kettle, C. (2008). Pregnancy and childbirth Perineal care. BMJ (Clinical Research Ed.), (1), 1–19.
  • Smith LA, Price N, Simonite V, Burns EE. Incidence of and risk factors for perineal trauma: a prospective observational study. BMC Pregnancy Childbirth. 2013;13:59. Published 2013 Mar 7. doi:10.1186/1471-2393-13-59
  • Friedman S, Blomquist JL, Nugent JM, McDermott KC, Muñoz A, Handa VL. Pelvic muscle strength after childbirth. Obstet Gynecol. 2012;120(5):1021–1028.
  • Woolner AM, Ayansina D, Black M, Bhattacharya S. The impact of third- or fourth-degree perineal tears on the second pregnancy: A cohort study of 182,445 Scottish women. PLoS One. 2019;14(4):e0215180. Published 2019 Apr 11. doi:10.1371/journal.pone.0215180
  • Williams, A. (2003). Third-degree perineal tears: Risk factors and outcome after primary repair. Journal of Obstetrics and Gynaecology23(6), 611–614.