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Physiotherapy appointment —you will be given an appointment to see a physiotherapist, who specialises in pelvic floor function, to check your progress and review your longer-term strengthening program.
Check-up with your family doctor GP —please make an appointment to see your GP for a check-up six weeks after the birth of your baby, as part of your routine postnatal care.
Contact your GP earlier if you have any concerns about your recovery. You will receive a follow-up phone call from the postnatal clinic at three months. A face-to-face appointment will be arranged if:. Comfortable sexual activity can begin after your body has completely healed which may take from six weeks to several months.
If you experience ongoing discomfort during sexual intercourse it is important that you discuss this with your doctor. Advice about future births will depend on how well you recover from this one. If you are fully recovered there at the time of your next pregnancy there is little evidence to suggest the best way for your baby to be born.
However if you have some ongoing incontinence problems, especially with your bowel, a vaginal birth may make this worse. When you are seen in the Perineal Clinic, via a telephone call or face-to-face appointment , the doctor will discuss with you the most appropriate way for your next baby to be born, depending on your individual situation. If you have any further questions about what happened this time, please ask to speak to your doctors prior to going home.
Please note: we will endeavour to respond to your enquiry within five 5 business days. Follow us on. Recovering from third and fourth degree perineal tears At the very end of your labour the skin and muscles around your vagina thin and stretch to allow your baby to be born.
Caring for your perineum Keep your perineum clean and free from infection Wash your perineal area several times a day and after each bowel motion. Change your sanitary pads every four to six hours. Always wipe or pat from front to back after going to the toilet.
Do not use a hairdryer to dry your perineum—this may delay healing or cause burning to the area. Avoid the use of creams, ointments or powder. Antibiotics may be prescribed by your doctor to prevent wound infection Keep comfortable Apply ice packs to the area every couple of hours for at least 24 to 48 hours. Take regular pain relieving medication as prescribed by your doctor. Lie down to rest for 20 to 40 minutes each hour as this will help the area to heal.
In an ideal situation, your doctor will accurately identify the severity of your tear and request a surgical repair by an obstetrician who has experience with third- and fourth-degree tears. In rare cases, a fourth-degree tear is misdiagnosed, which happened to mother Nicki during the delivery of her third child. It was my first bowel movement and it came through the vagina, so I knew there was a major problem. The surgeon recommended a sphincteroplasty and fistula repair to fix her damaged anal sphincter muscles.
Pain, including pain during intercourse, and urinary incontinence are common side effects of any vaginal delivery, especially in the first four to six weeks. Women who experience third- and fourth-degree tears also have trouble holding in gas. You could require the repair of a rectovaginal fistula or additional surgery if your muscles are severely damaged.
Richards also notes that she sees vaginal and rectal prolapses because support to the bowels is decreased when a tear goes to the anus.
A posterior vaginal prolapse is where the front wall of the rectum bulges into the back wall of the vagina. The six-month period after childbirth is key to a good recovery.
Your doctor will likely recommend pain medicines, including ibuprofen Advil , naproxen Aleve and acetaminophen Tylenol , or a morphine derivative if required, but never codeine. Your doctor will prescribe stool softeners and plenty of fluids, which can help prevent the pain of passing hard stools. Breastfeeding women are already at risk for constipation because they have to take in a couple of extra ounces of fluid for every ounce of breast milk they produce, says Giesbrecht.
Even if you hate getting up to go the bathroom constantly or find it painful, do not restrict your fluids. One of the most important ways to improve recovery is to work with a pelvic health physiotherapist, says Giesbrecht. The program involves deep-core activation and breathing exercises that mobilize the scar from day one. Then, at six weeks, she continues to teach her patients how to mobilize again, connect with their pelvic floor and strengthen their muscles, she says.
She also works on massaging out scar tissue, so they get full mobility and their muscles can contract and act like they should. Attend your follow-up appointments as scheduled and be sure to report any issues, including fecal incontinence, as soon as they arise. The sooner you report them, the better your chances of getting timely care. Over the first six months with your new baby, you should continue to see improvements in your muscle strength and a reduction in symptoms if you consistently do the work.
Fistulas and severe tissue damage are not automatic side effects of fourth-degree tears, but they do happen sometimes, as was the case for Nicki and Chey. Since then, both have had reparative surgeries: a sphincteroplasty and perineoplasty for Nicki, and a fistula repair and sphincteroplasty for Chey.
Though they were long and painful processes, they have improved their fecal incontinence. But I still need to see a pelvic health physiotherapist because I continue to experience frequent urinary incontinence.
No one wants to experience a fourth-degree tear, but if it happens to you, the best thing you can do is educate yourself and push for proper diagnosis and care. If your doctor is unfamiliar with fourth-degree tears and how to treat them, you could end up with long-term difficulties that require additional surgery. It made me feel very alone. This article was originally published online in May
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