Medicines for Perineal tear

What it is

A perineal tear is a tear of the perineum — the area of skin and muscle between the vagina and the anus (back passage) — that can happen during a vaginal birth as the baby is born. Perineal tears are common, and most are minor. They are graded by how deep they go: first-degree tears involve only the skin and are small; second-degree tears involve the skin and the muscle of the perineum and usually need stitches; third- and fourth-degree tears (together called obstetric anal sphincter injuries, or OASI) are less common but more significant, extending to or through the muscle around the anus, and need repair by an experienced doctor, usually in an operating theatre. A related procedure, an episiotomy, is a deliberate cut sometimes made to enlarge the opening during birth. After a tear or episiotomy, the perineum is repaired with stitches that usually dissolve on their own. Most perineal tears heal well within a few weeks with simple aftercare, though the area is often sore and tender at first. The important things are good aftercare to aid healing and prevent infection, and knowing when to seek advice — for example if healing is not progressing, there are signs of infection, or (particularly after more significant tears) there are ongoing problems such as pain or difficulty controlling wind or bowel movements, which need follow-up.

How it is treated

Care of a perineal tear focuses on relieving soreness, aiding healing, preventing infection, and follow-up where needed. Most tears are repaired with dissolvable stitches after birth. Helpful aftercare measures include: keeping the area clean and dry, changing sanitary pads regularly, and washing hands before and after; gentle regular cleaning (for example with warm water) and patting dry; pain relief that is suitable (a midwife can advise, including when breastfeeding), and cooling the area (for example with a cold pack wrapped in a cloth) for comfort in the early days; pouring warm water over the area while passing urine if it stings; and eating well and drinking plenty of fluids, with measures to avoid constipation and straining (which can be uncomfortable and put pressure on the stitches). Pelvic floor exercises, once comfortable, aid recovery. Resting and avoiding heavy lifting help in the early weeks. Most tears heal within a few weeks. For more significant (third- and fourth-degree) tears, specialist repair and follow-up are arranged, and physiotherapy and review help recovery and reduce longer-term problems. It is important to seek advice if there are signs of infection (increasing pain, redness, swelling, offensive discharge, or fever), if the wound opens or is not healing, or if there are ongoing problems with pain, sex, or bowel or bladder control. The reassuring message is that perineal tears are common, most are minor and heal well with simple aftercare, and support and follow-up are available for more significant tears.