What Is Perineal Tear And How To Prevent It?

Perineal tears. Have you heard of them? Shed no tear. There is a way how to lower the risk of experiencing them in quite a significant way.

Let ́s shed light on this obstetric injury that is a national issue, according to the Royal College of Obstetricians and Gynaecologists.

How many suffer from it? Well, the same source says that around 90% of women experience tearing during childbirth. Women having their first baby, women having epidural, women over 25 years old, women carrying babies with higher birth weight or sometimes women of specific ethnicity (women of South/SE/East Asian origin) are at highest risk.

Perineal Tear Aniball

Perineal tears have a range of severity. Some heal on its own, some need sutures. Some do not have time to occur because an episiotomy was needed – a surgical incision. That is a doctor ́s decision.

Studies differ, but mostly they agree that types of birth positions, directed pushing or instrumental delivery, using a birthing pool or an "old-school" hospital bed... do not make a huge difference.

However, when it comes to natural tears, you can make a decision now that may prevent them. Yes, there are several types of "them".

We will dive into medical terms a bit now. Anterior perineal trauma occurs more in the urogenital area and posterior trauma in the posterior vaginal wall, perineal muscles, and anal sphincters (muscles controlling rectum.) Those last ones, anal sphincter tears occur in 0.5% to 7% of women (data from the UK and US).

There are 4 degrees of posterior perineal tears. First two are mild, the other two severe:
- 1st-degree tearing – sometimes called a spontaneous tearing is just a skin-deep tearing where nature usually takes its course, and it heals naturally.
- 2nd-degree tearing – deeper one, affecting the muscle of the perineum as well as the skin. Stitches come to the scene. Healing process lasts from 2 to 3 weeks.
- 3rd-degree tearing - extending further from the vaginal wall and perineum to the anal sphincter. Treatment includes stitches (sutures) again + combined with cold pack application, painkillers or antibiotics if needed and secondary treatment methods such as baths.

A more severe type of tearing results in a longer healing process (around a month) and no sexual activity for some time.

- 4th-degree tearing is extending to the anus or rectum. The risk of a third or fourth- degree tear increases with maternal age. Apart from longer healing time, there is also the aspect of psychological impact on women following a severe perineal trauma like this.

Perineal wounds, therefore, impact not only women's body but also psyche and mental health, sex life, family relationships, the relationship between the mother and her baby. It can also disrupt breastfeeding. And every mother wants to give the best start in life to her baby.

Third and fourth degree are the worst ones, and in the UK, the rate jumped from 1.3% in 2001 to 4.6% in 2010.

Numbers of women with perineal tearing escalate. The rate of third‐ or fourth‐degree perineal tears tripled from 1.8 to 5.9% and the rate of episiotomies varied between 30 and 36% according to a study conducted in England between 2000-2012 (1 035 253 deliveries).

The rate of second-degree tears increased by 23.5%.

Can you beat the odds? Yes.

The most common practice is the perineal massage. We recommend combing perineal massage with Aniball which is not only much more effective but also brings other benefits such as quicker birth and prevention of incontinence.

During labour, your pelvic muscles stretch. Head circumference of your baby can be well over 35 cm, and the baby can weight over 4 kg.

The simple act of gently inserting the balloon, inflating it to a comfortable size and exercising for 15-30 minutes per day works wonders. Aniball is also recommended by doctors, midwives, and mums.

To summarize it, nowadays in the UK:
- about 23-42% of women continue to feel pain and discomfort for 10-12 days after birth,
- 7-10% of women continue to have long-term problems (3-18 months after delivery),
- 23% of women experience pain during intercourse for 3 months,
- 3-10% report faecal incontinence,
- up to 24% have urinary problems.

These statistics are not meant to scare you. However, they are often ignored. Education in this matter is essential and perineal tearing is a widespread problem that should be addressed.