Labor & Delivery: Treatment for Vaginal Tears Health Article

Caring for Vaginal or Cervical Lacerations After Delivery

Cervical lacerations are suspected when increased vaginal bleeding occurs after delivery. When a laceration is identified, it is repaired with absorbable sutures (stitches) that do not require removal. Once the bleeding has been stopped, no additional treatment is required.

After delivery of the baby and the placenta, the vagina and perineum are cleaned and carefully examined. The physician must be sure there has been no tearing of the vaginal walls or cervix. The doctor or midwife may use a special instrument (a metal retractor) to see the vagina and cervix. The physician may wash the area with a saline or antibacterial soap solution. If the tear involves the lining of the rectum or the anal sphincter (the muscle that controls the anus and prevents leakage of stool), soap and water may be used to wash out the wound. In most cases, the injury only involves the vaginal lining and the tissue directly below the vagina. However, if the laceration extends into the anal sphincter or the rectal lining, these portions should be repaired first.

All repairs are performed with sutures (surgical threads) that absorb into the body tissues and do not require removal. A very thin, absorbable suture is used to close the rectal mucosa; larger and stronger sutures are used to repair the anal sphincter. After the rectal mucosa and the anal sphincter have been repaired, simple repair of the remaining laceration is required. Several stitches may be required to bring together the deeper tissues below the vaginal lining; a continuous suturing of the vaginal mucosa and the skin outside the vagina is required to close the incision completely.

Local wound care and pain management begins immediately after the delivery. During the first 12 to 24 hours, an ice pack may be helpful in preventing both pain and swelling.

The wound should be kept clean and dry to avoid infection. Frequent sitz baths (soaking the area of the wound in a small amount of warm water for about 20 minutes several times a day) can help keep the area clean. The wound should also be cleaned after a bowel movement or after urination; this can be accomplished with a spray bottle and warm water. A spray bottle may also be used during urination to decrease the pain that occurs when urine comes in contact with the wound. After the site has been sprayed or soaked, it should be dried by gently blotting with tissue paper (or a hair dryer can be used to dry the area without the irritation of abrasive paper).

Third and fourth degree lacerations involve the anal sphincter or the rectal mucosa. In these cases, stool softeners may be used to prevent further injury or re-injury. To facilitate the healing of a larger wound, a patient may be kept on stool softeners for more than a week.

Several studies have determined that non-steroidal, anti-inflammatory medications, such as ibuprofen (Motrin), are most efficacious in treatment of vaginal trauma and its associated pain. However, acetaminophen (Tylenol) has also been used with encouraging results. When a large laceration has occurred, the doctor may prescribe a narcotic medication to help ease the pain.

Patients should avoid tampons or douches in the postpartum period to ensure proper healing and to avoid re-injury. Patients should abstain from sexual intercourse until the laceration has been reevaluated and is completely healed. This may take four to six weeks.

For more information about cervical and vaginal tears, go to Labor & Delivery: Risk Factors for Tears and Labor & Delivery: Complications From Vaginal Tears.