Getting closer to your due date? You’ve probably read a lot about how to deal with the pain from contractions, how to breathe throughout labor, and even how to push your baby out into the world.
Tearing, on the other hand, isn’t necessarily a topic that’s on your radar.
Here’s more about what exactly a fourth-degree tear is, how it’s repaired, and some tips for recovery once you’re home.
Tears from childbirth are categorized according to how deep and far they extend into the tissue. A fourth-degree tear is also called fourth-degree laceration.
This is an extensive tear that goes through the vaginal tissue and perineum (area between the vagina and anus) and stretches into the anal canal and rectum.
As a result, this type of tear is also called an obstetric anal sphincter injury (OASI).
A number of situations may lead to this degree of tearing.
For example, babies over 8 pounds and 13 ounces may be more likely to lead to a fourth-degree tear than smaller babies. Labor induction may be another contributing factor for a small percentage of women.
Other contributing factors include:
- having an epidural
- a baby presenting with their back to their mother’s back (occiput posterior)
- a pushing stage of labor lasting more than 1 hour
- having had a previous episiotomy
- using forceps or other assistance during birth
- having weak tissue or short perineum (due to genetics)
Experts estimate that around 6 percent (so, 6 out of 100) of people giving birth for the first time may experience a fourth-degree tear. For those who have previously given birth vaginally, that number is around 3 percent (3 out of 100).
Curious about what to expect after giving birth? Here is your guide to postpartum recovery.
Again, tears are classified according to how deep and far they extend into the tissue. A third-degree tear goes from the vaginal wall through the perineum and into the anal sphincter muscle. However, it doesn’t extend into the large bowel (anal canal) or rectum, so it doesn’t impact the inner lining of the anus (anal mucosa).
While a third-degree tear is somewhat less severe, it’s treated similarly to a fourth-degree tear. Both require stitches following delivery.
And without proper care, both may lead to:
- chronic pain
- anal/urinary incontinence
- pelvic floor issues
A healthcare professional can repair your tear soon after your baby is born.
A tear of this nature usually requires more than simple stitches at the bedside. Instead, your doctor will likely take you to an operating room and give you medication if necessary for pain.
You may be offered either a spinal block or epidural and your baby and partner, if you have one, can stay with you and continue skin-to-skin contact.
In some cases, your doctor may give you general anesthesia. If so, you’ll be asleep for the procedure.
From there, your doctor will insert stitches that’ll eventually dissolve on their own.
These stitches will go on the skin between your vagina and anus and in the area under your skin, knitting together the tissue that has torn apart. How many stitches you’ll get depends on:
- the extent of your tear
- where it is located
- how deep it is into the tissue
The stitches will generally take the form of either a single suture or multiple sutures in a continuous fashion.
After your procedure, a doctor may prescribe antibiotics for around 1 week to prevent infection as your stitches heal.
Pain medication is another point to discuss with your doctor. You may use over-the-counter pain relievers or, in some cases, your doctor may prescribe you medication.
Stitches on the surface of the skin may only take a few weeks to heal and dissolve on their own. Stitches that are placed internally may take up to 12 weeks or longer to dissolve.
You might also be wondering about how you’ll empty your bowels with everything that’s going on down there. Your doctor may suggest using laxatives for a short while (2 weeks or so) to help soften your stool.
There’s no need to feel embarrassed to ask about this. Many people worry about their first bowel movements after tearing — and after childbirth in general.
See more on how life changes after the delivery of your baby.
Speak with your doctor about any restrictions you may need to follow while you heal. Each tear and repair is different, even if it’s the same degree of tearing.
As a result, the guidelines your doctor recommends for your healing may be different than the guidelines others have followed after giving birth.
Most doctors don’t recommend inserting anything into the vagina or rectum for up to 3 months after repair. The idea is that the internal stitches may take up to 12 weeks to heal and dissolve on their own.
Some people are ready sooner — but you should wait until your stitches heal and your bleeding has stopped. Be sure to ask your doctor before having sex or inserting other objects, like tampons, into the vagina.
Personal hygiene is very important to keep the area clean.
You should be OK to take a shower after having a fourth-degree tear repaired. In fact, your doctor may even suggest taking a sitz bath several times a day for 10 minutes at a time to help with healing.
You may also want to ask your doctor about exercise.
In general, it’s a good idea to avoid particularly strenuous exercise (think lifting heavy weights or running) until your tear has fully healed, or for at least 4 to 6 weeks.
Each case is unique, so your doctor may have guidelines for you to follow that are specific to you and your body.
Taking care of a newborn is hard work. When you add in repair of a fourth-degree tear, it can be quite uncomfortable at times.
In the first several days after birth, be sure to take it easy and get as much help as you can with daily tasks, like diaper changes and feeds.
Fortunately, you can do a number of things at home to make your healing more comfortable.
Keep it clean
Keeping your stitches clean and dry is key to recovery and avoiding infection.
Try taking a shower or bath once a day. You may even want to add a couple of drops of essential oils (lavender, tea tree oil) that are anti-inflammatory, antiseptic, and anti-bacterial.
Otherwise, make sure you change your sanitary pads frequently. Wash your hands often, too.
Use heat or ice
You may feel better after applying ice packs or hot compresses to the area.
The ice can help with inflammation while heat can help soothe your discomfort. Do not apply ice or heat directly — wrap it with a towel or cloth first.
You may also try using local anesthetic spray to help with itching and soothe the area.
Take the pressure off
Take time to get off your feet as much as possible, especially soon after delivery. You may want to create some time in the morning and in the afternoon to take it easy.
The same goes with sitting and laying down. Try sleeping on your side or sitting atop a donut-shaped pillow.
Stay hydrated and eat well
You’ll want to drink plenty of fluids (13 cups, or 104 ounces, each day) and eat fresh fruits, vegetables, and other high fiber foods to ensure your bowels keep moving regularly.
Constipation and hard stool can be very uncomfortable during the healing period. If your bowels are slow moving, chat with your doctor about stool softeners.
Once your doctor gives you the all-clear, ask about doing pelvic floor exercises. Working your muscles will promote blood flow to the area and help with your overall healing.
A basic Kegel can be performed by squeezing the muscles in your vagina and anus as if you are trying to stop the flow of urine. Start by doing just a few and holding for 10 seconds and work your way up to doing 3 sets of 10 per day, according to the UK advocacy group National Childbirth Trust.
It’s important to keep an eye on your stitches to watch for any signs of infection. These signs might include:
- warmth in and around the tear
- a foul odor coming from the area of the tear
- feeling particularly drained or tired
You should also contact your doctor if you’re unable to control your bowels or bladder or if you have any other concerns surrounding how your body is healing. Your doctor may refer you to a physical therapist who specializes in rehabilitating the pelvic floor muscles.
It is not easy to predict if you’ll experience fourth-degree tearing in future vaginal births. Many of the situations that lead to this degree of tearing aren’t evident until the birth is underway. So, prevention is difficult.
That said, the number of people who have fourth-degree tears with a second, third, or other subsequent birth does decrease from 6 percent to 3 percent, as mentioned earlier.
The main factor that seems to increase chances of a second fourth-degree tear is the weight of the baby, according to a
You may have heard that an episiotomy (a cut your doctor makes between the vagina and anus) will help prevent tearing. However, that same study shows this isn’t necessarily the case.
Perineal massage after 35 weeks into your pregnancy is one possible option. It may help soften the tissues, making them more elastic before delivery.
Here’s how to do it:
- Be sure your nails or your partner’s nails are short before massaging.
- If you’d like, you can begin by taking a warm bath.
- Once you’re out of the bath and dried off, settle into a comfortable position on your bed or a sofa. You may use pillows for extra support.
- Apply some olive oil, vitamin E oil, or other safe lubricant to your perineum. Massage using the thumbs to stretch the vaginal wall toward the anus and hold for approximately 1 minute.
- Continue gently massaging the skin in this area by moving the thumbs in a U pattern, outward and inward for 2 to 3 minutes (a total of 2 to 3 times).
- Repeat daily for the best results.
The very thought of tearing can be scary and unpleasant. The good news is that between 6 to 8 out of every 10 people who have third- and fourth degree tearing won’t experience any long-term effects after 1 year.
Be sure to stay in touch with your doctor about your recovery, share any concerns you have, and follow up with a physical therapist as needed for pelvic floor rehab.