the management of third degree tears
A third degree tear is where the ring of muscle around the back passage (the anal sphincter) can be damaged during childbirth. This happens in about 1% of all vaginal deliveries. It may happen during a normal delivery or sometimes when assistance is required as with forceps or ventouse.
Why is anal sphincter important?
The anal sphincter muscle acts like a valve to keep the anus closed and is therefore very important in helping to maintain bowel control. Normally the bowel and anal sphincter work together to ensure bowel contents are not passed until an appropriate me. The anal sphincter may be weaker following a third degree tear.
What happens if I have a third degree tear?
After every vaginal delivery your midwife or doctor will examine you to decide whether you need stitches
If there is evidence of a third degree tear, the muscle will be repaired before you leave the labour ward. Dissolvable stitches are used so you will not need to have the stitches removed.
Following repair you will be prescribed oral antibiotics for 5 days as well as a gentle laxative to aid easy passage of a soft stool.
How might a third degree affect me?
For many women a third degree tear will cause no particular problems and bowel function will return to normal. Some women, however, may experience some problems with bowel control. These are often minor and temporary, clearing up within 12 weeks. Occasionally, bowel control problems last longer.
These may include:
• An urgent need to rush to the toilet to empty the bowel, with difficultly ‘holding on’.
• Some difficulty controlling wind.
• Loss of liquid or solid stool from the bowel at an undesirable me.
What can I do to aid my recovery?
It is important to keep the area very clean, so take plenty of baths or showers while in hospital and after you go home.
Pelvic Floor Exercises –
These exercises help to restore muscle strength and you may start these as soon as possible after delivery. A Physiotherapist will visit you before you leave the hospital to make sure you know how to do these exercises.
Avoid constipation –
For your own comfort try to avoid constipation. The Physiotherapist will also teach you a position to adopt while on the toilet to ensure effective passage of a bowel motion.
Check-up appointments –
You will be given an outpatient appointment at
• 6 weeks – to see your Physiotherapist
• 8—16 weeks postnatally for the perineal clinic
It is important that you keep these appointments so that we can make sure everything has healed properly.
These visits will involve a general discussion on how you are getting on and will provide opportunity for you to discuss any problems you may have noted. An examination may also be carried out to make sure the area is healing and your muscles are working well.
What other treatment might I need?
Pelvic floor muscle training with the aid of a special ‘biofeedback’ unit will further assist you in strengthening your anal sphincter muscle. Like any other muscle in the body the more exercise the sphincter muscle receives the stronger it will be.
The food you eat can affect bowel function particularly if you have a tendency to an ‘irritable bowel’. For this reason dietary advice may help restore bowel control.
A combination of medication may be needed to help bowel control, particularly if the bowel motion is very soft or loose. Your doctor will advise you on whether such medication could be of benefit to you.
Referral to a Bowel Specialist –
At 12 weeks after your delivery if you are still troubled by problems with bowel control you may be referred to a specialist. They may do a test to assess the strength of the sphincter muscle using a pressure measuring device and a scan to take a closer look at the muscle itself. These tests are not sore and they do not need any special anaesthetic. They take about 10 minutes in total. You will usually be given the results on the same day. Depending on these results, you may be advised to have further physiotherapy or surgery.
What about future pregnancies and
Some women who have had problems after a third degree tear may be advised to have a caesarean section for their next delivery.
Your doctor or midwife can discuss this with you either before you get pregnant or at any stage during your pregnancy.
For further advice/information contact:
University Hospital Galway
Tele: 091 544489
Your Public Health Nurse/Midwife