Perineal Tears After Birth: Degrees, Stitches, and Recovery
Tears during vaginal birth can affect different parts of the birth canal. Many involve the perineum, the tissue between the vaginal opening and anus, but tears can also occur in the vaginal walls, labia, or other tissues around the vaginal opening. Less commonly, the cervix can tear during birth.
Most perineal tears are first or second degree and heal well. Deeper tears need more careful repair and follow-up, while cervical tears are a different type of birth injury that can sometimes cause significant bleeding and need prompt medical treatment.
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Quick Answer
Perineal tears are classified from first to fourth degree according to how deeply they extend. First-degree tears involve skin, second-degree tears extend into perineal muscle, and third- and fourth-degree tears involve the anal sphincter, with fourth-degree tears extending into the rectal lining. Tears that need repair are usually closed with dissolvable stitches.
Tearing is not simply a matter of whether the tissue is ‘elastic enough.’ It can happen for several reasons, including how quickly the baby is born, the baby’s position and size, and whether instruments are needed. A very fast birth can give the tissues less time to stretch gradually.
Where Can Tearing Happen?
The term perineal tear is commonly used when talking about birth injuries, but not every tear follows the same path. Damage can involve the perineum, vaginal walls, labia, or tissue around the vaginal opening. The location and depth are assessed after birth so the clinician can decide whether repair is needed.
What About Cervical Tears?
The cervix can also tear during vaginal birth. Cervical lacerations are less common than perineal tears, but they are important because a deeper cervical tear can cause substantial postpartum bleeding. The cervix and vaginal walls may need to be examined when bleeding is heavier than expected or the source is unclear.
A cervical tear that is actively bleeding generally needs surgical repair by an experienced clinician, sometimes with better lighting, anesthesia, and access in an operating room. This is different from the usual recovery from a small perineal tear and is managed according to the location, depth, and amount of bleeding, per WHO guidance on postpartum hemorrhage.
The Four Degrees of Perineal Tearing
First-Degree Tear
A first-degree tear affects the skin and superficial tissue. Some small tears can heal without stitches, while others are repaired depending on bleeding, location, how the wound edges come together, and the clinician’s assessment, according to RCOG’s guide to first- and second-degree tears.
Second-Degree Tear
A second-degree tear extends into the perineal muscles as well as the skin. These tears usually need stitches so the deeper tissues can heal in the correct position.
Third-Degree Tear
A third-degree tear extends into the anal sphincter, the muscles that help control bowel movements. These injuries need careful repair and closer follow-up, and are covered in detail in RCOG’s guide to third- and fourth-degree tears (OASI).
Fourth-Degree Tear
A fourth-degree tear extends through the anal sphincter and into the lining of the anus or rectum. It is the deepest degree of perineal tear and requires specialist repair.
How Are Deeper Tears Checked?
After a vaginal birth, the birth canal is examined to identify the location and depth of any injury. When a third- or fourth-degree tear is suspected, assessment includes the anal sphincter and rectal area so the full extent of the injury can be identified before and after repair.
This matters because the repair needs to restore the damaged layers accurately while making sure the anal canal and rectum have not been unintentionally involved in the sutures, as the MSD Manual explains for spontaneous vaginal delivery.
What to Expect From the Stitches
Tears that need repair are usually closed with absorbable stitches. These dissolve over time and normally do not need to be removed. Small pieces of thread can sometimes be noticed as the stitches dissolve.
The tissues around a new repair may be quite swollen during the first days after birth. As that swelling settles, the area can look and feel different. Pain and swelling should gradually improve, and the wound should remain closed.
A Practical Point From Maternity Care
In maternity care, I sometimes saw women return because they were worried about how their stitches looked several days after birth. The tissues can be very swollen when a tear is first repaired, and once that swelling goes down, the stitches and wound can look quite different.
If a stitch loosens or the wound begins to separate, it should be assessed rather than managed at home. Wound breakdown can happen because of infection, bleeding or pressure under the tissues, or problems with healing. Whether a wound can or should be re-stitched depends on the situation, especially whether infection is present.
What Can Help While You Heal?
A few simple things can support healing in the days and weeks after a tear:
- Keep the area clean with water, change pads regularly, and wash your hands before and after using the toilet or changing a pad.
- Use a peri bottle with lukewarm water to make urination and cleaning more comfortable.
- Apply cold packs wrapped in cloth for swelling and discomfort during the first day or two.
- Try a plain-water sitz bath later in recovery if it feels soothing.
- Avoid putting unprescribed creams, sprays, antiseptics, or other products directly on the wound unless your maternity team specifically recommends them.
- Use paracetamol or ibuprofen for pain when they’re suitable for you. Both are generally compatible with breastfeeding, but your own medical conditions, allergies, and medications still matter.
- Keep stools soft, especially after a third- or fourth-degree tear. Your healthcare team may recommend a stool softener or laxative after a deeper repair.
When to Get the Wound Checked
Contact your maternity service or healthcare professional if pain or swelling is getting worse rather than better, the wound appears to be opening, or you notice new bleeding, pus, or an unpleasant smell. Fever or feeling generally unwell can also suggest infection.
After a third- or fourth-degree tear, problems controlling gas or bowel movements, strong urgency, or persistent pain should be discussed with a healthcare professional. These symptoms deserve assessment rather than simply waiting for a routine postpartum visit.
Conclusion
Most first- and second-degree tears heal without long-term problems, but the degree of the tear is only one part of your overall postpartum recovery. The location of the injury, swelling, pain, wound healing, and bowel or pelvic floor symptoms all matter.
The general pattern should be gradual improvement. If the wound becomes more painful, swollen, open, or foul-smelling, or if bowel control is affected, have it checked. A postpartum wound does not need to wait for a scheduled follow-up appointment if something is not healing as expected.
Sources
- Royal College of Obstetricians and Gynaecologists (RCOG). Perineal Tears During Childbirth.
- Royal College of Obstetricians and Gynaecologists (RCOG). First- and Second-Degree Tears.
- Royal College of Obstetricians and Gynaecologists (RCOG). Third- and Fourth-Degree Tears (OASI).
- Royal College of Obstetricians and Gynaecologists (RCOG). Perineal Wound Breakdown.
- MSD Manual Professional Edition. Management of Spontaneous Vaginal Delivery.
- World Health Organization (WHO). Consolidated Guidelines for the Prevention, Diagnosis and Treatment of Postpartum Haemorrhage.
