Fourth-degree tear after giving birth: recovery and warning signs

The repair is normally performed soon after birth with anaesthesia. Recovery care commonly includes prescribed pain relief, antibiotics, medicine to keep stools soft, wound hygiene, and follow-up of bowel and pelvic-floor function.

This is the deepest type of perineal tear: it involves the tissue between the vagina and anus, both layers of the anal sphincter, and the lining of the rectum. It may cause soreness, difficulty sitting, and temporary changes in control of wind or stool while swelling settles and the muscles heal.

Follow-up matters even if recovery feels smooth. A clinician can assess healing, continence, pain, and pelvic-floor strength, then discuss sex, exercise, and birth planning for a future pregnancy.

Take the full course of prescribed medicines and use stool softeners as directed. Drink fluids, include fibre in meals, and avoid straining when opening your bowels. Keep the area clean with water, change maternity pads regularly, and wash your hands before and after toilet care.

Begin only the gentle pelvic-floor exercises advised by your maternity or physiotherapy team. Build activity gradually and avoid heavy lifting or high-impact exercise until your clinician confirms that healing is progressing.

Contact your maternity unit promptly if pain is worsening rather than easing, the wound becomes red or swollen, there is pus or an unusual smell, stitches seem to separate, or you develop fever. New trouble controlling wind or stool, stool leaking through the vagina, or difficulty emptying your bladder also needs assessment.

Seek urgent care for heavy bleeding, faintness, severe weakness, rapidly increasing swelling, or severe pain. These signs require examination rather than waiting for a routine postnatal appointment.

Ask when your wound and bowel function will be reviewed, how long to continue stool-softening medicine, and which pelvic-floor exercises suit your stage of healing. If you have urgency, leakage, painful sex, or fear about opening your bowels, name the symptom directly so the team can arrange the right examination or rehabilitation.