Birth tearing levels explained

The grade guides repair, pain relief and follow-up. It is assigned by examining the vagina, perineum and, when necessary, the anal sphincter after birth.

A first-degree tear affects perineal skin. A second-degree tear extends into perineal muscle. A third-degree tear involves part or all of the anal sphincter muscle, while a fourth-degree tear extends through the sphincter into the lining of the rectum.

Third-degree tears may be described with additional letters to show how much of the sphincter is affected. This detail helps the surgical and follow-up teams understand the injury. The tear's grade and your symptoms both matter; discomfort alone cannot identify its depth.

Follow the repair team's instructions on pain relief, washing, pad changes and bowel care. A superficial tear may heal without stitches in selected cases, whereas muscle or sphincter injuries need accurate repair. Medication to soften stools may be offered after a deeper injury so the repaired area is not strained.

Attend the planned postnatal review even if day-to-day healing seems comfortable. Describe bladder leakage, bowel urgency, difficulty controlling wind, pain with bowel movements or persistent pelvic pressure. Postnatal physiotherapy can provide a tailored progression for pelvic-floor exercises and functional recovery.

Seek prompt maternity advice for worsening perineal pain, fever, unpleasant-smelling discharge, increasing redness or swelling, bleeding from the wound, or stitches that appear to separate. Urgent assessment is needed for heavy bleeding, fainting or rapidly worsening illness.

New loss of bowel control, stool passing through the vagina, inability to pass urine, or severe rectal or pelvic pain should not wait for a routine appointment. These signs can indicate a repair or function problem that needs direct examination.

Ask for the exact degree and, if relevant, sphincter subtype to be written in your discharge information. Useful questions include who will review healing, how long to use bowel medication, what symptoms warrant earlier contact, and how this injury may shape planning for a future birth.