Buttonhole perineal tear after childbirth

The injury creates an opening between the vagina and the rectal lining without necessarily tearing through the skin at the perineal edge. Because the outside can appear less damaged, a careful vaginal and rectal examination after birth is needed to find it and assess the anal sphincter separately.

Repair aims to restore the rectal and vaginal tissue layers and prevent a persistent passage between them. The procedure is performed with suitable anaesthesia by a clinician trained in perineal repair. The care team may prescribe antibiotics, pain relief and medicine that keeps stools soft so the wound is protected while healing.

Take prescribed medicines as directed and keep stools soft with the fluids, food and laxative plan provided by your maternity team. Clean the area gently, change maternity pads regularly and pat dry. Avoid straining, heavy lifting and vaginal or anal penetration until your clinician confirms that healing is adequate.

Attend the planned follow-up even if discomfort is improving. The visit can check wound healing, bowel control, pain and pelvic-floor function. Postnatal physiotherapy may help with graded pelvic-floor recovery and safe return to activity, particularly if you have urgency, leakage or difficulty coordinating the muscles.

Contact the maternity team promptly for worsening pain, fever, foul-smelling discharge, increasing redness or swelling, pus, wound opening, or difficulty passing urine or stool. Passing wind or stool through the vagina requires urgent assessment because it may indicate an abnormal connection or a repair that has not healed properly. Heavy bleeding, faintness or feeling acutely unwell also warrants emergency care.

Ask which tissues were involved, whether the sphincter was intact, how to use prescribed bowel-softening medicine and when the wound will be reviewed. Discuss bowel leakage, urgency, painful bowel movements, sexual comfort, pelvic-floor rehabilitation and how this injury may affect planning for a future birth.