Stages of Perineal Tear: What to Know

A first-degree tear affects the skin around the vaginal opening. A second-degree tear extends into the perineal muscle and may need stitches. A third-degree tear reaches the anal sphincter, the muscle that helps control bowel movements. A fourth-degree tear extends through that muscle into the lining of the rectum. The degree is recorded after birth by examination, and a tear can be repaired with local or regional pain relief depending on its depth and circumstances.

Healing can include soreness, swelling, bruising and discomfort when sitting. Deeper tears need follow-up because bowel control, wound healing and pelvic-floor function may need assessment.

Keep the area clean with water, change pads regularly and pat dry rather than rubbing. Use prescribed pain relief as directed, rest when possible, and follow advice about bathing and activity. Preventing constipation helps protect the repair: drink fluids, eat fibre-rich foods and use a stool-softening medicine if your clinician recommends it. Pelvic-floor exercises are often introduced gradually; postnatal physiotherapy can help with pain, muscle coordination and return to activity.

Attend the follow-up arranged for a deeper tear, even if symptoms are settling. Ask when sex, driving, exercise and lifting are appropriate for your repair.

Contact your maternity team promptly for worsening pain, increasing swelling, heavy bleeding, fever, foul-smelling discharge, pus, a wound that opens, or difficulty passing urine. Seek urgent medical care if you cannot control bowel movements, are leaking stool, feel faint, or become suddenly very unwell. These signs can indicate infection, bleeding or a problem with the repair and should not wait for a routine appointment.

Ask: What degree was my tear, which tissues were involved, and how was it repaired? When should the wound be checked? Which pain, bowel-care and pelvic-floor steps are suitable for me? What symptoms should prompt a same-day call?