- It is important not to put pressure on the pelvic floor, therefore straining on the toilet should be avoided.
- To avoid stress on the pelvic floor, always try to pull in the pelvic floor muscles and abdominal muscles before you cough, sneeze, lift or participate in any exercise.
We advise you not to have sex until approximately six weeks, once the vagina has healed and the area feels comfortable. You may find that lubrication such as an aqueous gel may make intercourse more comfortable. If you feel apprehensive about sex or experience pain it is important to speak to your doctor when you attend the hospital.
What are the long term effects of a third or fourth degree tear?
You may find that you need to rush urgently to the toilet. Some women will experience symptoms such as leakage of urine from the bladder or wind or bowel motions from the anus.
This is often temporary and can improve over time with doing regular pelvic floor muscle exercises. For some women symptoms may appear several months after the repair, in this case seek advice from your physiotherapist.
Stitches have usually dissolved by ten days after the birth of your baby. Sometimes a knot of stitch material can persist and cause discomfort. All stitch material used in the repair should eventually dissolve. Often the stitches around the anus remain in place for up to twelve weeks and can make passing bowel motions uncomfortable. Ensure you do not become constipated and if the pain is intense or you lose blood with the stool seek advice from your doctor.
Rarely a connection can form between the vagina and the rectum (rectovagina fistula). It is important to report any unexpected leakage of faecal material from the vagina to your GP or midwife. This is not common and can usually be repaired if it does not heal by itself.
Will there be any hospital follow up?
All women who have a significant perineal trauma including a third or fourth degree tear will receive an appointment in the post with an obstetrician and physiotherapist. You will be assessed on the healing of the wound, muscles, urine and bowel function. You will have the opportunity to discuss any concerns that you may have. If you need further treatment this will be discussed and arranged at this appointment. If you have problems after you are discharged from the clinic, then you should seek advice from your GP or health visitor, who can arrange referral back to hospital if necessary
What about subsequent pregnancies and births?
This will depend upon a variety of factors. Your obstetrician will use your hospital visit to discuss this fully with you. If your tear has healed completely and you do not have any symptoms you should be able to have a vaginal birth. If you are continuing to experience problems you may wish to consider caesarean delivery. It is advisable to wait at least a year before becoming pregnant again to regain strength and ensure you do not have any residual problems. Another vaginal birth may sometimes make any symptoms of anal incontinence worse.
This is an opportunity to meet with a midwife and talk about any concerns you may have following the birth of you baby. Phone 0191 2820212 and leave a message on the answer phone. A midwife from the RVI will return your call.
If you feel you are not coping with your problems, ask your doctor or midwife to refer you to a physiotherapist.