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Third and fourth degree tears (OASI)

Repair of third and fourth degree tears, care of your stitches, and what to expect when healing

For some women the tear may be deeper and extend to the muscle that controls the anus (the anal sphincter).

Third or fourth degree tears, also known as an obstetric anal sphincter injury (OASI), can occur in 6 out of 100 births (6%) for first time mothers and less than 2 in 100 births (2%) of births for women who have had a baby before.

 

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OASI repair stitches positionRepair of third and fourth degree tears

If you have sustained a third or fourth degree tear, you will be transferred to an operating theatre for your muscles to be repaired.

You will be given spinal or epidural anaesthesia so that you have good pain relief and can be examined thoroughly.

Following the repair, you will be given antibiotics and pain relief.

Medications should not affect your ability to breastfeed.

You will have stitches between your vagina and anus (see diagram) and also underneath your skin. They will eventually all dissolve (soften and fall out).

 

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Infection

How do I prevent infection?

Keep the area clean.

Wash or shower at least once a day and change your sanitary pads regularly. Wash your hands both before and after you do so.

This will reduce the risk of infection.
 

I think my wound is infected, how do I know?

The skin part of the wound usually heals within a few weeks of birth, and after that you should feel much less raw and tender.

If you find that your wound is still open or bleeding, or if your wound becomes smelly or increasingly painful at any point, you should seek medical attention.
 

What do I do if my stitches get infected?

If you think your wound is infected, get a healthcare professional to examine you.

You may require antibiotics to help it heal, or if you have been given antibiotics already you may need your medication reviewed.

 

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Pain

Should I feel pain after the wound has healed?

After having any tear, it is normal to feel pain or soreness for 2-3 weeks after giving birth, particularly when walking or sitting.

The stitches can irritate as healing takes place but this is normal.

Passing urine can cause stinging.

The skin part of the wound usually heals within a few weeks of birth, and after that you should feel much less raw and tender.
 

Should my scar tissue be uncomfortable?

It may feel uncomfortable at first, particularly for 2-4 weeks after giving birth.

If the scar tissue continues to be uncomfortable you should seek medical attention.

 

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Your bowels

If I get constipated, will the tear open up again?

You will be given some laxatives for the first few days so that you don’t get constipated and don’t need to strain to open your bowels.

Sometimes, the laxatives work so well that you may struggle to get to the toilet in time. This should improve and settle over the first few days.

It is important to eat well and drink plenty of water to help avoid constipation.

You should drink at least 2 litres of water every day and eat a healthy balanced diet (fruit, vegetables, cereals, wholemeal bread and pasta).

It can be helpful to put your feet on a footstool to raise your knees above your hips while sitting on the toilet (see image). This can make it easier to open your bowels. Try not to rush or strain.

Opening your bowels should not open your repaired tear, but if you are concerned that you have, you should get a healthcare professional to examine you.
 

How can I improve my bowel control?

For a few days after your third or fourth degree tear is repaired, your bowel control may not be as good as it was before you had your baby.

Don’t delay if you have the urge to empty your bowels.

Gentle pelvic floor exercises should help improve bowel control.

Your pelvic floor muscles will not be very strong initially after childbirth.

You may also feel that you have difficulties working with your pelvic floor and that you have very little sensation.

This usually improves with time and the more you are able to work your pelvic floor muscles, the quicker the recovery will be.

Read about the pelvic floor
 

What is anal incontinence?

Anal, or faecal, incontinence is when you have problems controlling your bowels.

Symptoms include sudden, uncontrollable urges to poo, or not being to control passing wind.

You may also soil yourself or leak faeces.

Don’t be embarrassed about talking to a healthcare professional if you have these symptoms as support and treatment is available for you.
 

Will I get anal incontinence in the future?

Most people who have a third or fourth degree tear heal completely.

However, some find they are not able to control their bowels or the passing of wind.

People who experience these symptoms should receive appropriate care, which may include pelvic floor exercises or surgery.

It is important to talk about any concerns to a healthcare professional because support is always available for you.

 

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Getting back to normal

What level of activity should I do?

Everyone's experience will be slightly different, and what you view as normal daily activities will differ.

For 4-6 weeks, you should avoid strain or pressure on the anus, and avoid high impact exercise or heavy lifting.

After this, you can gradually increase your general activity.
 

When can I have sex again?

It's common to be worried by the thought of resuming sexual intercourse after having given birth, particularly if you have experienced a third or fourth degree tear.

Once your stitches have healed and bleeding has stopped, you can have sex again when it feels right for you.

Prior to commencing intercourse, you should consider a suitable method of contraception. It is possible to get pregnant very soon after giving birth.

Perineal massage, either on your own or with your partner, may help you feel more comfortable before you begin having sex again.

Sometimes, women who have recently had a baby may notice the vagina is drier than usual, this can be the case particularly if you are breastfeeding.

You may wish to use an appropriate lubricant the first few times you have intercourse (if you are using condoms you should use a water-soluble gel).

It make be a little uncomfortable and feel different the first few times but the discomfort should not persist.

Chatting with your partner about sex and any anxieties either of you may have and choosing a time when you both feel relaxed can help.

If you continue to experience pain or discomfort, it is important to contact a healthcare professional to discuss your concerns.
 

What will happen if I have another baby?

Many women go on to have a straightforward vaginal birth after a third or fourth degree tear.

If you continue to experience symptoms from the third or fourth degree tear, you may wish to consider a planned caesarean section.

You will be able to discuss your options for future births at your follow-up appointment or early in your next pregnancy.

Your individual circumstances and preferences will always be taken into account so that you can make a decision that is right for you.

 

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Support

You will usually be offered an appointment with a healthcare professional approximately 6 weeks after you had your baby to make sure that you are recovering well.

At that appointment, you will be able to discuss any concerns and ask any questions you may have about the birth of your baby and any of your symptoms or concerns about future pregnancies.

If you feel need to see someone sooner, get in touch with a healthcare professional (e.g. a GP, midwife, or health visitor).

You may be given an appointment with a physiotherapist to help you strengthen your pelvic floor muscles.

Looking after a newborn baby and recovering from a third or fourth degree tear can be hard.

As well as care from healthcare professionals, support from family and friends can help.

Organisations offering information and support

The MASIC Foundation
https://masic.org.uk

Birth Trauma Association
www.birthtraumaassociation.org.uk

Bladder and Bowel Foundation
www.bladderandbowel.org

 

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Further reading

 

 

 

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