The perineum is the tissue that is located between the vagina and the anus. There are layers to the tissue being skin, subcutaneous tissue, and the pelvic floor muscles. The pelvic floor muscles are important muscles in regards to the passing of stool and urine.
During vaginal delivery, the perineal tissue is stretched with the passing of the baby, mainly the head and shoulders, which can lead to tears of the perineal tissue. There are different grades ranging from 1 to 4 of perineal lacerations.
- Grades 1 and 2 are most common.
- Grades 3 and 4 are more severe with tearing of muscles and the anal sphincter.
An episiotomy is an intentional perineal laceration made by the physician at the time of delivery. This was performed routinely some number of years ago, but is no long a routine procedure. Episiotomies are usually performed if there is concern for grade 3 or 4 perineal laceration or if there is concern to deliver the baby quickly.
Perineal lacerations only occur with vaginal delivery and therefore women with Cesarean sections are not at risk for perineal lacerations. Perineal lacerations most commonly occur with women delivering their first baby. A woman is also at risk for a perineal laceration if the baby is large or if any assistive devices are used by the physician or midwife to deliver the baby such as forceps or a suction device.
The diagnosis of a perineal laceration is made at the time of delivery. After the baby has been delivered, the physician will inspect the vagina and perineum for tears that may have occurred. In the case of episiotomy, it will be known that a specific laceration has been made in the perineum.
Initial treatment for perineal lacerations is repair with sutures at the time of delivery. Many women will have local anesthesia or use the anesthesia from their epidural to suture the laceration just after delivering the baby. Women with grade 3 or 4 lacerations, may likely need to have a surgery in order to repair the perineum adequately. The remainder of treatment is aimed at taking care of the wound at home, using ice, avoiding harsh soaps and cleaning in the area, abstaining from vaginal intercourse, reducing constipation, and avoidance of high impact exercises. Bellefit abdominal binders are also beneficial by providing compression to the abdomen to help reduce the abdominal pressure and any straining. Reduction of the abdominal pressure allows for proper healing of the tissue in the perineal area, as they are not subject to straining and pressure.
Having a perineal laceration with one delivery does not correlate with the chance of sustaining a perineal laceration with another vaginal delivery. The majority of repaired perineal lacerations will heal within 3-4 weeks after repair with sutures and with the proper after home care. There can be long term issues with perineal lacerations. The most common complication is persistent perineal pain or pain with vaginal intercourse. This type of pain can be common for the first 3 months after delivery, but can also persist much longer. Other complications are urinary or fecal incontinence and the risk for the development of prolapse of the organs in the pelvic area, which may be the uterus, bladder, or rectum.
Persistent pain, urinary or fecal incontinence, or feeling a bulge in the vaginal area, are all signs to seek care from your doctor for a possible complication of a perineal laceration that may need further medical management.