What a perineal tear is
The perineum is the area between the vaginal opening and the anus. During a vaginal birth the tissue there can tear when it is stretched a lot. A perineal tear is a common birth injury and does not indicate a successful or unsuccessful birth.
More useful than self-blame are three practical points: the exact degree should be documented, the wound needs appropriate care, and you need a postpartum plan that supports healing rather than constantly pushing your limits.
Degrees 1 to 4 and why this matters for follow-up care
The classification by degree describes which structures are affected. It does not reliably predict how much pain you will feel, because swelling, hematomas, and individual sensitivity play a major role.
Perineal tear — degree 1
Skin and mucosa are affected. This can cause burning and discomfort when sitting, but it often heals relatively quickly.
Perineal tear — degree 2
The perineal muscles are additionally affected, but not the anal sphincter. Healing is often noticeable for longer here, especially if there is swelling or bruising.
Perineal tear — degrees 3 and 4
Here the anal sphincter is involved; in degree 4 the rectal mucosa is also affected. These injuries are often referred to as OASI, which stands for obstetric anal sphincter injury. With OASI, repair and follow-up care are particularly important, because otherwise later problems with controlling wind or stool are more likely.
A clear overview of OASI, repair, and typical follow-up is available from the RCOG. RCOG: Third and fourth degree tears (OASI)
Why a perineal tear happens
A perineal tear usually occurs in the second stage of labor, when the head or shoulders are born. Stretch, speed, tissue tension, and birth mechanics interact. There is rarely a single trigger.
Situations that may increase risk include instrumental births, a very rapid birth, a prolonged second stage, or circumstances with high pressure on the perineum. This is not a prediction but an explanation of why perineal protection and good support are important in those situations.
Care immediately after birth
After birth the perineal area is examined. Smaller tears are either sutured or managed conservatively depending on location, bleeding, and wound edges. Deep injuries must be reliably recognized so that suture technique, pain control, and follow-up match the findings.
OASI repair is usually performed under optimal conditions, often in an operating room. Afterwards bowel regulation, pain management, and structured follow-up are often part of care. ACOG emphasizes in its guidance how crucial correct diagnosis and proper repair are for later function. ACOG: Prevention and management of obstetric lacerations
Healing in the postpartum period: what is often normal
Pain, burning, pulling
In the first days pain when sitting, standing up, and during bathroom visits is common. Burning when urinating can occur if urine contacts irritated mucosa. For many people this improves noticeably within days; deeper tears tend to take weeks.
Swelling and bruising
Swelling is expected after tissue trauma. A hematoma can feel like a firm, tender area and can be very painful, even if the tear itself is not very deep. If pain is very severe, suddenly increases, or you feel unwell, it should be evaluated.
Sutures, poking sensations, and an unusual feeling
Sutures can poke or pull, especially when sitting. This is often temporary. Some sutures dissolve on their own. If you feel something rubbing or stinging like a small wire, a check-up can help, because sometimes a small adjustment is possible.
Having a bowel movement is often the hardest moment
Fear of the first bowel movement is common. If you tense or strain strongly, pain often increases. Soft stools are usually the best relief, especially after OASI. This is not a comfort issue but wound protection.
Practical relief in daily life
In the postpartum period less matters than a setup that reduces friction. The goal is to avoid repeatedly provoking swelling and to organize toilet visits so you don't build up fear each time.
Cooling, positioning, avoiding pressure
- Cooling can reduce swelling and pain in the first days, especially after activity.
- Sitting on your side briefly, taking short sitting periods, and changing positions often are often more helpful than enduring long periods sitting.
- Lying on your side with a pillow between your legs can relieve pressure if lying flat is uncomfortable.
Using the toilet without added strain
- Lukewarm water over the intimate area can reduce burning when urinating.
- Gentle cleaning is better than vigorous wiping, especially when the wound is sensitive.
- If you notice yourself straining, pausing is often more sensible than forcing pressure.
Exercise in moderation rather than all or nothing
Total immobility makes many things harder: the bowel becomes slower, pelvic floor sensation can feel less reliable, and mentally things feel more constricted. Short, regular walks are often the better strategy. If you feel noticeably worse in the evening than in the morning, your daytime load was probably too high.
Pelvic floor, postpartum recovery, and physical therapy
The pelvic floor is stressed after every pregnancy, regardless of whether a tear occurred. After a perineal tear it can be more sensitive or feel unstable. Postpartum recovery is less about intensive training initially and more about dosing: start gently, watch symptoms, and do not work beyond pain.
After OASI structured follow-up is especially important because problems sometimes only become apparent when everyday activity increases again. A patient information sheet on third- and fourth-degree tears summarizes follow-up, daily life, and typical recommendations well. NHS: Advice following third and fourth degree tears
Warning signs: when you should not wait
Many complaints are unpleasant but expected. The following signs are more suggestive of a complication or that the situation should be medically re-evaluated.
- Fever, chills, marked overall feeling of being unwell
- Wound becomes noticeably red, hot, leaking, or smells unpleasant
- Pain clearly gets worse over days instead of better
- Severe, increasing swelling or a tender lump that changes quickly
- New problems with holding wind or stool, especially after OASI
If you are unsure, an early check-in is often the shorter path. Many problems can be stabilized more quickly in the postpartum period than later under prolonged stress.
Prevention for a future birth: what the evidence shows
No one can prevent a perineal tear with certainty. However, there are measures that in studies are associated with fewer severe injuries or fewer episiotomies and that many people can implement.
Perineal massage during pregnancy
A Cochrane review describes that antenatal perineal massage can reduce the likelihood of perineal trauma, particularly episiotomy, and that persistent perineal pain is reported less often. Cochrane: Antenatal perineal massage
Warm compresses and perineal massage in the second stage
A Cochrane review of techniques in the second stage found evidence that warm compresses and massage can reduce the risk of severe perineal trauma. Cochrane Library: Perineal techniques during second stage
Practical takeaways
- Talk during pregnancy about how perineal protection is handled in the delivery room.
- Ask whether warm compresses are possible.
- If you had an OASI, discuss birth planning early in a subsequent pregnancy.
Myths and facts about perineal tears
- Myth: Severe pain always means a severe tear. Fact: Swelling or a hematoma can cause severe pain even with smaller tears.
- Myth: A perineal tear always heals quickly and completely without follow-up. Fact: Many heal well, but structured follow-up is crucial after OASI.
- Myth: You just have to push through bowel movements. Fact: Straining and fear often increase pain; soft stool and rest are usually the better strategy.
- Myth: Scar care means constantly doing something. Fact: Early on protection and rest matter; later gentle mobilization can be useful, while overactivity can irritate tissue.
- Myth: Noticeable odor is always normal in the postpartum period. Fact: Foul odor together with pain or fever can be a warning sign.
- Myth: Movement is always bad after a perineal tear. Fact: Graded movement is often helpful; overloading is the problem.
Conclusion
A perineal tear is a common birth injury with highly variable severity. For most people: it improves step by step when pain, toilet visits, and daily life are realistically supported. For deep tears, structured follow-up is especially important.
If you remember two things: watch the trend over several days and take warning signs seriously. Seeking help early is not overreacting but sensible postpartum care.
