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Tearing down there!

When giving birth a large percentage of women will have tearing in the perianal area (the area between the vagina and anus). Episiotomies were the standard procedure for many years but they are now only done when a forceps or vacuum delivery is needed and then only when necessary.

During my labor I had a 2 degree tear which means I have a giant paper cut on my tush. In more medical terms here is the breakdown of the degrees of tearing.

  • First degree: Tearing of only the skin around the perineum. This tearing usually requires stitches and heals fairly quickly.

  • Second degree: Tearing of the skin and muscle tissue in the pelvic floor. This will require stiches of each layer (stiches are dissolvable), will take weeks to heal and does cause more discomfort.

  • Third degree: Tearing that involves the muscle and skin but extends to the rectum and can even include the anal sphincter. This can be uncomfortable for months and can cause some incontinence.

  • Fourth degree: Tearing that involves the muscle and skin but extends to the rectum and can even include tearing completely through the anal sphincter to the tissue below.

Tears most often occur if:

  • This is your first vaginal delivery.

  • You've previously given birth vaginally and had a third- or fourth-degree tear.

  • You have an assisted delivery, particularly if forceps are used.

  • You have an episiotomy or you had one in a previous delivery.

  • Your baby is big.

  • Your baby is born in the posterior position (face-up).

  • You push for a long time.

  • The distance between your vaginal opening and anus is shorter than average.

Once you have tearing how do you treat it? The most common way is to use witch hazel pads called Tucks. The hospital will usually provide these to you. Unfortunately I found out that not only am I allergic to witch hazel, but some of the other ingredients in Tucks.

One technique I learned is to do sitz baths using loose leaf or bagged varieties of the sitz bath and doing a light soak. The best technique is to do what is called a pad-sicle. A pad-sicle is where you soak a maxi pad in water or witch hazel and place it in a bag and freeze. It is wise to do this before baby comes so that you have several in the freezer. Then even if you have a mild tear you can ice the area and then dispose of the pad as bleeding will be present from your uterus. I loved putting ice on this area with a gentle barrier. It felt amazing.

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