Perineal Tears Obstetrics & Gynaecology Women & Children's Services - Northern Lincolnshire and Goole NHS Foundation Trust
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
Information for patients and visitors Perineal Tears Obstetrics & Gynaecology Women & Children’s Services This leaflet has been designed to give you important information about your condition / procedure, and to answer some common queries that you may have.
Information for patients and visitors
Introduction prevent a 3rd or 4th degree tear from
happening.
You have been given this leaflet because
you have had a tear during the birth of your Why did I tear?
baby.
Although there are known risk factors with
What is a perineal tear? perineal tears, in many cases there is no
clear reason.
Many women, 8-9 out of 10 (85%), have a
tear during childbirth. Tears usually occur in Your chance of developing a perineal tear is
the perineum, which is the area between the increased when:
vagina and the anus (your bottom). You have a large baby (> 4kg or 8lbs
The tear, which is usually due to 13oz)
overstretching of the soft tissue of the birth It is your first vaginal delivery
canal, may vary in severity and may be
identified as follows: Labour is induced
1st degree tears – these are small, involving Second stage of labour (the time from
the skin only, they usually heal naturally. when the cervix is fully dilated to the birth
Most women do not require stitches. of the baby) is longer than expected
2nd degree tears – these are slightly You have an assisted delivery (forceps
deeper, affecting the perineal muscles as or ventouse)
well as the skin. All second degree tears
Your baby’s shoulder gets stuck behind
require stitches.
your pubic bone
For some women (2-6%) the tear may be
You have had a third or fourth degree
more extensive, involving the muscle around
tear before
the anus (the anal sphincters) and / or the
lining of your bottom.
Could the tear have been
3rd degree tears – this involves the vaginal prevented?
wall, and the perineum to the anal sphincter
(the muscle that controls your bottom). Sometimes perineal massage in the
antenatal period may reduce your risk of
4th degree tears – As a 3rd degree tear but tearing in labour. Unfortunately, there are no
with damage to the lining of the bowel. medical interventions available during
childbirth to prevent a third or fourth degree
Is an episiotomy different to a tear? tear from occurring and it is very difficult to
Yes – an episiotomy is a deliberate cut made predict when they might happen.
by a doctor / midwife to increase the outlet
space for the delivery of the baby. The cut is How are tears treated?
made through the vaginal wall and perineum. Tears especially 2nd, 3rd and 4th degree
A tear happens as the baby stretches the tears are treated by surgery. If your doctor /
vagina during birth. Research has shown midwife suspects a tear a thorough
that although an episiotomy makes more examination will be performed and a
space for the baby to be born, it does notInformation for patients and visitors
discussion of the findings and options of before and after changing your sanitary
treatment will be discussed with you. The towels or using the toilet.
usual pathway of repair is surgery (stitching). It is important that you avoid constipation. In
order to do so the following advice may be
Surgery helpful:
These tears require specially trained
Drink 2-3 litres of water a day.
healthcare personnel to repair them as soon
as possible after childbirth. Your midwife is Eat a healthy balanced diet with plenty of
the most likely person to suture a 1st or 2nd fibre.
degree tear.
Empty your bowel as soon as you get the
The repair for third and fourth degree tears is urge.
carried out in theatre and will require
Use a sanitary towel to support your
anaesthesia; usually an epidural or spinal but
perineum when going to the toilet.
occasionally a general anaesthetic may be
required. 3rd or 4th degree tears are sutured
by Senior Doctors. You will be asked to sign
Passing Urine
a consent form. Some women find that it is uncomfortable to
pass urine whilst their wound is healing.
Medication Passing urine in the bath or pouring warm
water over your perineum whilst trying to
Following surgery you may require certain
pass urine often eases this discomfort.
medication, which will include:
If you have had a 3rd or 4th degree tear
Antibiotics – you will be given antibiotics
repaired, you may have a drip in your arm to
to reduce the risk of infection, because
give you fluids and a catheter (tube) in your
the stitches are near the anus. It is vital
bladder.
that you complete the course
The catheter is important as you may not feel
Painkillers – you will be offered the need to pass urine initially, but it stops
painkillers to ease your discomfort, such your bladder getting over full.
as paracetamol, ibuprofen or diclofenac
When your catheter is removed (usually after
Laxatives – These should be used for at six hours) you may be asked to keep a chart
least ten days and help soften your recording how much fluid you drink and how
stools. This makes it more comfortable much urine you pass.
to open your bowels which reduce the
strain on the stitches Pelvic Floor Exercises
What should I be doing? Pelvic floor muscles wrap around the
underside of your bladder and bowel. They
Bowel Care are important for controlling bowel and
Keep the perineum clean. Have a shower or bladder function. Pregnancy and tearing
bath daily (you do not need to add anything weaken these muscles meaning they cannot
special to the water); wash your hands carry out their function.Information for patients and visitors
Doing these exercises aids the healing First and second degree tears will be cared
process by increasing the circulation of blood for you midwife who will inspect your
to the area. It is important that you perform perineum to asses healing when you have a
pelvic floor exercises for 6-12 weeks after postnatal appointment. Usually you will be
birth. You will be given a separate leaflet for discharged from midwifery care on or around
these exercises. day 10 after the birth of you baby.
Breastfeeding Can I have sexual intercourse?
None of the treatments will prevent you from Many women experience reduced libido after
breastfeeding. giving birth this is normal. There is no “right”
time for sex; however, it may be best to wait
What can I expect afterwards? until your stitches have fully healed and
bleeding has stopped.
After having a tear or an episiotomy, it is
normal to fell pain or soreness around the Make sure that you have arranged
tear or cut for two to three weeks after giving contraception before you begin to have
birth, particularly when walking or sitting. intercourse again as you can conceive
Continue to take your painkillers when you straight away. Some women find that they
go home. may need to use a vaginal lubricant initially
and try different positions that may make it
Most of the stiches are dissolvable and the
more comfortable.
tear or cut will heal within a few weeks,
although this can take longer. The stitches If you are worried about starting to have sex
can irritate as healing takes place but this is again, make sure that you talk to your
normal. You may notice some stich material partner, and start gently.
fall out, this is also normal.
Will I be able to have another
Your follow up appointment vaginal delivery?
If you have a third or fourth degree tear you This depends on a number of factors. A lot
will be either seen by the obstetric team at of women do go on to give birth vaginally
the hospital or contacted by phone 6-12 following 3rd and 4th degree tears, however,
weeks after giving birth. there is an increased of this happening
again, between 5-7 women in 100 who have
They will discuss with you how your stitches had a third or fourth degree tear will have a
are healing; if you have a hospital review the similar tear in a future pregnancy. You
doctor will also check your perineum. You should receive counselling from your doctor
will be asked about your bowel and urinary before making any decisions.
habits.
If you still have symptoms associated with
You should tell the doctor or midwife about your tear, you may be offered a caesarean
any other concerns you may have, including section to reduce the risk of further problems
sexual intercourse. If there are any occurring. If your tear has healed properly
complications, you may be referred to a and you have no symptoms a vaginal birth is
specialist. an appropriate option.Information for patients and visitors
Are there any long term effects? Useful telephone numbers:
Most 3rd and 4th degree tears will heal in Scunthorpe General Hospital
time but you might experience some of the Antenatal Clinic: 01724 290168
following:
Antenatal day Assessment Centre:
Pain and soreness in the perineum 01724 290409
Inability to control flatulence (breaking Diana Princess of Wales Hospital,
wind) Grimsby
Problems with your bowels including Antenatal Clinic: 01472 875248
leakage, urgency and lack of control
Antenatal Day Assessment Unit:
Haemorrhoids 01472 875558
Apprehensive towards sex Goole Midwifery Centre:
Concerned about future deliveries 01405 720720 ext 4079
Fistula (connection) between the anus 01724 29002
and the vagina after the repair has
healed. This is uncommon and can be Concerns and Queries
repaired by further surgery If you have any concerns / queries about any
of the services offered by the Trust, in the
When should I contact a Midwife / first instance, please speak to the person
Doctor? providing your care.
Contact your doctor or midwife if any of the For Diana, Princess of Wales Hospital
following occur: Alternatively you can contact the Patient
If your pain is not well managed Advice and Liaison Service (PALS) on
(01472) 875403 or at the PALS office which
If you become concerned about your is situated near the main entrance.
stitches or there is any smelly discharge
For Scunthorpe General Hospital
If you suspect you have a fever
Alternatively you can contact the Patient
If you keep having to rush to the toilet to Advice and Liaison Service (PALS) on
open your bowels (01724) 290132 or at the PALS office which
If you cannot control your bowels or situated on C Floor.
flatulence Alternatively you can email:
If you have any other concerns or worries do nlg-tr.PALS@nhs.net
not hesitate to contact your midwife or GP.
Confidentiality
Information on NHS patients is collected in a
variety of ways and for a variety of reasons
(e.g. providing care and treatment, managingInformation for patients and visitors
and planning the NHS, training and Please tell a member of staff on the ward or
educating staff, research etc.). in the department you are attending / visiting.
Everyone working for the NHS has a legal
duty to keep information about you Moving & Handling
confidential. Information will only ever be The Trust operates a Minimal Lifting Policy,
shared with people who have a genuine which in essence means patients are only
need for it (e.g. your GP or other ever lifted by nursing staff in an emergency
professionals from whom you have been situation.
receiving care) or if the law requires it, for
Patients are always encouraged to help
example, to notify a birth.
themselves as much as possible when
Please be assured however that anyone who mobilising, and if unable to do so, equipment
receives information from us is also under a may be used to assist in their safe transfer.
legal duty to keep it confidential.
If you have any questions regarding moving
and handling of patients within the Trust,
Zero Tolerance - Violent, please speak to a member of staff in the
Threatening and Abusive Behaviour ward or department you are visiting.
The Trust and its staff are committed to
providing high quality care to patients within Northern Lincolnshire and Goole NHS
the department. However, we wish to advise Foundation Trust
all patients / visitors that the following Diana Princess of Wales Hospital
inappropriate behaviour will not be tolerated: Scartho Road
Swearing Grimsby
01472 874111
Threatening / abusive behaviour
Scunthorpe General Hospital
Verbal / physical abuse Cliff Gardens
The Trust reserves the right to withdraw from Scunthorpe
treating patients whom are threatening / 01724 282282
abusive / violent and ensuring the removal of Goole & District Hospital
those persons from the premises. Woodland Avenue
All acts of criminal violence and aggression Goole
will be notified to the Police immediately. 01405 720720
www.nlg.nhs.uk
Risk Management Strategy
Date of issue: May, 2016
The Trust welcomes comments and
Review Period: May, 2019
suggestions from patients and visitors that
could help to reduce risk. Author: Author
Perhaps you have experienced something IFP-559 v1.2
whilst in hospital, whilst attending as an
outpatient or as a visitor and you felt at risk. © NLGFT 2016You can also read
