A third degree tear is where the ring of muscle around the back passage (the anal sphincter) can be damaged during childbirth. It happens in about 1% of all vaginal deliveries. It may happen during a normal delivery, or sometimes when assistance is required, such as with forceps or ventouse.
For many women, a third degree tear will cause no particular problems, and bowel function returns to normal. Some women experience temporary problems with bowel control, which usually settle within 12 weeks. A small number have longer-lasting symptoms. We support you closely through recovery and follow you up to make sure healing is on track.
The anal sphincter is a ring of muscle that acts like a valve to keep the back passage closed. It is what gives you bowel control, working with the rest of the bowel to ensure bowel contents are not passed until you choose. Following a third degree tear, the anal sphincter may be weaker for a time, which is why we give the careful repair, the medication and the follow-up that we do.
After every vaginal delivery, your midwife or doctor will examine you to check whether you need stitches and to identify any tear.
If there is evidence of a third degree tear, the muscle will be repaired in an operating theatre before you leave the labour ward, usually under a spinal or epidural anaesthetic so you are comfortable. Dissolvable stitches are used, so you will not need to have them removed.
Following repair, you will be prescribed:
These are routine after a third degree tear, and you should take the full course.
For many women, a third degree tear will cause no particular problems, and bowel function returns to normal. Some women, however, experience temporary problems with bowel control. These are often minor and clear up within 12 weeks. Occasionally, bowel control problems last longer. These may include:
If you experience any of these symptoms, please tell your midwife, doctor or physiotherapist at your follow-up appointments. Many problems respond well to treatment, especially pelvic floor physiotherapy.
1. Bathing It is important to keep the area very clean. Take plenty of baths or showers while in hospital and after you go home. Pat the area dry; don’t rub.
2. Pelvic floor exercises These exercises help to restore muscle strength, and you may start them as soon as possible after delivery. A physiotherapist will visit you before you leave the hospital to make sure you know how to do them correctly.
3. Avoid constipation For your own comfort, try to avoid constipation. Drink plenty of fluids, eat fibre-rich foods, and continue the gentle laxative for as long as prescribed. The physiotherapist will also teach you a position to adopt while on the toilet that helps with the passage of a bowel motion.
4. Pace yourself Avoid heavy lifting and strenuous activity for the first 6 weeks. Healing takes time. Ask for help with older children and the housework.
You will be given outpatient appointments at:
It is important to keep these appointments, so that we can make sure everything has healed properly. The visits include a general discussion of how you are getting on, an examination, and a chance for you to raise any problems you may have noticed. If anything is not quite right, this is when we pick it up and act on it.
If you have any new or worsening symptoms before your appointment, do not wait. Contact the maternity unit or your GP.
A third degree tear in a first delivery does increase the risk of a similar tear in a subsequent vaginal birth, but the great majority of women who have a vaginal birth next time do not have a repeat tear. Your obstetrician will discuss your options for your next birth in detail. Whether a vaginal birth or an elective caesarean is recommended depends on how you have recovered, any ongoing symptoms, and your preferences.
In the first few weeks, the area will be sore, and it is normal to feel hesitant about sex. Most women find that, once healing is complete (usually by 6 to 12 weeks), sex returns to normal. If pain or discomfort persists, please raise it at your follow-up appointment; treatment is available.
Do not wait. Contact your GP, or ask to be re-referred to the perineal clinic. The earlier any problem is picked up, the more effectively it can be treated.
The stitches dissolve, and the scar is internal. The visible area heals quickly for most women. A physiotherapist or the perineal clinic can examine the area and reassure you about healing.
Yes, ideally. Pelvic floor exercises are protective for bowel and bladder control throughout life, especially after childbirth. The physiotherapist will give you a programme to follow.
Your physiotherapist and the perineal clinic are your first points of call. If you would value emotional support, your GP, public health nurse, or a counsellor can help. You are not alone, and you do not need to manage this on your own.
