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Be aware that the following information describes rare complications that some readers may find disturbing. You may choose not to read all or parts of this section. |
3rd and 4th degree tears in Australia
How do they occur?
Stitching 3rd and 4th degree tears
Care of the stitches
Possible complications after a 3rd or 4th degree tear
Assessing the healing and function of the anal sphincter
Another vaginal birth?
Emotional considerations
Incontinence support
Third and fourth degree tears happen when the woman's
perineum tears during childbirth down to the edge of (or through) the anus, injuring a muscle called the anal sphincter. In some cases part of the bowel wall is also injured. The anal sphincter is a double ring of muscle (external and internal) that voluntarily controls the opening and closing of the sphincter to hold in and release wind and bowel motions.
Both 3rd and 4th degree tears involve injuries similar to a 2nd degree tear in that the tear involves the vaginal wall skin, the layer of underlying tissue and the pelvic floor muscles of the perineum. However, a third degree tear extends further to reach the edge of the anus, but does not go right through to the anus, tearing the external anal sphincter. A fourth degree tear extends completely through to the anus, tearing the external and internal anal sphincters and sometimes the internal wall of the rectum or bowel. Third degree tears are not common (less that 2%) and fourth degree tears are quite rare. The medical term for third and fourth degree tears is Obstetric Anal Sphincter Injury or OASI.
3rd and 4th degree tears in Australia
The reporting of 3rd and 4th degree tear rates is controversial as not all caregivers will recognise what constitutes a third degree tear, leading to the condition often being undiagnosed or not treated accordingly.