The common issues encountered for women with a 3rd or 4th degree tear in the early days after birth are the pain and discomfort that can be associated with the tear and the stitches that were needed, as well as constipation. Occasionally the stitches can become infected, meaning that the woman will need to take a course of antibiotics to treat this. If breastfeeding, the antibiotics prescribed are the types regarded as safest for the baby.
The majority of women who sustain a 3rd or 4th degree tear recover well without any long term problems. For some women though, there can be ongoing issues that persist for weeks or months and in some cases years after the birth.
These may include:
Anal incontinence
Continued perineal pain
Painful sexual intercourse
Anal incontinence
Anal incontinence means that the anal sphincter is weak or not functioning efficiently, causing the woman to have poor control over the passing of wind and sometimes her bowel motions. For these women, anal incontinence can mean they pass wind frequently and uncontrollably and occasionally actually passing bowel motions uncontrollably or have a feeling of urgency to get to the toilet fast before the motion is actually passed.
The reported incidence of this complication varies widely, being as low as 7% or as high as 59%. Incontinence is more common with a 4th degree tear than a 3rd degree tear. One study surveyed 177 women 13 years after sustaining 3rd and 4th degree tears with 25% of women who had had a 4th degree tear and 11.5% of women having a 3rd degree tear still experiencing anal incontinence to some extent. Of the 114 women who had since had another vaginal birth, only the women who had sustained a 4th degree tear experienced an increase or aggravation of the anal incontinence they had before the birth.
Treatments.There are many treatments offered for anal incontinence, all with varying degrees of success.