What Exactly Is A Vaginal Tear?

Let's face the fact. there are some, well, unpleasant parts of childbirth we don't love to talk about. And one of them is an "almost-certain consequence" of vaginal deliveries is vaginal tearing. Vaginal tearing is part of the normal process of a baby passing through the birth canal and out the vagina. It tends to be more common in first-time moms or among those who have big babies.

What is the vaginal tear?

During birth, the vagina has to stretch enough to allow a baby, to come through it. If the vagina fails to stretch as much as necessary, it will tear. Vaginal tear refers to the spontaneous tearing of the perineum (the region between the vagina and rectum) during vaginal delivery. It can happen in any part of the vaginal wall.

What are the chances of vaginal tearing?

Sadly, the chances of vaginal tearing during the vaginal birth are fairly high during the first time deliveries. However, during the successive deliveries, its chances will reduce as the tissues in peritoneum becomes more flexible due to the previous delivery or deliveries. Here are the odds of vaginal tearing:

  • First-time moms have a 95 percent chance of experiencing vaginal tearing during delivery since the tissue down there is less stretchy.
  • The position of the baby is another factor that determines the vaginal tearing and its intensity. Some positions like breech put extra pressure on the bottom of the vagina, thereby intensifying the tearing.
  • Having a vacuum- or forceps-assisted delivery can bring about vaginal tearing
  • Long labor can result in severe vaginal swelling thereby increases the chance of vaginal tearing.

Types of vaginal tear

Vaginal tears are classified by degrees. The classification is based on how deep the tear is. There are five types of vaginal tear:

Periurethral tears:

Vaginal tears that happen in the region around the urethra, the opening through which urine comes out, is called ' Periurethral tears'. The difficulty with these types of tears is that the high chances of profuse bleeding even from a small tear because that area has a rich blood supply. Suture will be required. Usually, very small stitches are used so that you won't have any trouble while urinating. The general cause for a periurethral tear is a sudden extension of the fetal head at the time of delivery

First-degree laceration:

These can happen either inside the vagina or outside on the perineum. In a first-degree tear, only the skin will tears, leaving everything underneath undamaged. As this type of tearing does not involve muscle, sometimes it does require a little suturing. However, if it bleeds, it can be rectified with stitches. These stitches are absorbable and dissolve its own and need not be removed.  Usually, the stitches will be single long, continuous one rather than a bunch of smaller ones.

Second-degree laceration:

This is the most frequently happening laceration. Here, the tear involves the vaginal lining and submucosal tissues of the vagina.  This type of tearing requires more stitches.

Third-degree laceration:

This laceration that involves the deeper layers of the vagina and extends to the muscles that make part of the external anal sphincter (band of muscle that functions to help hold stool in). The doctor should sew each layer individually, paying special attention to closing the muscle layer supporting the sphincter. Women who experienced this kind of tear are often put on stool softeners to help avoid constipation.  Sometimes these women also need strong painkillers as well.

Fourth-degree laceration:

This deep tear encompasses all of the above and extends right through to the rectal lining so that there is a direct passage from the vagina into the rectum. Luckily, this is the least common tear experienced. This usually happens when the shoulder of the baby is stuck in the birth canal. Additional layers of the suture are used to separate the vagina from the rectum. This takes a longer period to rectify and the recovery period can be extremely painful. 

Recovery period:

During the first- or second-degree tear, you can expect some level of uneasiness for a week or so when you're sitting straight up (depending on the location of the tear). By the second week, the tear should be pretty well healed and the stitches will be dissolved.

Healing for third- and fourth-degree lacerations, on the other hand, takes more time, with two to three weeks of the initial pain. A third-degree tear can cause uneasiness during sex or bowel movement for quite some period.  Fourth-degree tears that penetrate into the vagina or rectum can cause pelvic floor dysfunction and prolapsed, urinary issues, bowel movement difficulties, and unignorable discomfort during the intercourse