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Perineal Tears: What They Are and How To Reduce Your Risk While Giving Birth

birth columbus dr. emma pelvic floor pregnancy sexual health Apr 24, 2023

During a vaginal delivery the pelvic floor muscles stretch close to four times their original length. Incredible! Perineal tears are one of the top concerns presented to me with my birthing moms, which is very understandable! So let’s dive into what a perineal tear even is and how we can reduce the risk of a severe tear. 

 

What is the perineum?

The perineum is the smooth area of skin between the vaginal opening and the anus. The perineum represents the space the perineal body is located. I like to describe the perineal body as the keystone of the pelvic floor. There are three layers of muscles to the pelvic floor and the perineal body is like the keystone of the first layer. It is where the superficial muscles meet and lock the pelvic floor together from side to side and front to back. 



What is a perineal tear?

There are four grades of tears that can happen. 

Grade 1: Small tear affecting only the skin.

Grade 2: Tear affecting the skin and muscular tissue.

Grade 3: Tear affecting the skin and muscular tissue of the perineum and into the muscle of the anus. 

Grade 4: Tear affecting the skin, muscular tissue of the perineum, anus and into the rectum. 

 

The impact of these tears can include painful sitting, peeing, pooping, urinary/fecal incontinence, leaking gas, or painful intercourse/orgasm. I want to clarify that just because you have a tear, that does NOT mean you will have these symptoms. I also want to clarify that if you are having these symptoms… there is help! I don’t want you to feel alone in your symptoms, which is why I think we should spell out what some of the symptoms are. If you are having any of these difficulties, please reach out to a pelvic health physical therapist.


How can we prevent severe tears?

The Australian Commission on Safety and Quality of Health Care has outlined seven quality statements and care standards. We will focus on three. 

 

  1. Perineal self-massage performed by you, by your birth partner, and/or your by a healthcare professional after 34 weeks of pregnancy may reduce the risk of third and fourth degree tears. For more information on how to complete perineal massage, check out this video! (Abdelhakim AM et al, 2020) 
  2. Pelvic floor muscle training may help prepare you for labor and birth and reduce the possibility of a third or fourth degree perineal tear. Pelvic floor muscle training involves training the pelvic floor muscles to contract, let go, and to lengthen. Our pelvic floor muscles need strength, flexibility, and coordination. (Sobhgol SS et al, 2020) 
  3. Perineal massage performed by your healthcare provider during the second stage of labor may reduce the risk of third and fourth degree perineal tears. 

 

What are some other factors to consider? 

Consider your birth provider, birthing location, and birth team. A great question to ask your birth provider is how they plan on protecting your pelvic floor and promoting your birth experience. It is important to have a birth team, which could include a doula and pelvic health physical therapist. A pelvic health physical therapist can help you to connect with, to mobilize and to coordinate your pelvic floor muscles, as well as educate you on labor and delivery. If you are in the Columbus or Atlanta area, know that this is what we are here to help you with! 

 

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Thanks for reading,

Dr. Emma, PT, DPT, OCS, CMTPT



Abdelhakim AM, Eldesouky E, Elmagd IA, Mohammed A, Farag EA, Mohammed AE, Hamam KM, Hussein AS, Ali AS, Keshta NHA, Hamza M, Samy A, Abdel-Latif AA. Antenatal perineal massage benefits in reducing perineal trauma and postpartum morbidities: a systematic review and meta-analysis of randomized controlled trials. Int Urogynecol J. 2020 Sep;31(9):1735-1745. doi: 10.1007/s00192-020-04302-8. Epub 2020 May 12. PMID: 32399905.

 

Australian Commission on Safety and Quality in Health Care. Third and Fourth Degree Perineal Tears Clinical Care Standard. Sydney: ACSQHC; 2021

 

Sobhgol SS, Smith CA, Dahlen HG. The effect of antenatal pelvic floor muscle exercises on labour and birth outcomes: a systematic review and meta-analysis. Int Urogynecol J. 2020 Nov;31(11):2189-2203. doi: 10.1007/s00192-020-04298-1. Epub 2020 Jun 6. PMID: 32506232.

 

This blog serves as information and is not individual medical advice. This does not replace an evaluation by a qualified healthcare provider. 



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