One page summary: Obstetric tears and pelvic floor injury

In two sentences

Tearing during vaginal birth is common. It is described in four degrees, and the ones that matter most are the third and fourth, which involve the muscle that controls the anus. Those are together called obstetric anal sphincter injury. ¹

The thing most people are not told plainly: leaking urine or stool, or being unable to control wind, after childbirth is common and it is not something you have to live with. It is a treatable injury, and the treatment works better the earlier you ask. ^{1 2}

The numbers, with their sources

• The four degrees. First degree involves skin only, second degree involves perineal muscle, third degree involves the anal sphincter muscle, and fourth degree extends through the sphincter into the lining of the anus ¹
• What OASIS means. Obstetric anal sphincter injury, meaning a third or fourth degree tear ¹
• The main risk factors. Operative vaginal birth, particularly forceps, a first vaginal birth, a large baby, and midline episiotomy ¹
• Episiotomy is not routine. Routine episiotomy is not recommended, and midline episiotomy is associated with a higher rate of severe tearing than restrictive use ¹
• Repair matters. Third and fourth degree tears require repair by an appropriately trained clinician, with attention to technique, antibiotics and follow-up ¹
• Follow-up is part of care. Postpartum care is an ongoing process, and symptoms of incontinence should be actively asked about rather than waited for ²

What to do this week

1. Find out what degree of tear you had and get it in writing.
2. Ask for stool softeners and use them.
3. Report urgently: increasing pain, fever, foul discharge, or the wound opening.
4. Ask for pelvic floor physiotherapy by name.
5. If you are leaking urine, wind or stool, say so. It is common and it is treatable.
6. Ask what follow-up is arranged after a third or fourth degree tear.
7. Ask what this means for a future birth, and note the answer.

Questions to take with you

Take these with you. Write the answers down in the moment, because you will not remember them later.

For the obstetrician or midwife

• What degree of tear did I have, and was there sphincter involvement?
• Was a rectal examination done to check?
• Who repaired it, and where?
• Were antibiotics given?
• What follow-up is arranged, and when?

For the pelvic floor specialist

• Is my sphincter intact on imaging?
• What is causing my symptoms specifically?
• What is the first-line treatment, and how long before we know if it works?
• What are the options if physiotherapy is not enough?

For a future pregnancy

• Given my previous tear and my symptoms, what mode of delivery do you recommend?
• What would you want assessed before I go into labor?

You can also build a printable list with the question generator.

Where to read more

The full page on this condition covers how it happens, causes split into what happens even with perfect care and what is associated with gaps in care, signs by age, diagnosis, treatment, outlook, daily life and lifetime cost.

Read the full page on Obstetric tears and pelvic floor injury

Related pages are listed at the bottom of it, including the events that can lead to this condition and the guides that cover therapy, school and money.