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10 things to do if you experienced a tear with childbirth

[ 0 ] 30/09/2015 |

 first-stage-labor-illustationGuest writer Carolyn Sultana*

 

A silent reality for some women

Everyone has his own special memory of childbirth with most women describing the birth of a child as the most wonderful, rewarding moment in life.  As amazing as that experience might be, some women do end up with physical trauma which causes them pain and distress.  Such trauma needs careful assessment and management.

85% of women will sustain vaginal / perineal trauma (tear) after childbirth and at least 70% will require suturing.  A small percentage of women will experience short-term complications such as difficulty in healing and infection of the wound.  Other women might have longer-term consequences such as urinary and fecal incontinence, pelvic organ prolapse, sexual pain, psychosocial problems and postnatal depression.  It is essential for health care providers to assess and repair the perineal trauma in an accurate manner and provide women with all the relevant and necessary information.

What is perineal trauma?

Trauma to the perineum caused by childbirth is classified according to the extent of the tear.  First-degree tear is limited to skin only.  Second-degree tear involves the perineal muscles (spontaneous tear or episiotomy).  Third degree tear involves the tearing of either the external or internal anal sphincter with fourth degree tear involving the anal sphincter complex and anal epithelium.

What are the risk factors?

Normally women, who have their first vaginal delivery, give birth to babies more than 4kg in weight and with prolonged second stage of labour are at an increased risk.  Women who had previous perineal repair are also at a risk.

How can I ease the discomfort of the stitches?

  • Keep the area clean and dry as much as possible, change sanitary protection regularly (at least every 4 hours) and do not use tampons
  • Take a daily bath or shower and wash with gentle soap and rinse with clear lukewarm water.  Pat dry the perineal area with a soft clean towel
  • Be aware of signs of infection such as increased pain, excessive discharge that has changed colour, suture breakdown and swelling
  • Take the pain killers as prescribed by the doctor
  • Eat a well balanced diet with plenty of water intake to ensure your urine is dilute and avoid stinging the wound
  • Pain and swelling can be decreased with the use of ice.  You can use the shower head to spray your perineum with cool water or else wrap an ice cube in cling film and massage the area for a few minutes, several times a day.  Do not sit on an icepack as this slows the circulation and the healing.
  • Avoid sitting or standing for long periods and you can also try breastfeeding your baby on your side.
  • Do not wear tight jeans or pants
  • When at the privacy of your house you may wish to lie in bed without a sanitary towel and letting your perineum ‘air dry’
  • Start pelvic floor exercises within the first 24 hours and only after any catheter has been removed and urine passed

Can perineal trauma lead to bladder problems?

Stretching of the muscles during birth can lead to weakening of the pelvic floor muscles.  Immediately after birth the area may feel numb and you might have difficulty controlling your urine.  There are situations when new mums leak when they stand, cough or laugh or before they manage to reach a toilet.  Most of the time, these symptoms will settle in the first few weeks after birth, however should they persist beyond six weeks you should seek the help of a specialized physiotherapist.

Will it be difficult to open the bowel after perineal trauma?

The idea of needing to open your bowels might seem daunting however there are ways to help yourself.  It is normal to worry about your stitches.  You can opt to hold a clean pad against your perineum to protect your stitches when you pass faeces the first few times.  The doctor might also be able to prescribe medications to soften your stools to make it easier.  Help yourself by drinking plenty of water, and eating a diet high in fibre, fruit and vegetables.  When you finish from the toilet, pat the area dry from front to back or you can opt to use a shower or bidet.

What about sex?

Perineal trauma is unfortunately related to painful intercourse.  Resuming sexual experience is different for every woman and varies between countries and cultures.  Normally women tend to wait for their postnatal visit at the obstetricians before their first postnatal sexual experiences.  Should the first experience be painful, couples should not be disheartened.  It is understandable that changes in sexual function and desire are normal after childbirth however if pain persists this should be discussed with a care provider and a referral to a women’s health physiotherapist should be done.  A women’s health physiotherapist is able to examine the pelvic floor, treat painful areas with massage and teach self-massage techniques and start a structured pelvic floor training programme.

If any of your problems related to trauma to the perineum persist you should talk to your obstetrician for further management and referral to a women’s health physiotherapist.

 

*Carolyn Sultana is a mum and a Women’s Health Physiotherapist BSc (Hons) SRP, MSc . Contact details:  M: 79962109, Clinic: T: 21493555 , St Anne’s Clinic, Triq Karmenu Pirotta, Birkirkara, E: carolynsultana@gmail.com, Facebook: WomensHealthPhysiotherapyMalta

 

Category: Guest posts, Resources for Malta Mums

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