Labor and delivery, postpartum care

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Fourth-degree vaginal tear

Fourth-degree vaginal tears are the most severe. They involve the perineal muscles and anal sphincter as well as the tissue lining the rectum. Fourth-degree tears usually require repair in an operating room — rather than the delivery room — and might take months to heal. Complications such as fecal incontinence and painful intercourse are possible.

Your health care provider will evaluate your recovery at your postpartum checkup. If you experience complications from a severe vaginal tear, you might be referred to a urogynecologist, colorectal surgeon or other specialist.

1. Makai G, et al. Evaluation and management of lower genital tract trauma in women. http://www.uptodate.com/index. Accessed Sept. 26, 2011.
2. Toglia MR. Repair of episiotomy and perineal lacerations associated with childbirth. http://www.uptodate.com/index. Accessed Sept. 26, 2011.
3. Ganapathy R, et al. Secondary repair of the perineum following childbirth. Journal of Obstetrics and Gynaecology. 2008;28:608.
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5. Life Saving Skills: Manual for Midwives. 4th ed. American College of Nurse-Midwives. http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000551/LSS%20Mod%209_10_final%20print2_11.pdf. Accessed Oct. 3, 2011.
6. Bagade P, et al. Outcomes from medium term follow-up of patients with third and fourth degree perineal tears. Journal of Obstetrics and Gynaecology. 2010;30:609.
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