Birth Injuries (Perineal or Vaginal Tears)

Injuries that occur during childbirth, such as perineal or vaginal tears, are not only a burden to manage in the hectic time after your delivery, but they also can be serious.

At the University of Chicago Medicine, our specialists have extensive experience treating all types of birth injuries. We have a multidisciplinary team dedicated to specialized peripartum care starting during pregnancy and continuing through your standard six-week postpartum visit with your obstetrician. Our compassionate team includes urogynecologic surgeons, obstetrician-gynecologists, advanced practice providers, physician assistants, pelvic floor physical therapists, sexual health counselors and psychologists.

We understand that having a baby is an exciting and overwhelming time, especially for first-time mothers. Our goal is to provide high-quality care to help optimize your health and healing during pregnancy and into your postpartum experience.

What is a Perineal Tear?

The perineum is the area between the vaginal opening and anus. During a vaginal delivery, you may have a perineal tear (laceration).

There are four types of tears:

• First- and second-degree tears are less severe and very common. They are limited to the tissues of the vagina.
• Third- and fourth-degree tears can cause more severe damage to the tissues and muscles of your vagina and anus. These tears are stitched back together in the delivery room. However, complications may occur during and after the healing process, which can lead to anal (fecal) incontinence and painful intercourse.

Risk factors for developing a more severe (third- or fourth-degree) perineal tear include:

• Prolonged pushing during labor
• Episiotomy (an incision made in the perineum to assist delivery)
• Large baby
• Delivery position of the baby
• Use of forceps
• Older maternal age

Treatment for Birth Injuries

If you had a birth injury (perineal injury) during delivery, our pelvic health team can help you treat your symptoms with surgical and nonsurgical options. We will see you within a week or two of your delivery to ensure that early intervention and treatment happens.

Perineal Care After Delivery

Although you may be busy recovering from delivery and taking care of a newborn, it’s important to take care of yourself after delivery. In addition to eating well, staying hydrated and exercising, you should also practice good perineal care. This includes:

• Sitting in warm baths twice a day and carefully drying the area afterward
• Taking antibiotics, if prescribed, to prevent or treat an infection
• Using over-the-counter stool softeners and the laxative polyethylene glycol to ensure that your bowel movements are soft and easy to pass

Pelvic Floor Physical Therapy

If you recently had a vaginal delivery, pelvic floor physical therapy can help you regain anal sphincter and pelvic floor muscle function — no matter the severity of birth injury. Pelvic floor physical therapy can also help reduce symptoms of painful intercourse or pain from vaginal scarring. At UChicago Medicine, we believe that every woman who has delivered a baby deserves pelvic floor physical therapy.

Treatment for Urinary and Anal (Fecal) Incontinence After Childbirth

After vaginal delivery, it is common to have symptoms of urinary incontinence or anal incontinence, especially if you had a severe tear during labor. At UChicago Medicine, we offer pessary placement for urinary incontinence and will work with you on optimizing stool consistency and muscle rehabilitation to treat anal incontinence immediately after delivery. These easy interventions can make a world of difference in perineal healing and recovery from a pelvic floor complication.

Surgical Treatment for Perineal Wounds

If a perineal tear does not heal properly, additional wound care with packing and dressing, and sometimes even surgery, may be required. Our urogynecologic surgeons have specialized training in correcting and managing even the most severe perineal injuries. We are here to ensure you are followed closely after your surgery so your healing will be a success.

Psychological Support and Sexual Counseling for Birth Injuries

Anxiety and depression are common after delivery and may be even worse if you suffered a more severe tear during delivery or another pelvic floor complication. Mental health conditions can also worsen if your delivery did not go as planned. If these issues are not addressed in the postpartum period, they can linger and lead to other mental health issues, including sexual dysfunction.

At UChicago Medicine, our team is dedicated to ensuring that you receive the care and support you need after delivery. Our psychologists and sex counselors work alongside other specialists to help both your body and mind heal after your delivery.