Treatment
The treatment of perineal tears depends on the severity of the condition described above. Perineal tears of the first degree, in which the musculature is not affected, can manage without treatment. Since the skin tears heal on their own even without sutures.
If deeper tears occur, they have to be sutured in layers. The treatment takes place in the delivery room, i.e. immediately after birth, usually under local anaesthesia. If the birth took place under epidural anaesthesia (PDA), no local anaesthesia is necessary, but the anaesthesia of the birth can still be used.
In the case of a second-degree perineal tear, self-dissolving sutures are used, so that no more sutures have to be removed after healing. Particularly in the case of a third- or fourth-degree perineal tear, special attention must be paid to correct treatment, since in both degrees the external sphincter muscle is also affected and thus faecal incontinence is a risk in the event of poor treatment. In both cases the sphincter and the bowel are supplied first before the perineum can be sutured.
If a complicated perineal tear is present, it is sometimes also treated under general anaesthesia. Before treating an perineal tear, the treating gynaecologist must examine various factors: Where is the tear located? Is only the skin affected or are the muscles also affected? If the musculature is affected, is the external sphincter muscle also affected? Is the intestine also affected by the perineal tear?
Care
A treated perineal tear must be well cared for to prevent inflammation or bleeding. Some patients are recommended to take an anti-inflammatory agent to prevent inflammation of the wound or to counteract the swelling that has developed. The anti-inflammatory agent reduces the swelling and improves the blood circulation, so that the wound can heal better. Short lukewarm sitz baths are well suited for care. After cleansing, the wound should always be dried well.
Bowel movement
In the first days to weeks after the treatment of an perineal tear, pain and a burning sensation in the area of the injury often occur during bowel movements. If the injury has not yet completely healed, strong pressing during defecation should be avoided so that the stitches do not tear open again. Furthermore, it is best to eat soft food so that the stool is also soft.
If the external sphincter muscle is also affected by the perineal tear, it can take up to several months before it can function properly again. A complication can also be permanent incontinence. However, this occurs very rarely.
In order to counteract functional disorders, targeted training of the pelvic floor muscles is suitable. In order to avoid a perineal tear during birth or to speed up the birth process, an episiotomy is sometimes performed. In most cases, an episiotomy is performed due to the child’s state of health, in order to reduce the strain on the child during birth.
Sometimes an episiotomy is also carried out to avoid an episiotomy tear. The perineal incision enlarges the pelvic outlet. However, if the perineal incision is too small, this can also lead to a perineal tear.
An episiotomy is often performed, but is controversial. An episiotomy can cause injury to blood vessels and nerve tracts, which can lead to bleeding and sensitivity disorders. An episiotomy, on the other hand, usually spares blood vessels and nerves. Even a later incontinence, which can occur in the case of an episiotomy, even though it is rare, cannot be prevented by an episiotomy. Pain and complications can occur in the area of the later scar of the perineal incision.
