Perineal tear: how to prevent and treat?

what is the dam

Avoiding a tear in the perineum: How to prevent it

In order to avoid a perineal tear as much as possible, you should have perineal massages before the birthexecute. With the help of the massages you make the perineum more supple and stretchy. This means that the tissue cannot tear as quickly. The perineum is also taken care of during the birth of your baby, because the midwife makes sure that your child’s head is not born too quickly. She relieves the perineal tissue by pressing her hand against the perineum. Her other hand rests on the child’s head and regulates its speed of passage. With clear announcements, the midwife explains when and how hard you should work. So she tries to dose the pressure on the perineum. However, the perineum should not be held for too long either, as this can have a negative effect on the deeper pelvic floor muscles. A birthing position that is gentle on the pelvic floor can also protect the perineum. These include, for exampleupright standing, squatting, kneeling, or quadruped positions .

The severity of perineal tears

Less severe perineal tears can occur with any birth. The most common reason is a quick birth and a larger head of the child. However, serious perineal tears are rather rare. However, they occur more frequently with suction cup or forceps births . To prevent these serious tears, doctors sometimes perform a preventive episiotomy . However, episiotomy has become rare these days, because it is assumed today that tissue that is torn naturally heals better than tissue that has been severed. A distinction is made between four degrees of severity depending on the severity of the perineal tear:

• Perineal tear, degree 1 : The posterior vaginal skin and the skin of the perineum are slightly torn. The perineal muscles remain unharmed.
• Perineal tear, degree 2 : The posterior vaginal skin and the skin of the perineum are severely torn. There is also a superficial tear in the perineal muscles.
• Third-degree perineal tear: not only the rear vaginal skin and the skin of the perineum, but also the anal sphincter is torn completely or partially.
• Perineal tear of the 4th degree : In addition to the consequences of the perineal tear of the third degree, there is also the tearing of the intestinal mucosa.

Perineal tear treatment in the delivery room

The treatment of the perineal tear depends on the degree of severity. The first degree perineal tear often heals without complications without stitches. A more serious perineal tear has to be stitched up in layers, usually under anaesthetic. Third and fourth degree tears in the perineum in particular require professional medical care in order to avoid chronic consequential damage. However, there is no hurry to treat the dam. First, as parents, you are given the time to get to know your baby. The child is often placed on the breast for the first time before the perineum is treated.

Perineal tear treatment in childbed

The perineal tear can cause pain, swelling, infection, and sometimes bleeding at the site of the tear. Lying down, walking, everyday movements and spreading your legs can hurt you in the time after the birth and should be avoided as far as possible. Going to the toilet and especially having a bowel movement can also be very painful. In rare cases, prolonged incontinence and painful intercourse occur. In most cases, however, a perineal tear heals well and doesn’t cause long-term problems. Above all, good hygiene plays a major role in wound healing. Therefore, new mothers in childbirth are advised to take the following measures:

• short sitz baths with healing salts and essential oils or rinsing the wound with clear water.
• The wound area should be kept as dry as possible after cleaning by gently dabbing the perineum with a drying cloth or gently drying it with a hair dryer.
• You should change your maternity pads frequently, otherwise they can cause painful infections.
• Ice or special compresses are recommended for cooling in order to promote blood circulation and allow swelling to subside. Some midwives also recommend breast milk compresses.
• In a few cases, anti-inflammatory drugs are used.
• Drug infection prophylaxis is rarely recommended.

Diet tips will help heal a perineal tear

You should follow a gut-friendly diet while your perineum is healing. The right diet softens the stool and thus makes it easier for you to have a bowel movement. So you have less pain. Many midwives recommend nuts and dried fruit and plenty to drink. Slightly reduce the consumption of foods with a high acid content, such as oranges, berries, and juices, as well as foods high in fiber. Try smaller meals than usual and eat more frequently instead. Take your time and chew each bite carefully. In the case of greater difficulties, a quick effect can also be achieved by taking lactose. It is available in pharmacies without a prescription.