Anal sphincter injuries resulting from vaginal childbirth are a significant and potentially debilitating complication. These injuries occur when the anal sphincter muscle tears either partially or completely, causing pain, discomfort, and long-term issues. Understanding the causes and implications of these injuries is crucial for effective prevention and management, ensuring the well-being of new mothers.
Degrees of childbirth tears
Tears during childbirth are wounds that occur in the perineal tissues during vaginal delivery. This is common in natural births, where tissues must stretch significantly to allow the baby to pass through. Tears can vary in severity and depth, and they are classified into four main degrees:
- First-degree tears: These are the least severe, affecting only the superficial layer of the skin without involving the underlying muscles. They often heal spontaneously within a few weeks, although in some cases, a few stitches may be applied to accelerate healing or improve the patient’s comfort. Pain associated with these tears is generally minimal.
- Second-degree tears: These are deeper than first-degree tears, involving not only the skin but also the muscles of the perineum (the area between the vaginal opening and the anus). This type of tear is more common and requires stitches to ensure proper healing, which may take a few weeks.
- Third-degree tears: These extend through the skin and muscles and involve the anal sphincter, the ring-like muscle surrounding the anal opening. If not properly treated, third-degree tears can have a significant impact. They require more complex suturing, and specialist interventions may be needed. Recovery time is longer compared to the previous degrees, and pain can be more intense, often requiring stronger pain management.
- Fourth-degree tears: These are the most severe and rare. In these cases, the tear extends beyond the anal sphincter into the anal canal and sometimes the rectal lining. The consequences of a fourth-degree tear can be very serious, including the risk of fecal incontinence and infections. As a result, surgical treatment is typically required, and recovery can be long and challenging for the new mother.
Causes of anal sphincter injuries
During childbirth, certain risk factors increase the likelihood of experiencing an ano-rectal tear, including:
- The use of instruments such as forceps or vacuum extractors to assist with the delivery.
- A high birth weight of the newborn (known as fetal macrosomia).
- A particularly long labor, or conversely, a very rapid delivery.
- Multiple previous pregnancies with operative interventions.
- An episiotomy, a surgical procedure in which the perineum is cut with scissors as the baby’s head crowns at the vaginal opening to widen it and facilitate delivery. When performed unnecessarily, this practice can be associated with a higher risk of sphincter tears.
Complications from ano-rectal injuries
Women who experience an anal sphincter injury may suffer from a range of symptoms, from intense perineal pain immediately following childbirth to long-term symptoms that profoundly affect their physical, psychological, social, and sexual health. The most common complications in the presence of anal sphincter injuries during childbirth include:
- Acute and persistent perineal pain, especially during movement or urination.
- Difficulty with bowel control (fecal incontinence and/or involuntary release of gas).
- Painful scarring.
- Sexual dysfunction.
- Pain during sexual intercourse (dyspareunia).
In this initial overview, we have introduced the classification, causes, and complications of ano-rectal injuries from childbirth. In October, we will continue to explore this sensitive topic in greater detail, discussing prevention and the available treatments.
The contents of this page are for informational purposes only and should in no way replace the advice, diagnosis, or treatment prescribed by your physician. Responses to the same treatment may vary from patient to patient. Always consult your doctor regarding any information related to diagnoses and treatments, and meticulously follow their instructions.
