If there was a delay in repairing your fourth degree tear because of medical error, you could be entitled to pursue a claim for compensation. Contact us for more information.
Repair of a 4th degree tear
When a fourth degree tear happens, the patient should undergo a prompt repair. This should be achieved within hours of the birth. Certainly a patient should not be allowed to leave hospital without undergoing a repair.
The procedure should be carried out in theatre by an experienced surgeon. The mucous membranes, the perineal muscles, internal anal sphincter, external anal sphincter and the skin will be repaired using dissolvable stitches – often 2-0 Vicryl Rapide. The rectal and vaginal mucosa will also be repaired. A rectal examination should be performed before and after the procedure to check the defect has been properly sutured.
Following the repair a fourth degree tear protocol must be implemented. This will involve administering antibiotics for 24 hours and prescribing stool-softeners (such as Lactulose). The patient should be referred for physiotherapy and reviewed by a consultant six weeks post-delivery.
Primary repair vs secondary repair
It is important that a fourth degree tear is repaired shortly after the birth. This is called a primary repair.
However, in some cases a repair will not be conducted until much later. This might be due to a delayed diagnosis. Alternatively the primary repair may be of a poor quality and so another repair is required at a later date.
A repair that is performed after a delay is called a secondary repair. The surgical repair of the anal sphincter is known as a sphincteroplasty.
Medical literature suggests that the results of a secondary repair are inferior to those of a primary repair. Only 40% of women report a successful outcome at five years following a secondary repair.
Therefore on the balance of probabilities, if the patient has an adequate repair following the diagnosis of a fourth degree tear, she will not suffer from faecal incontinence. There is a possibility that she will suffer from some incontinence of flatus (wind) and infrequent episodes of passive incontinence. However, these will not be intrusive and will not impact on her lifestyle.
Claiming for a delayed repair
A fourth degree tear should be repaired shortly after the delivery. A secondary repair of a fourth degree tear is not acceptable, unless there were exceptional circumstances (such as the mother’s health was at risk.)
If a tear is not repaired due to medical error – for instance, a failure to diagnose or a failure to perform an adequate primary repair – there may be grounds for a compensation claim. Contact us to talk to a solicitor today.