The type of repair required for a perineal tear will depend upon the injury that has been sustained.
First and second degree tears
First and second degree tears are more minor injuries.
A first degree tear is the laceration of the vaginal epithelium (the tissue lining the vagina) or perineal skin only.
A second degree tear is the laceration of the perineal muscles and fascia as well as the vaginal epithelium and perineal skin.
First and second degree tears can be repaired by a doctor or a midwife in the delivery suite. The laceration will be sutured together using absorbable stitches. Sutures suitable for soft tissue injuries must be used, such as Vicryl Rapide.
It is standard practice to perform a digital rectal examination both before and after the repair to ensure a more serious tear has not been missed.
Third and fourth degree tears
Third and fourth degree tears are more serious injuries.
A third degree tear is the laceration of the anal sphincters, as well as the vaginal epithelium, perineal skin, perineal body. A third degree tear can be subdivided into:
- 3A, where less than 50% of the external anal sphincter has been divided;
- 3B, where more than 50% of the external anal sphincter has been divided; and
- 3C, where both external and internal sphincter muscles have been divided.
Fourth degree tears are the same as a 3C tear, but also include the disruption of the anal or rectal mucosa/skin.
Both third and fourth degree tears must be repaired by an experienced surgeon in an operating theatre with optimal anaesthesia, lighting and equipment.
When repairing a third degree tear, the surgeon will normally use an overlap technique, using a standard long-term absorbable suture.
When repairing a fourth degree tear, the surgeon should identify the internal anal sphincter and repair it separately from the external anal sphincter.
Again, it is standard practice to perform a digital rectal examination both before and after the repair.
If the wrong type of repair is carried out, a patient will be left with a defect in her peri-anal area. Ordinarily this will happen because an incorrect diagnosis is made.
If this is something that has affected you, you could be entitled to claim compensation. This is because you have been the innocent victim of medical error, for which you deserve financial redress. To find out more, please get in touch with us today.