A primary repair of a third degree tear carries a much better prognosis than a secondary repair.
If a third degree tear does occur, a woman should undergo a repair shortly after the delivery. A repair carried out soon after the injury is sustained is called a ‘primary repair’.
Those who undergo a primary repair have a positive outlook. The Royal College of Obstetricians and Gynaecologist (RCOG) estimate that 60 to 80% of women who have a primary repair will make a full recovery within 12 months.
If a third degree tear is not repaired immediately post-partum (after the birth), a defect will remain in the anal sphincter and perineum. It is likely that this will need to be repaired at a later date, once the injury is finally diagnosed. Such a repair is called a ‘secondary repair’.
Secondary repairs may be required in women who have previously undergone a primary repair. As suggested by the RCOG, 20 to 40% of women who have a primary repair will remain symptomatic 12 months after giving birth.
Therefore it is not certain that a secondary repair will be completely avoided, even if a competent repair is carried out immediately post-partum. However, on the balance of probabilities, the patient would have a significantly reduced risk of requiring a secondary repair.
Secondary repair prognosis
The long-term prognosis of secondary repairs may be poor as there is often a residual defect in the anal canal. In any event secondary repairs carry a poor prognosis with less than 50% of women remaining continent at five years. The patient may deteriorate to such an extent that she requires sacral nerve stimulation. It may even be that she comes to require a colostomy.
An undiagnosed third degree tear may also result in a deficient perineum which will make a direct material contribution to the widening of the introitus of the vagina and lack of vaginal sensation. Some women may not be able to retain a tampon and may not find sexual intercourse pleasurable.
If a tear is not identified at the time of the delivery and the patient suffers from faecal incontinence thereafter, this would be considered to be reflective of a standard of care below which the patient would reasonably be entitled to receive.
If you did not undergo a primary repair for a third degree tear and you have developed complications, you could be entitled to claim compensation. Contact us today to find out more.