A 4th degree tear is an injury sustained during vaginal childbirth. It involves the perineum and the anal sphincter complex.
Anal sphincter injury
The anal sphincter complex is responsible for controlling the passage of wind (flatus) and faeces. This includes holding a stool in the rectum until the individual is ready to pass a motion.
When the anal sphincter is injured – as it will be in a 4th degree tear – the ability to control flatus and faeces will be compromised. This can mean that someone is unable to defer defecation for very long, in turn resulting in episodes of incontinence.
Will a 4th degree tear make me incontinent?
If a 4th degree tear is not repaired (or not repaired to an adequate standard), a defect will remain in the anal sphincter complex. Function will be reduced and it may lead to incontinence.
However, the prognosis is good if a 4th degree tear is properly repaired. The patient may find it difficult to control the passage of flatus, but most will not be incontinence of faeces.
Therefore you will not be incontinent just because you have sustained a 4th degree tear. If a good repair is conducted, you stand a good chance of regaining normal (or nearly normal) function.
What if the tear was not repaired?
But as mentioned above, if the tear is not treated, a defect will remain in the sphincter. The patient will subsequently have trouble controlling wind and faeces.
A repair can be carried out at a later date. This surgical procedure is called a sphincteroplasty. The literature suggests that 40% of patients have a satisfactory long-term outcome following a sphincteroplasty.
Nevertheless, this leaves 60% of patients with an unsatisfactory outcome.
Furthermore, due to the effects of ageing and the menopause, the patient’s continence may deteriorate in the future and she may require further treatment. Currently this would be by means of neuromodulation, although it is not known how medical treatment will advance in the future. There is a possibility that the patient will require a permanent stoma.
Will I get compensation if I’m left incontinent?
If you are left incontinent because a 4th degree tear was not repaired, or was not adequately repaired, you could be entitled to pursue a claim for compensation. To find out whether you are entitled to financial redress, you need to talk to a solicitor today.