A primary repair of a third degree tear carries a much better prognosis than a secondary repair.
Primary repairs
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.
Secondary repairs
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.
Claiming compensation
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.
Call us free now on 0800 234 3300 (or from a mobile click to call 01275 334030) or complete our Free Online Enquiry and we will be happy to advise you.