A perineal tear that extends from the vagina to the anus is called a fourth degree tear. It is the most severe type of perineal injury that can be sustained during childbirth.
Fourth degree tear
A fourth degree tear is a perineal injury that can be suffered by a woman giving birth vaginally. The tear will involve the vaginal wall, perineum, anal sphincter complex (the muscles that controls the anus) and rectum.
A fourth degree tear not quite as bad as a cloacal defect where there is no tissue left between the vagina and anus. This is also known as a cloacal deformity.
How to repair a fourth degree tear
According to the Royal College of Obstetricians and Gynaecologists (RCOG), a fourth degree tear must be repaired by an appropriately trained clinician, or by a trainee under supervision.
The repair will be conducted in theatre. Dissolvable sutures will be used to stitch the wound together. Afterwards a digital rectal examination should be carried out to ensure the defect has been properly stitched. A digital rectal examination will also confirm that sutures have not accidentally been inserted through the anorectal mucosa.
Medication should then be prescribed to prevent the breakdown of the wound, including antibiotics to ward off infection, and laxatives to promote the easy passage of stools.
Will I recover from a fourth degree tear?
Studies reveal that 60-80% of women who have an obstetric anal sphincter repair are without symptoms within 12 months.
However, these studies incorporate women who have had third and fourth degree tears. Normally third degree tears have a better outcome. Fourth degree tears are often associated with a degree of incontinence, normally incontinence of flatus (wind).
Some women will also suffer incontinence of faeces, finding they must be close to a toilet at all times to avoid an accident. This is because the anal sphincter muscles control our ability to defer defecation. If they are injured it can increase the urgency of defecation.
I am incontinent of faeces after a fourth degree tear
If you have become incontinent after a fourth degree tear (or indeed a third degree tear), you need to check that you have not been the victim of medical negligence.
For instance – was your tear diagnosed and repaired soon after the delivery? If it was not and there was a delay in the diagnosis and repair, you could be entitled to claim compensation.
If you believe your medical care has fallen below an acceptable standard, please contact us today.