Repairing third degree tears
Third degree tears should be diagnosed during a routine examination soon after the delivery. Once detected, a patient should be taken to theatre at the earliest available opportunity for a repair. This must be performed by an experienced surgeon – usually an obstetric or colo-rectal surgeon. Appropriate pain relief should be given and the laceration sutured together with dissolvable stitches.
Third degree tears therefore differ from first and second degree tears, as a repair must be carried out by a surgeon in the operating theatre, rather than by a midwife in the delivery suite.
Post-operative care for third degree tears
After the procedure, antibiotics should be administered to reduce the chance of infection. Pain-relief medication and laxatives should also be provided, as it can be difficult to open the bowels after a third degree tear.
When the stitches are thought to be healing properly, a patient can be discharged from hospital. Before leaving, medical advice should be given upon wound management. This includes keeping the stitches clean, eating a balanced diet and doing pelvic floor exercises.
The injury should also be checked during a follow-up appointment to ensure it is healing well. If there are any problems, these should be highlighted and further treatment provided accordingly.
Further treatment for third degree tears
If complications do develop as a result of a third degree tear, additional medical treatment will be required. The exact nature of this will depend upon the problems present, but may involve:
- Physiotherapy to strengthen pelvic floor muscles
- Further surgery to rectify a poor repair, a fistula or an undiagnosed tear
- A colostomy bag for faecal incontinence
- A catheter for urinary incontinence
- Biofeedback
- Sacral nerve stimulation
With such treatment, it may be possible for a woman to make a full recovery. However, this is often dependent upon whether the third degree tear was identified soon after the delivery.
If there is a delay in treating a third degree tear, the results will be much less effective than if a primary repair had been performed. Any complications may, therefore, be permanent. In such cases it may be possible to make a medical negligence claim.
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