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Concept
Perineal tear
Summary
A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus. Perineal tears mainly occur in women as a result of vaginal childbirth, which strains the perineum. It is the most common form of obstetric injury. Tears vary widely in severity. The majority are superficial and may require no treatment, but severe tears can cause significant bleeding, long-term pain or dysfunction. A perineal tear is distinct from an episiotomy, in which the perineum is intentionally incised to facilitate delivery. Episiotomy, a very rapid birth, or large fetal size can lead to more severe tears which may require surgical intervention.
In women, an anatomical area known as the perineum separates the opening of the vagina from that of the anus. Each opening is surrounded by a wall, and the anal wall is separated from the vaginal wall by a mass of soft tissue including:
The muscles of the anus (corrugator cutis ani, the internal anal sphincter and the external anal sphincter)
The medial muscles of the urogenital region (the superficial transverse perineal muscle, the deep transverse perineal muscle and bulbocavernosus)
The medial levator ani muscles (puborectalis and pubococcygeus)
The fascia of perineum, which covers these muscles
The overlying skin and subcutaneous tissue
A perineal tear may involve some or all of these structures, which normally aid in supporting the pelvic organs and maintaining faecal continence.
Tears are classified into four categories:
First-degree tear: laceration is limited to the fourchette and superficial perineal skin or vaginal mucosa
Second-degree tear: laceration extends beyond fourchette, perineal skin and vaginal mucosa to perineal muscles and fascia, but not the anal sphincter
Third-degree tear: fourchette, perineal skin, vaginal mucosa, muscles, and anal sphincter are torn; third-degree tears may be further subdivided into three subcategories:
3a: partial tear of the external anal sphincter involving less than 50% thickness
3b: greater than 50% tear of the external anal sphincter
3c: internal sphincter is torn
Fourth-degree tear: fourchette, perineal skin, vaginal mucosa, muscles, anal sphincter, and rectal mucosa are torn
Button-hole tear: the tear involves rectal mucosa with an intact anal sphincter complex
In humans and some other primates, the head of the term fetus is so large in comparison to the size of the birth canal that delivery may result in some degree of trauma.
Official source
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