Perineal Tear Repair
What is Perineal Tear Repair ?
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Why do you need Perineal Tear Repair ?
Perineal tear repair is indicated for:
- Perineal tears during vaginal delivery:
- First-degree: Superficial tear involving only the vaginal mucosa or perineal skin.
- Second-degree: Involves the perineal muscles but not the anal sphincter.
- Third-degree: Extends into the anal sphincter (3a: <50% sphincter torn; 3b: >50%; 3c: includes internal sphincter).
- Fourth-degree: Extends through the anal sphincter into the rectal mucosa.
- Associated conditions:
- May occur alongside an episiotomy (a controlled incision) if the tear extends beyond the episiotomy site.
- Risk factors: First vaginal delivery, large baby (>4 kg), prolonged second stage of labor, forceps/vacuum delivery, or shoulder dystocia.
The procedure aims to close the tear, prevent infection, reduce pain, and restore perineal function (e.g., for continence and sexual activity) while promoting healing.
Why Do Perineal Tear Repair Costs Vary in Philippines?
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Perineal Tear Repair Procedure
- Before Repair Assessment:
- Evaluation:
- Performed immediately after delivery, before or after placental expulsion.
- The degree of tear is assessed through visual inspection and a rectal exam (to check sphincter involvement).
- Third/fourth-degree tears require careful identification of anal sphincter and rectal mucosa damage.
- Medications: Local anesthesia (e.g., lidocaine) if not already under epidural; antibiotics (e.g., cefazolin, metronidazole) for third/fourth-degree tears.
- Consent: Usually part of delivery consent; risks (e.g., infection) explained.
- Evaluation:
- Surgical Techniques:
- First/Second-Degree Tear Repair:
- Performed in the delivery room, lasting 10–20 minutes.
- The patient is in the lithotomy position (legs in stirrups).
- Local anesthesia is injected if needed (epidural often sufficient from labor).
- The tear is cleaned with antiseptic solution.
- Layered closure:
- Vaginal mucosa: Continuous or interrupted absorbable sutures (e.g., Vicryl) close the vaginal tissue.
- Perineal muscle (second-degree): Interrupted sutures approximate the muscle layer.
- Skin: Subcuticular (under the skin) or interrupted sutures close the perineal skin.
- Third/Fourth-Degree Tear Repair:
- Lasts 20–40 minutes, often in an operating room for better lighting and instruments.
- General or regional anesthesia may be used if epidural wears off.
- Anal sphincter: Repaired with end-to-end or overlapping technique using absorbable sutures (e.g., PDS for external sphincter).
- Rectal mucosa (fourth-degree): Closed with fine sutures to prevent fistula formation.
- Remaining layers (vaginal mucosa, muscle, skin) are repaired as above.
- Suture Materials:
- Absorbable sutures (e.g., Vicryl, chromic catgut) dissolve in 4–6 weeks; non-absorbable (rare) require removal.
- First/Second-Degree Tear Repair:
- After Repair:
- Observation: 1–2 hours in the delivery ward; hospital stay of 1–3 days (vaginal delivery).
- Pain management: Analgesics (e.g., ibuprofen, paracetamol) for 3–7 days.
- Antibiotics: For third/fourth-degree tears (5–7 days) to prevent infection.
- Hygiene instructions: Perineal care with warm water rinses; avoid wiping (pat dry) for 2 weeks.
- Ice packs: Applied for 24–48 hours to reduce swelling.
- Laxatives: For third/fourth-degree tears to avoid straining (e.g., lactulose, 1–2 weeks).
Recovery After Perineal Tear Repair
- Hospital Stay: 1–3 days (part of vaginal delivery stay); longer (3–5 days) for third/fourth-degree tears.
- Post-Repair Care:
- Pain: Perineal discomfort for 1–2 weeks (first/second-degree) or 2–4 weeks (third/fourth-degree), managed with analgesics; worse with sitting/walking initially.
- Swelling: Peaks at 2–3 days, resolves in 1–2 weeks; ice packs help.
- Hygiene: Warm water rinses or sitz baths (2–3 times daily) for 1–2 weeks; pat dry to prevent infection.
- Activity: Avoid heavy lifting or straining for 2–4 weeks; walking encouraged to prevent clots.
- Bowel movements: Laxatives (third/fourth-degree) to avoid straining for 1–2 weeks.
- Intercourse: Avoid for 4–6 weeks until healed.
- Diet: High-fiber foods (e.g., fruits, vegetables) and 2–3 liters water daily to prevent constipation.
- Follow-Up:
- Visit at 1–2 weeks to check healing; 6 weeks for postpartum check-up.
- Third/fourth-degree: Pelvic floor physiotherapy (after 6 weeks) to improve sphincter function.
Most resume normal activities in 2–4 weeks; full healing takes 4–6 weeks (first/second-degree) or 6–12 weeks (third/fourth-degree). Pain resolves in 90–95% of cases by 6 weeks; continence issues (third/fourth-degree) improve in 60–80% with physiotherapy.
Risks and Complications
- Immediate Risks:
- Infection (2–5%): Redness, swelling, or pus at the site; treated with antibiotics.
- Hematoma (1–2%): Blood collection causing swelling/pain; may need drainage.
- Dehiscence (1–3%): Wound reopening; requires resuturing or healing by secondary intention.
- Functional Complications:
- Painful intercourse (5–10%): Due to scarring; usually resolves by 3–6 months; pelvic floor therapy helps.
- Anal incontinence (third/fourth-degree, 10–20%): Gas or fecal leakage; 60–80% improve with physiotherapy; 2–5% may need surgical repair (e.g., sphincteroplasty).
- Long-Term:
- Perineal pain (2–5%): Chronic discomfort, often with poor healing.
- Scar tissue (1–3%): May cause tightness; massage or surgery (rare) for severe cases.
- Fistula (fourth-degree, <1%): Rectovaginal fistula; requires surgical correction.
Report fever, severe pain, swelling, or fecal leakage promptly.
Frequently Asked Questions (FAQs)
What causes perineal tears?
Vaginal delivery, especially with large babies, prolonged labor, forceps/vacuum delivery, or shoulder dystocia; first births increase risk.
Can I avoid a perineal tear?
50–70% of vaginal births have some tearing; perineal massage (third trimester), warm compresses, and controlled pushing may reduce severity.
Is perineal tear repair painful?
Not during repair (anesthesia used); perineal discomfort for 1–4 weeks post-repair, managed with medication.
How soon can I resume activities?
Light activities (e.g., walking) immediately; normal routines in 2–4 weeks; intercourse after 4–6 weeks.
Is perineal tear repair covered by insurance in India?
Yes, as part of delivery costs; confirm with your provider.
Signs of complications?
Fever, severe pain, swelling, pus, or fecal leakage (third/fourth-degree tears).
Will I have a scar?
Yes, but usually minimal; visible scarring fades over 6–12 months; 1–3% may have tight or painful scars.
Lifestyle changes post-repair?
Maintain perineal hygiene, avoid straining, use sitz baths, delay intercourse for 4–6 weeks, and attend follow-ups; third/fourth-degree may need physiotherapy.
Conclusion
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Looking for Best Hospitals for Perineal Tear Repair
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.