tear of the perineum

Dam outline: description

The dam is located between the vagina and intestinal outlet (anus). During birth, the skin and muscles in this area are heavily stressed. In particular, when the child’s head passes through the birth canal during the expulsion phase, the stretch is particularly severe. Sometimes the tissue reaches its limits – a collapse of the perineum is the result. In addition to the dam other regions can tear during birth, such as vaginal skin, labia, cervix (cervix) or clitoris.

A dam crack is divided into different degrees of severity:

• Dammriss 1st degree: The skin on the perineum is torn only superficially. The muscles are not affected.
• Dammriss 2nd degree: The injury affects the skin and muscles, the sphincter is still intact.
• Dammriss 3rd degree: The sphincter is partially or completely ruptured.
• 4th degree dam ridge: Sphincter and intestinal mucosa are affected.

episiotomy

Sometimes the doctor increases the pelvic outlet specifically by an episiotomy (episiotomy). If this cut is not big enough, it sometimes comes to the perineal tear during birth.

Damline: symptoms

A perineal tear manifests itself through pain and bleeding. Many women often do not perceive the symptoms of epidural anesthesia (PDA) or decreased pain sensitivity after birth trauma itself. Here the exact examination by the midwife or the gynecologist is necessary.

Damline: causes and risk factors

Whether it is a rupture of the perineum during birth or not can not be predicted. But the danger is mainly with a very large child, an unfavorable child situation, a fast birth with a short opening period and an insufficient dam protection. Often, a perineal tear occurs as part of an operative vaginal birth, ie when using mechanical aids (forceps or vacuum bindings).

Damline: examinations and diagnosis

Immediately after birth, the gynecologist examines the mother’s vagina and dam very carefully. If there is a dam crack, it accurately assesses the location and extent of the injury. Among other things, the following questions need to be clarified:

• At what point is the crack?
• Is only the skin ripped?
• Is the perineal musculature also injured?
• Is the sphincter affected?
• How far is the intestine involved in the perineal tear?

Damline: Treatment

Smaller cracks in the skin heal on their own and do not need to be sewn. First and second degree tears are usually uncomplicated. They are sewn with self-dissolving suture – so you do not have to pull threads later. Women without epidural anesthesia receive local anesthesia before starting to suture. Depending on the extent of the injury, pain, swelling, a feeling of tightness and discomfort while sitting may last for a while. The walk to the toilet in the first days and weeks quite uncomfortable and often associated with a burning of the wound.

Dam tears of third and fourth degree are more problematic. Important here is the restoration of the sphincter and intestine. With a pronounced and complicated perineal tear, a treatment under general anesthetic may be useful. After surgical treatment of muscle and intestine, the doctor sutures the embankment in layers. Often it takes after the healing of the wound for a few weeks to months, until the sphincter works completely normal again. Abscesses, fistulas or permanent incontinence are very rare, even after a high-grade perineal tear.

Damline: Disease course and prognosis

Both the perineal tear and the episiotomy can cause pain during intercourse as a result of scarring.

Basically, the prognosis for a dam is good. With simple measures, the healing process can also be positively influenced:

• Avoid heavy pressing during bowel movements.
• Prefer food that promotes a soft stool (soft diet).
• If possible, avoid intestinal examinations, enemas and suppositories.
• Pay attention to hygiene.
• Make short, lukewarm sitting baths.
• Dry the wound well after cleaning.
• It may be useful to take anti-inflammatory drugs to prevent inflammation.

Insist on one tear of the perineum Functional complaints, these can be improved with a targeted pelvic floor training.