Personal Health

Perineal tear – causes, symptoms and treatment

When the dam breaks – causes and therapy

In the case of a dam tear the tissue between the Vulva and the Anus – called the perineum tearing. Usually this happens during birth, when the torso of the infant comes out. Perineal tears can be in different degrees of severity to be divided: If there is a crack in the first degree, are only skin and subcutaneous tissue of the perineum was not injured, but the muscles, the second degree of the crack reaches to a maximum at the outer sphincter of the anus; the third degree of the external anal sphincter is torn, the fourth degree of the mucous membrane of the rectum and a tear, finally. Possible cracks in the clitoris, the cervix and the uterus. Here are the main facts:

  • An Episiotomy is almost always during the birth, and only very rarely by other operations or accidents.
  • Perineal tears are divided into different levels of severity, from slight cracks in the skin up to deep cracks in the muscles.
  • A dam crack that needs to be sewn, is usually treated immediately after the birth.
  • Needs to be sewn, the seam under local anesthesia.
  • Symptoms are burning pain during defecation, or sexual intercourse.
  • An Episiotomy does not always prevent, massage, baths and creams to keep the skin elastic, but can be prevented.
  • Unwanted scarring can not always be avoided, the importance of a thorough follow-up, when the wound heals well.
  • To stitch an episiotomy is a routine treatment today is and only takes a few minutes.

Table of contents


A dam crack preventing can be caused. Perineal massage during pregnancy to loosen the fabric, warm compresses also ensure elasticity.

Perineal tears occur mainly at the time of birth. Massage and warm compresses can have a preventive effect by promoting the elasticity. (Image: artem_goncharov/


The treatment depends on the Severity of the crack. Grade I healed without a seam, deeper cracks must be sutured in layers, so that the fabric sits to the healing of wounds to the right place. Caution: injuries to third-and fourth-degree must be medically cared for in case of poor healing can otherwise be permanently pulled the continence affected. Perineal tears are healing in General, good, greater bleeding and inflammation occur rarely – good Hygiene required.

The Episiotomy

An episiotomy is supposed to prevent crack in a Dam, so the medical motto, at least until recently. Some of the clinics conducted at each of the second birth, an episiotomy. Today, many Doctors to see a controlled Tear as advantageous. They argue that such a crack is often only a minor injury (if only the tissue is affected and there is no muscles), and that he heals easier than a cut. The disadvantage of the supporters of the intestine section, but that is a dam crack on unchecked tear in contrast to a localized section.

The consensus today is that the need for a dam section must be individually evaluated. The episiotomy as a Routine, so I reject it, just as a dam is to protect the cut but are sometimes necessary – to have the child. Such emergencies can be a high-toned dam, as well as a premature birth. An advantage of the dam section is that the pressure on the head of the child subsides.

Symptoms of a perineal tear

Just light the dam cracks is not Affected at birth, often. Other pain and exhaustion to cover it. For weeks after the birth of, the Affected come to feel often pain when walking, when Sitting, or when playing sports. Slight bleeding are also typical, but easy with the bleeding of the birth to be confused.

Slight Perineal tears are not recognized by Affected often specifically say, but for weeks due to pain during movement or during a bowel movement. (Image: motortion/

It is essential for a dam is cracking, Urinating hurts, and likewise, the stool – a strong burning pain. The pain at the dam are crack extremely and does your urine smell bad, can have the crack and/or the urinary tract inflamed. In the Healing can ignite the seam and hemorrhoids as Abscesses form. These manifest themselves by itching, pain and sometimes slight bleeding. Most of the time the complaints disappear due to a Dam rupture in the first weeks after birth.

Diagnosis and treatment

To diagnose a perineal tear is easy, because it extends the view to the dam. The doctor examine, now, how deep the crack is and how far, and then you divide it into degrees of severity, according to which the number of stitches and dimensions for sewing. In the case of a perineal tear of the first degree, there is no medical treatment, but the treatment here means simply good Hygiene, which protects the wound from germs.

Must be sewn, numbs the injured area locally and then sutured. The birth itself took place under an epidural anesthesia, you must not be extra stunned. By the way, the Tear itself is for the woman not usually painful, but, on the contrary, often as a relief, because the crack takes away the pressure from the tank. Also distributed hormones to dampen the pain.

Perineal tears of first-degree heal in the normal case of deeper cracks can be sutured under local anesthesia layer-by-layer. (Image: Francois du Plessis/


A perineal tear is a serious injury, the inflamed, also, rarely seriously. Complications are possible, depending on the degree of the injury. In the case of serious cracks on the sphincter can lead to incontinence and infections in the anus area. It is also possible to suffer from a circulatory shock is, however, almost only in patients who are exposed to this risk.

Burning pain the toilet are a Symptom, a possible complication is the Tearing of the fresh scar defecation. Excessive scarring can later lead to problems during sexual intercourse. Severe Perineal tears can form Abscesses and fistulas may occur between the intestine and the vagina, the further operations necessary.

When to see a doctor?

The Episiotomy medical assistance is the most present, because it takes place during the birth. In the follow-up operation to pain when stool, during sexual intercourse, while walking, etc., then a Doctor or physician should clarify this. A doctor should be consulted in the case of open wounds in the Region of the Anus and the vagina, as germs can enter the body and cause disease. It is necessary to close the wound and sterilize.


Perineal tears can now heal properly. To sew the wound is Routine and comes to complications it only rarely. The healing will take a maximum of a few weeks. A possible consequence of the accidental formation of scar, however, as before, and this can lead to problems during intercourse and defecation. In very rare cases, a colonoscopy is due to the scarring later difficult.


To avoid complications, follow-up care of the wound attached. So patients to get the decongestant medications that soothe the irritated tissues. Also Kühlgele relieve the pain and help reduce Swelling. Sitz baths feel Concerned as pleasant, however, you should not be performed daily for longer than ten minutes to the skin to soften, making them swell more. Suitable for baths with chamomile or Calendula. The persons Concerned should go in the five days after the crack as little as possible, or sitting in small steps to the bathroom don’t move, the strain on the wound.

In order to heal, the wound to fresh air, and the area should be seamless to the dry. Until the wound is completely healed, you should not engage in sports that strain the abdominal or pelvic muscles, such as rowing or Cycling. Until complete healing, you should sit on a ring-shaped pillows, and when Lying to the side roll to get up. A soft bowel movement relieves the wound. These promote it with yogurt, dried fruit, lots of water and Magnesium. (Dr. Utz Anhalt)