Recovering from a 4th Degree Tear
As a Pelvic Floor Therapist, I like to call it “when two holes become one”… also known as a 4th degree tear.
Perineal tearing during delivery is quite common. Perineal tears are graded on a scale of 1-4 based on severity. Grade 1 is the most minimal and Grade 4 is the most severe. The definition of a fourth-degree tear is when injury occurs to the anal sphincter and into the anal canal. There are several techniques that research suggests may help to prevent perineal tearing (which we teach in our birth prep sessions!), but we aren’t going into that here because if you’re reading, you’re likely dealing with a 4th degree tear yourself. So, in that case, let’s talk about how there IS hope and steps you can take to become more comfortable and set yourself up for a swift recovery.
First and foremost, know that you are not alone on this journey and that your body is capable of healing. I recommend finding yourself a well-trained pelvic floor therapist to help you along this journey. A 4th degree tear, while severe, can be managed with the right care, patience, and support. Here are some key steps to help you recover as comfortably and efficiently as possible.
1.Prioritize rest and gentle movement
Your body has been through a very traumatic event. Childbirth of any kind is a traumatic event to a woman’s body, and a 4th degree tear adds another layer of complexity. While it’s important to avoid excessive strain, gentle movement, such as moving around the house or purposeful breathwork, can promote circulation and aid in recovery. Try to lie down as much as possible in the first few weeks to reduce pressure on the perineum, and BREATHE… which leads me to my next point
2. Diaphragmatic breathing is your BFF
When the body goes through trauma, it is natural for the surrounding areas to “tense up”. When our body is in pain, it is also natural for the surrounding areas to “tense up”. As a pelvic floor therapist who has helped hundreds of women recover from delivery, I see time and time again that oftentimes the perineal tear itself is not the issue that continues to cause problems, but rather the muscles guarding around the scar in the pelvic floor, hips and abdomen. Diaphragm breathing will not only help to minimize this muscle guarding throughout the pelvis, but it also works as a natural way to optimize blood flow and lymphatic movement to the area of the perineal scar which, in turn, promotes healing.
3. Manage pain and swelling:
Pain management is an important part of healing in the first couple of weeks. As a pelvic floor therapist and women’s health specialist, these are the things I recommend to postpartum moms with perineal tears in the early recovery period.
Stool softeners: there is nothing more scary than pooping after your perineum has torn. Take the stool softeners! This will help keep bowel movements as soft as possible, making straining less likely and improved comfort on the toilet.
Stiz baths: Get in the bath a few times a day if possible, for just a short amount of time (5-15 minutes). Sitz baths are so helpful for aiding in recovery by keeping the area clean, improving blood flow to the area, and allowing relaxation of the pelvic floor muscles surrounding the perineal tear.
Ice packs: Ice multiple times throughout the day for 10-20 minutes. An easy way to create an ice pack for your perineum is by taking an organic panty liner, getting it wet and freezing it. Keep a large baggy of perineal ice packs in your freezer so they are quick and easy to grab.
Compression: oftentimes support to the perineum can feel really relieving in the first couple weeks. I suggest fitted underwear or even biker shorts to reinforce support in the area. Compression also helps to move swelling out of the area, which in turn, decreases pain.
4, Find a trusted pelvic floor therapist
The journey after a fourth degree tear can be isolating and scary. I see women as early as 3-4 weeks postpartum to begin discussing how we can optimize healing. Oftentimes this begins with gentle breathwork and stretching to help manage pain and minimize tightness later on. When ready, we will move into scar tissue mobilization and optimizing pelvic floor muscles. Many women experience pelvic floor tightness or discomfort after a 4th degree tear, and targeted therapy can address those issues effectively.
See our previous blog post here regarding how to find a Pelvic Floor Therapy Specialist to support your in your recovery.
5. Give yourself grace
Recovering from a 4th degree tear can feel overwhelming at times. Some days will feel easier than others, and that’s completely normal. Seek out support from professionals, friends, and other moms who understand what you’re going through. You’re not alone, and your body is stronger than you think.
If you're navigating recovery after a 4th degree tear and want personalized guidance, our team of pelvic floor specialists are here to help. We are experts in pelvic floor therapy in Omaha, NE. We have extensive experience working with moms recovering from challenging deliveries.
We make it simple for you to connect with us and begin your recovery journey. You can get in touch with us through a variety of convenient methods:
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Email Us: Have more detailed questions? Send us an email at nicole@pelvicwellnessomaha.com and we’ll get back to you promptly.
About Pelvic Wellness Physical Therapy
Pelvic Wellness Physical Therapy is a pelvic health specialty physical therapy clinic in Omaha, NE that focuses on individualized treatment of pelvic floor conditions to determine the root cause of the symptoms. Our goal is to evaluate every patient in a holistic manner to determine the best treatment methods to help return patients to what they love.
Pelvic floor symptoms can be embarrassing and lonely. When pee, poop and sex are not functioning the way we expect, our life is significantly impacted. Pelvic Wellness is here to listen and be your guide in eliminating these symptoms and regaining your life back.
If you are dealing with pelvic floor dysfunction or are wondering if you might be a good fit for an evaluation, call Pelvic Wellness Physical Therapy at (402)-625-0313 to set up a free 15-minute discovery call or contact us via our online contact form.
