From the Guidelines
For vaginal tears, especially those that are deep, bleeding heavily, or causing significant pain, immediate medical attention is necessary as they may require stitches, prescription antibiotics, or other medical interventions, as evidenced by the American Journal of Obstetrics and Gynecology study 1.
Treatment Approach
When treating vaginal tears, it is essential to prioritize proper care to prevent infection and complications.
- Clean the area gently with warm water and mild soap
- Apply an antibiotic ointment
- Wear cotton underwear to allow air circulation
- Over-the-counter pain relievers such as ibuprofen (400-600mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can help manage discomfort
- Sitz baths (sitting in warm water for 10-15 minutes) 2-3 times daily can promote healing and reduce pain ### Postoperative Care For more severe tears that require surgical intervention, postoperative care is crucial, as outlined in the study by Schmidt 2.
- Clear documentation of laceration type and repair technique
- Arrange early follow-up within two weeks, ideally in a specialized postpartum perineal clinic
- Patient education on degree of injury
- Stool softeners (polyethylene glycol 4450 or mineral oil twice daily) for six weeks postpartum to achieve toothpaste consistency stools
- Pain control: acetaminophen; ibuprofen; ice packs; opiates only if needed
- Sitz baths twice daily until first wound check ### Prevention of Infection Preventing infection is critical in the treatment of vaginal tears, and the use of antibiotics has been associated with lower rates of postpartum wound complications, as shown in the study 1.
- Preoperative antibiotics should be administered before repair
- Surgical-site vaginal preparation with povidone-iodine or chlorhexidine gluconate can help prevent postoperative infection ### Quality of Life Proper hydration, nutrition, and wound care can support tissue healing and improve quality of life, as patients recover from vaginal tears 2.
- Avoid sexual activity until healing is complete, typically 1-2 weeks
- Monitor for signs of infection (increased pain, redness, swelling, discharge, or fever) and seek medical attention promptly if they occur.
From the Research
Treatment of Vaginal Tears
- After every vaginal birth, a careful inspection and/or palpation by the obstetrician and/or the midwife must be carried out to exclude a 3rd or 4th degree perineal tear 3
- Vaginal and anorectal palpation is essential to assess the extent of birth trauma 3
- The surgical team must also include a specialist physician with the appropriate expertise (preferably an obstetrician or a gynecologist or a specialist for coloproctology) who must be on call 3
- In exceptional cases, treatment may also be delayed for up to 12 hours postpartum to ensure that a specialist is available to treat the individual layers affected by trauma 3
Pain Management
- Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment for pain management after a vaginal delivery with perineal trauma 4
- Epidural morphine (≤2 mg) is recommended among women with labor epidural analgesia and severe perineal tears, with adequate respiratory monitoring 4
- Ice or chemical cold packs are recommended for postpartum pain first-line treatment due to their simplicity of use 4
- Transcutaneous nerve stimulation and acupuncture are recommended as adjuvants 4
Wound Care
- Daily cleaning of the area under running water is recommended, particularly after bowel movements 3
- Cleaning may be carried out either by rinsing or alternate cold and warm water douches 3
- Therapy should also include the postoperative use of laxatives over a period of at least 2 weeks 3
- Cold gel pad therapy and treatment with natural oil on perineal wounds can affect perineal pain and wound healing 5
Surgical Repair
- A continuous suture compared with an interrupted suture for the repair of episiotomy or second-degree perineal tears is recommended for the outcome of pain 4
- For women with first-degree or second-degree perineal tears, no suturing or glue compared with suturing is recommended for the outcome of pain 4
- The surgeon must use the method with which he/she is most familiar for the management of tears of the external anal sphincter, as neither the end-to-end technique nor the overlapping technique have been found to offer better results 3