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Your guide to perineal and bowel trauma

Woman holding newborn baby - perineal and bowel trauma

Perineal tears, which can occur quite naturally during childbirth, are categorised by their degree of severity. It is vitally important that the injury is identified and the appropriate surgical repair is made to avoid complications, which can have a traumatic effect on a woman’s future physical and psychological wellbeing.

If a mother is reluctant to talk about her concerns surrounding such an intimate injury, this can mean that painful symptoms and inadequate or negligent treatment can be left for a long time.

If you have suffered a perineal tear and believe that the standard of your treatment fell below your expectations, then you may have a clinical negligence claim.

It is never easy to decide whether to make a civil claim for clinical negligence after a maternal injury and complications associated with maternal injuries are often viewed as embarrassing.  Our team of male and female lawyers will treat you with the highest degree of sympathetic and sensitive understanding, putting you at ease if you feel embarrassed, and ensuring that your case is considered properly.  We will give you the expert guidance that you need and we will advise you whether we believe that there is a case to answer.

Your Legal Friend has many years of experience in successfully resolving many different types of clinical negligence cases.  Our specialist knowledge of both legal and medical issues, together with a sensitive awareness of how everyone involved is affected, means we can help you:

  • Find out the reason why something went wrong with a diagnosis, treatment or procedure.
  • Secure financial compensation for the injury or harm caused to you.

Not an uncommon injury

  • More than 8 in 10 women (85%) are affected by some form of perineal injury.
  • Around a third of women (60-70%) will need sutures (stitches) to treat perineal injury.
  • Around 2 in 100 women will experience a 3rd or 4th degree tear.

 The risk of 3rd and 4th degree tears at birth occurs in up to:

  • 7% of deliveries using forceps /suction cap
  • 4% of first pregnancies
  • 4% of births where the baby is lying in a difficult position
  • 4% of births at the ‘pushing’ stage
  • 4% of births where the baby’s shoulders are difficult to deliver
  • 3% of midline episiotomies - incision of the perineum to ease delivery
  • 2% of births where the baby weighs more than 8lbs 13oz (4 kg)       
  • 2% of births where  labour was induced
  • 2% of births where an epidural is administered.

         (NHS Trust, January 2015)

What is a perineal tear?

The female perineum is located in the genital area between the vulva and the rectum.

During childbirth it is common for women to get tears of the skin and muscles, which occur in the area of the perineum.

Perineal tear - classification

Perineal tears can vary in severity and are classified as first, second, third and fourth degree tears.

  • 1st  degree - injury to skin only. Underling muscles exposed but not torn.
  • 2nd degree - injury to perineal muscle but not to anal sphincter.
  • 3rd degree - injury to the perineum involving areas of the anal sphincter.
  • 4th degree - injury to the perineum where the anal canal may be torn and the tear may have spread to the rectum.

Repair and treatment

  • 1st  degree tears - usually heal naturally or are simply repaired by stitches. Long-term problems are rare. 
  • 2nd degree tears - are often a cut made by the midwife or doctor to allow the easier passage of the baby during delivery.
  • 3rd and 4th degree tears - are likely to need specialist treatment. 

3rd and 4th degree perineal tears

Symptoms

Symptoms, which can last for years, include:

  • Severe pain
  • Incontinence of flatus (wind)
  • Solid stool
  • Extremely painful sexual intercourse

A woman suffering a fourth degree tear is almost twice as likely to report faecal incontinence as a woman with a third degree tear.

Assessment and treatment

The management of third and fourth degree tears is set out in the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines No. 29, which advises:

  • Severity of every tear to be adequately assessed to determine if the tear involves the anal sphincter.
  • A third or fourth degree tear to be repaired in theatre with either local or general anaesthetic.
  • A third or fourth degree tear should always be repaired by an appropriately trained obstetrician. Inexperienced attempts at anal sphincter repair may contribute to subsequent anal incontinence.

Following a third or fourth degree repair it is recommended that:

  • A range of antibiotics and a laxative be given for 5-7 days.
  • Physiotherapy is offered after 6 to 12 weeks - to be reviewed by an experienced obstetrician and gynaecologist.

What happens next?

If a perineal tear is correctly assessed and competently repaired, then around two thirds of women will be almost clear of symptoms within 12 months. The most common remaining symptoms can still be incontinence of flatus or urgency to pass stool.

Future pregnancy

It is important that a woman’s previous history of childbirth is taken into account by a GP or doctor when pregnancy reoccurs as a previous perineal tear could cause a risk of developing anal incontinence. If a woman still has symptoms at the time of a subsequent pregnancy, it may be necessary to consider a caesarean section.

How Your Legal Friend can help you

Injuries caused to the perineum and their degree of severity should be correctly identified as quickly as possible following childbirth.

As experienced clinical negligence specialists, we know that you will want to find out why the midwife or doctor attending the delivery failed in their duty to provide the expected standard of care in the diagnosis and treatment of a maternal injury, especially a 3rd or 4th degree perineal tear.

We ensure your case is properly investigated and your voice heard in order to bring the hospital, health trust or medical practitioner to account for the harm and suffering they have caused, and to prevent others from suffering in a similar way.

Your Legal Friend is committed to ensuring victims of clinical negligence obtain answers and receive appropriate compensation so that their future medical treatment and care needs are properly met.