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Perineal repair is one of the most common surgical procedures performed. It generally occurs after a vaginal birth when the perineum is torn naturally or cut during an episiotomy. The perineum is the area between the vaginal and anal openings and is made primarily from muscle tissue. Tearing is common during a natural delivery, and episiotomies are commonly used by many doctors. Repair often involves the sewing together of torn or cut tissues to allow proper healing. In some rare instances, a perineal tear my occur during sexual activity.
The challenges presented when doing perineal repair vary based on the situation. An episiotomy cut is generally a straight line from the vaginal opening to the perineum, and it is administered at the same time the infant's head begins to emerge or “crown.” This procedure provides a straighter cut that is easier to repair, although the damage to the perineum and vagina is often more severe than a naturally occurring tear. When the vagina tears during delivery, natural methods can help keep tearing to a minimum and perineal repair is no more complicated than with an episiotomy. In some rare cases, a very large or jagged tear may occur, making repairs more difficult.
Most times, perineal repair involves using a needle to stitch up and close the cut or torn tissue. This is usually a very routine and trouble-free procedure that is performed directly after the infant's birth. Stitches generally allow the wound to heal more effectively and prevents additional tears from occurring later. In some cases they may fall out on their own or dissolve, and in others they must be removed by a physician.
Care for the site of perineal repair may include using pain medications, sitz baths, and keeping the area clean and as dry as possible between baths. The area is usually sore for several days and a special pillow may be needed to reduce pressure on the vagina and perineum. Healing time varies from woman to woman and can range from a week to over a month, depending on how severe the original injury was.
In some very extreme instances, the perineum may have been ripped or cut very deeply, and additional perineal repair may be needed in the form of surgery or additional stitching. If the muscles below the skin are severely damaged, the patient may experience severe pain along with fecal or urinary incontinence. For this reason, surgical repair of the muscles, when feasible, is often needed to prevent these problems from persisting.
There are some methods which can be used to help prevent tearing of the perineum during an episiotomy-free childbirth. Some suggest that gentle massage in the weeks prior to delivery may help to gently stretch the area. This can be done using two clean fingers inserted at the bottom of the vagina, and by applying gentle pressure until a slight stinging sensation emerges. Another method is to stop pushing just as the baby’s head crowns, thus allowing it to emerge slowly and gently. This gives the vagina’s flexible walls enough time to stretch naturally, preventing serious tears.