Perineal Tear
A perineal tear is a birth injury feared by pregnant women that may or may not occur during childbirth. Tearing of this delicate perineal region is also divided into different degrees of severity, based on which the injury is graded by the attending physician after delivery:
In the case of a first-degree perineal tear, only its upper layer of skin is maximally teared in the middle of the perineum, thus not extending the anus and deep muscle layers. A strong vaginal tear of the head tissue just before the anus is called a second-degree perineal tear. In the third degree the entire perineum cries and includes the sphincter muscle. In the last and obvious degree the entire perineum, sphincter and anterior parts of the wall are dissected.
Reasons of Perineum Tear
During the ejection phase, contractions, also known as "pushing," involve very strong downward pressure from the contractions of the uterus and the mother's pushing. The full weight of the baby presses on the woman's delicate pelvic floor during this phase, putting abnormal pressure on the sensitive perineal area. Normal spontaneous birth. In the final stage, the baby's head is born first after its shoulders and then the rest of it. The size of the head and body puts a lot of pressure on the vaginal and perineal muscles, and the vagina is stretched to its maximum. However, if it is excessively stretched, the tearing of the tissues described at this point Occurs with or without muscle involvement Multiple perineal tears may also occur simultaneously.
Signs, complaints and symptoms of Perineum Tear
Complaints such as pain, burning or bleeding are possible even a few weeks after birth. If the perineal tear is not properly noticed at birth and not treated, it often becomes noticeable pain when walking, sitting or exercising. Light bleeding may occur, which is often not self-recognized due to premenstrual bleeding. Bowel movements and urination in particular can be very painful in the first days of birth and are often associated with a strong burning sensation. Although the wound usually heals quickly, the skin can be hard. Depending on the severity of the injury this stiffness can often be evident and cause pain during sexual activity or exercise even after healing. If the perineum itself causes severe pain and is accompanied by foul-smelling urine, it may indicate a urinary tract infection or even an infection. Hemorrhoids and blisters can also form around the perineal suture and are manifested by itching, pain and possibly slight bleeding. However, most signs and symptoms of perineal tears disappear within the first few weeks after birth.
Diagnosis and course of Perineum Tear
By classifying the severity of this birth injury, the treatment can determine how many stitches will be needed to sew it up. Immediately after delivery, after the removal of the newborn, the woman's wound is sutured under local anesthesia. If the birth is under peridermal anesthesia, the sutured area is not anaesthetized separately. At this point it should be noted that a woman who tears the perineum during expulsion understands that she is giving birth as pleasant and relaxing rather than painful, since all the pressure closes her pelvis. Also, delivery of injuries occurs under the influence of the body's own hormones and is rarely considered seriously painful.
Complexity of Perineum Tear
A perineal tear can lead to various complications. Depending on the degree of injury, there may be an innocent laceration of the skin sphincter muscle or a severe tear associated with pain, dysfunction and further discomfort. Surgical intervention may be associated with further injury and infection in the rectal region. Patients at risk also run the risk of transfusion shock and similar complications Swelling and pain may occur during wound healing. A sutured perineum causes tension pain and other discomfort after several days. There may be burning pain while going to the toilet and rarely tearing. Additional lesions may appear after wound healing, especially causing discomfort during bowel movements and sexual intercourse. In more severe perineal tears, abscesses may form, requiring another operation. Severe perineal tears can form fistulas between the vagina and the intestines. An injured sphincter can lead to temporary incontinence affecting diaper discharge. Impaired muscle functions can cause functional discomfort after a perineal tear, which should be treated specifically with pelvic floor training.
When should you see a doctor for Perineum Tear?
A perineal tear occurs in direct relation to childbirth. This should always be supported by a physician and/or midwife. If the perineum weeps outside of a birth process, it is considered abnormal. If pain and discomfort occur in the anus during defecation or sexual activity, they should be treated and clarified by a physician. If the discomfort worsens or becomes more widespread, a doctor should be consulted to find out the cause. If there is bleeding or an open sore in the area around the anus or vagina, bacteria can enter and trigger further illness. For this reason, a doctor should be consulted so that the wound can be treated and closed in a sterile manner. Should fever, itching, skin changes or a burning sensation occur, a physician should be consulted. Any discomfort during locomotion, sitting or bending posture is also necessary to see a doctor. If there is no bowel movement for more than two days, medical examination should be started. A physician should also consult a physician for small tears in the skin near the perineum, as complications may occur if the wound is self-tended.
Treatment and therapy of Perineum Tear
Perineal treatment is described by direct suturing of the cut wound. Some doctors also choose prophylactic perineal incisions during the birth of the child, but this is being performed less and less because of the tearing smell growing together and healing better than in patients caused by the scalpel. The perineal and vaginal areas are very busy and involve mucous membranes so there may be delays or problems with the healing process. Sitting, walking, or going to the toilet routinely stretches and stresses the suture, which can re-rupture the suture or cause wound healing problems. Hygiene is the top priority at this time, but so is caution and patience. In most cases, absorbable, i.e. self-dissolving, sutures are used for suturing, which do not require drainage. Nevertheless, the suture should be regularly checked by a gynecologist or flow-up midwife for inflammation or other types of wound healing problems.
Perspectives and Previews of Perineum Tear
Perineal cuts are easily curable with today's treatment options. The procedure takes a few minutes and is considered routine treatment. The patient is usually discharged from treatment a few days or weeks after the revision procedure. But there may be lifelong complications or weakness. Because the perineal tear is diffuse, the procedure carries the risk of unwanted scarring. In some cases, it leads to problems with bowel movements or sexual intercourse. To improve well-being, patients can take various measures that are helpful and comfortable in daily life. Straining while going to the toilet should be avoided. Nutrition and hygiene can be optimized. Short, flavored sits baths seem pleasant and beneficial. If taking measurements is not enough, the patient can be treated once more in the neck therapy. The diagnosis in this case is different and depends on the existing severity of the lesion. However, deterioration is considered rather unlikely. As with late chocolate, perineal lacerations can lead to increased inflammation. They are considered unpleasant but they are easily treatable unfit In adverse cases, perineal rupture may delay colonoscopy, enema or other bowel examination difficult. This is considered particularly unfortunate in cancer screening.
Resistance of Perineum Tear
Prevention of perineal tears, perineal massage with a suitable oil can be done in the last weeks of pregnancy. There are several techniques that can soften the tissues, usually inserting the fingers about pad-deep into the vagina and massaging with the index finger.
Nursing the newly recovered patient of Perineum Tear
Perineal tears and subsequent similar sutures cause tissue irritation and profuse swelling. To prevent this, patients are given immediate decongestant medication. Cooling the area with special cooling gels or cold packs also reduces swelling and relieves pain. Midwives also recommend soaking the pads in oil and using them instead of cooking gel or cold packs. The cold effect obtained in this way is perceived as more pleasant and at the same time has a caring effect on the skin. Some sufferers prefer healing sits baths made from hot water instead of adding special baths or extracts with healing plants. But the bath should be used only once a day for ten to fifteen minutes to soften the sores and avoid increased swelling. It is very important to observe a rest period of at least five days, during which the affected person should not sit or walk if possible. When going to the toilet, it is recommended to take small steps that do not stretch or spread the wound. There are a few things to keep in mind while going to the toilet yourself. Increase in fluid volume dilutes urine and thus reduces burning when urinating. Similarly, sufferers can quickly pour water into their feet from a glass to reduce further. Also, care should be taken to ensure soft bowel movements. It can be promoted by drinking water, eating yogurt and dry fruits or by additional administration of magnesium. The wound can be treated with warm water during urination to prevent painful burning during urination. Gentle rinses and sits baths can also be done with herbal extracts of chamomile or aloe bark, which are available in pharmacies. For the first few days, the wound can also be cooled with a cool pad wrapped in a towel to relieve swelling and pain.
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