What to do if perineum is torn? It needs to be repaired in time

Perineal tears often occur during childbirth or are caused by sexual intercourse. Dry stool can also easily cause perineal tears. Perineal tears must be disinfected in time. If they are caused by constipation, constipation must be treated in time and more fresh fruits and vegetables should be eaten.

1. The vulva should be disinfected in time;

2. Use soapy water and gauze to clean the vulva and vagina . Rinse with clean water, and then use 1:1000 Sanisol to rinse the vulva and vagina. A gauze roll is placed inside the rectum to prevent intestinal secretions from overflowing. Before cutting the vaginal wall, it can be disinfected with 75% alcohol.

3. Expose the surgical field : Spread the sterile sheet and separate the labia minora to the sides and sew them on the labia majora and sterile sheet.

4. Incision: Use tissue forceps to grasp the end of the ruptured recto-vaginal wall. Make an incision at the junction of the vaginal mucosa and the rectal mucosa, and reach the sides of the depression on both sides of the anus, that is, the sides of the folds where the anal sphincter is retracted into the stump. Trim away any remaining scar tissue.

5. Separate the vaginal wall and the rectal wall: Use tissue forceps to pull the vaginal wall and insert curved blunt-tipped scissors into the interface between the vagina and the rectum. With the blunt tip facing forward, push upward and separate the vaginal wall and rectal wall in the midline. Cover your fingers with gauze and peel upwards and to both sides to free the rectum as much as possible, leaving a wide free surface. The tension can be reduced when suturing the rectal wall, avoiding suture rupture and affecting healing.

6. Repair of the anterior rectal wall: The first layer is sutured with interrupted 00-gauge chromic intestinal suture without passing through the mucosa. The first stitch is the most important and should be placed above the top of the wound. The second stitch is at the top, with interrupted sutures, and the two stitches are about 1/2 cm apart. The second layer is made using the continuous Rembert stitch method, starting above the first stitch of the first layer, reinforcing and burying the first layer. It would be best to sew a third layer, including some muscle fibers and connective tissue, to turn the second layer inward and push the rectum backwards.

7. Find the anal sphincter stump

The retracted end of the anal sphincter can be found in the depression of the anal skin fold. First, use curved vascular forceps to reach into the subcutaneous tissue to open the gap; then use tissue forceps to reach into the gap and try to clamp out the broken ends of the sphincter at one time to avoid pulling it several times, which would cause damage to the few remaining muscle fibers. After finding the broken ends on both sides, pull them toward the midline, insert one finger into the anus, and feel whether the anal finger is tightened. The sphincter is sutured with 2-3 stitches of medium-gauge silk thread. The sphincter can be sutured later because the external opening becomes smaller after suturing the sphincter, which affects the suturing of the internal levator ani muscles.

8. Suture the levator ani muscles symmetrically.

Afterwards, pay attention to establishing the perineal body according to the posterior vaginal wall repair technique.