What should I do if an old perineal laceration appears after a normal delivery?

Author: Lou Wenjia Peking Union Medical College Hospital

Reviewer: Zhu Lan, Chief Physician, Professor, Doctoral Supervisor, Peking Union Medical College Hospital

Postpartum perineal laceration is a common complication of normal obstetric delivery. Many mothers who give birth naturally have perineal lacerations, whether mild or severe. If it is not treated in time or treated improperly, it will cause chronic perineal lacerations.

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1. What is a chronic perineal laceration? Is surgery necessary?

Most perineal lacerations are caused by vaginal delivery, while a small number are caused by various accidents. During vaginal delivery, the perineum is overstretched by the pressure of the fetal head descending and giving birth, which can cause perineal lacerations. Common risk factors include primiparity, precipitous delivery, excessive fetal weight, malposition of the fetus, forceps delivery, episiotomy, etc. If the laceration is not repaired in time, or the repair does not heal well, it will leave scars, which are called old perineal lacerations.

Clinically, perineal lacerations can be divided into degrees I to IV from mild to severe, among which degrees II and III are more common.

Grade I : Only the vaginal epithelium is damaged without involving the muscular layer. If the tear is small and there is no active bleeding, it may heal on its own without repair.

Grade II : The injury extends to the fascia and muscle tissue of the perineal body, and the anal sphincter remains intact.

Grade III : The injury penetrates the fascia and muscle tissue of the perineal body and involves part of the anal sphincter complex.

Grade IV : The injury involves the anal sphincter complex and reaches the intestinal mucosa.

Severe lacerations can cause pain, hematoma, inability to control urination and defecation, etc., which not only cause psychological and physical pain to the patient, but may also affect sexual life. At this time, surgical treatment is required.

2. How to repair perineal lacerations

The doctor will design the size of the incision and the range of separation of the vaginal mucosa according to the degree of laceration and the amount of scarring. The following 8 principles must be followed during repair .

1. Fully expose the laceration site and examine it carefully.

2. Complete removal of scar tissue.

3. Suture strictly according to the anatomical layers.

4. Completely eliminate dead space.

5. Avoid sutures penetrating the rectum and causing rectal fistula.

6. Actively prevent infection and strictly follow aseptic procedures.

7. Provide good nutritional supplements.

8. Proper bowel management.

Although the above principles are mastered by doctors, as patients, we try our best to understand and cooperate with the doctor's instructions and requirements, so that we can help ourselves recover better and faster.

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3. Preoperative preparation and postoperative adjuvant treatment

The operation is usually performed 3 to 7 days after the menstruation ends. Adequate preparation is required before the operation to facilitate the success of the operation.

1. Bowel preparation is required for 3 days before surgery . On the first day, you can eat semi-liquid food (steamed buns, bread, noodles, wontons, etc., but not rice and fried vegetables); on the second day, you can eat liquid food (porridge, egg custard, lotus root starch, etc.); on the third day, you cannot eat anything, but can only drink water and juice. In order to ensure normal body function and water and electrolyte balance, the doctor will give you intravenous infusion on the second and third days. In addition, you will also need to take laxatives or enema every day.

2. Inflammation needs to be controlled before surgery . If you have chronic cough, constipation and other diseases, remember to actively seek treatment.

3. Three days before the operation, the nurse will wash your vulva and vagina every day.

So, what kind of auxiliary treatment is needed after surgery?

1. In order to avoid fecal contamination of the wound and improve the success rate of the operation, it is generally necessary to maintain a bowel movement for 1 week after the operation. During this period, because the patient is not allowed to eat, the doctor will give the patient intravenous infusion as an alternative nutritional support, and will also give drugs to slow down intestinal peristalsis every day. After 1 week, gradually transition to a normal diet. As the diet resumes, bowel movements will also resume. Before the first bowel movement, you can carefully use enema and take some drugs or laxatives to soften the stool orally. Do not exert excessive force when defecating.

2. The anal area should be kept clean after surgery, and the perineum should be flushed after urination and defecation.

3. Antibiotics may be needed after surgery to avoid wound infection and affect healing.

4. Avoid urethral infection.

5. Perform appropriate exercises under the guidance of a doctor to help patients recover.

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Conclusion

Generally speaking, old perineal lacerations are caused by various reasons during normal delivery and are not treated in time. Once a perineal laceration occurs, it is necessary to take reasonable measures, handle it in time, and actively treat it. In daily life, mothers should also pay attention to the hygiene of the perineum at all times to avoid infection, so as to prevent the degree of laceration from being aggravated and causing unnecessary trouble.