Perineal tears are one of the most common birth-related injuries experienced during vaginal delivery, but they’re rarely talked about openly. These tears occur in the area between the vagina and anus (the perineum) and can range from mild to more severe, depending on how many layers of tissue are affected. The good news? With the right preparation, treatment, and recovery plan, most women heal well and regain full pelvic function.
The 4 Grades of Perineal Tears
Perineal tears are classified into four grades based on severity:
First-degree: A small tear of the skin around the vaginal opening. These usually heal naturally within a few weeks.
Second-degree: Involves both the skin and muscle layers of the perineum. Stitches are usually required.
Third-degree: Extends into the anal sphincter muscle. These need medical repair and guided rehabilitation.
Fourth-degree: The most severe, involving the anal sphincter and lining of the rectum. Specialist care and physiotherapy are essential for long-term recovery.
How Can You Minimise the Risk of Perineal Tears?
While not all tears can be prevented, there are several ways to reduce your risk and support your body before, during, and after labour:
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Perineal Massage:
Regular perineal massage in the final weeks of pregnancy can help improve tissue elasticity and reduce tearing during birth. Our women’s health physio video demonstrates safe, effective techniques to get started. -
Pelvic Floor Preparation:
Learning to relax — not just strengthen — your pelvic floor muscles can help during the pushing phase of labour. Pelvic floor physiotherapists can guide you through breathing and relaxation exercises to optimise control. -
Warm Compresses and Controlled Pushing:
Midwives may apply a warm compress during delivery to increase blood flow and soften tissues. Controlled, guided pushing (rather than holding your breath and pushing hard) also lowers strain on the perineum. -
Positioning During Labour:Your position matters! Staying upright and mobile (such as on all fours, kneeling, squatting, or leaning forward over a birth ball) helps your baby move down and can make contractions more effective and comfortable.If you have an epidural, don’t worry! You can still avoid lying flat. Side-lying or using a peanut ball between your knees can keep your pelvis open and support good baby positioning.The best position is the one that feels right for you. Listen to your body and change positions as needed. Movement really is your friend during labour!
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Early Postnatal Rehabilitation:
If a tear occurs, early involvement of a women’s health physiotherapist is key. Gentle scar management, pelvic floor re-education, and gradual return to activity can help restore confidence and function.
Final Thoughts
Perineal tears are a common part of many birth stories, but they don’t have to lead to long-term issues. With proactive care, education, and physiotherapy support, most women make a full recovery and return to pain-free, confident movement.
If you’ve experienced a perineal tear or want to prepare your body for birth, our women’s health physiotherapist can help.
Book a FREE discovery call online or reach out to learn more about our tailored postnatal recovery services.