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3rd Degree Tear Grading

3rd Degree Tear Grading

There are four different grades of perineal tear a first degree tear, second degree tear, third degree tear and fourth degree tear.

Perineal tear classification

The classification is based upon how deep the tear is, and is a sliding scale ranging from a first degree tear (the least severe) to a fourth degree tear (the most severe).

A third degree tear is the only one that has been further subdivided into another three categories. These are called 3a, 3b and 3c, and again are included in the sliding scale of severity. Therefore a 3c tear is the worst type of third degree tear.

The Royal College of Obstetricians and Gynaecologists (RCOG) defines the types of perineal tear as follows:

  • First degree tear: injury to the perineal skin only
  • Second degree tear: injury to the perineum including the perineal muscles, but no injury involving the anal sphincter
  • Third degree tear: injury to the perineum involving the anal sphincter complex:
    • 3a: less than 50% of the external anal sphincter torn
    • 3b: more than 50% of the external anal sphincter torn
    • 3c: both the external anal sphincter and internal anal sphincter torn
  • Fourth degree tear: injury to the perineum involving the anal sphincter complex (both the external anal sphincter and internal anal sphincter) and the anal epithelium

Buttonhole tears

There is actually another type of tear called a buttonhole tear. A buttonhole tear is when the anal mucosa tears but the anal sphincter complex is uninjured.

The anal mucosa is the lining of the anal canal. If there is a hole in the anal mucosa which is left unrepaired, there is a chance that it will develop into an ano-vaginal fistula. This is when there is a passageway between the anus and vagina, causing faeces to leak into the vagina and out of the vaginal opening. This can lead to recurrent urinary tract infections and will be very upsetting for the individual concerned.

Failure to repair a perineal tear

Problems can also arise if a perineal tear is not repaired, or is not properly repaired. This is because a tear will be left in the perineum, which can be very painful and can result in a dragging sensation, particularly when walking or standing for long periods of time.

A tear that extends to the anal sphincter complex will also mean that a defect remains in the sphincter muscles. These muscles control continence, so it will become very hard to prevent the passing of wind and faeces.

Claiming for a missed tear

A perineal tear that is not diagnosed and/or properly repaired will cause the patient long-term problems. This could amount to medical negligence, meaning there will be grounds for a compensation claim. Contact us for more information.

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