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4th Degree Tear Misdiagnosis

4th Degree Tear Misdiagnosis

Recent research has suggested that 4th degree tears suffered in vaginal childbirth are being regularly missed by medical practitioners.

Perineal trauma in childbirth

Tears to the perineum are a common occurrence in the course of vaginal childbirth but not all perineal tears are the same. Most women experience small tears, described as 1st or 2nd degree tears which usually recovery quickly and fully. However, increasing numbers of new mothers seem to be experiencing more severe injuries - 3rd and 4th degree tears - which cause damage across the perineum and including the sphincter muscles of the anus.

4th Degree Tears

A 4th degree tear is the most severe form of perineal tear which a woman can experience is childbirth and is associated with the greatest degree of long-term anal dysfunction and reduced quality of life.

A 4th degree tear damages both the external and internal sphincter muscles of the anus which contribute to a person's ability to maintain control of their bowels. This means that the woman is likely to experience involuntary wind or faecal incontinence. A 4th degree tear also damages the lining of the anal canal, raising the possibility that a fistula or hole will develop between the rectum and the vagina, allowing faecal matter to leak via the vagina.

Understandably, these distressing symptoms can have a dramatic impact on a woman's ability to work effectively. It can, furthermore, have a significantly detrimental effect on her emotional health and relationships.

Diagnosing 4th degree tears

Given the appalling nature of these symptoms, it is clear that an accurate diagnosis of a 4th degree tear is absolutely imperative.

If a 4th degree tear is repaired competently at the time, there is a good chance that the woman will recover from her injury.

If the extent of the tear is missed, however, any repair is likely to be inadequate and will leave the woman to struggle with embarrassing side-effects.

Diagnosis of 4th degree tears can be difficult due to their internal nature. According to the guidelines published by the Royal College of Obstetricians and Gynaecologists, assessment of genital trauma should include the following aspects:

  • a rectal examination to assess whether there has been any damage to the external or internal anal sphincter if there is any suspicion that the perineal muscles are damaged
  • the assessment and its results should be fully documented, preferably pictorially
  • the woman should be referred to a more experienced healthcare professional if uncertainty exists as to the nature or extent of the trauma sustained

Medical Negligence

Failure to diagnose a perineal tear or a diagnosis that underestimates the degree of damage may be considered to have been negligent.

If you are suffering the appalling effects of a misdiagnosed severe perineal tear, contact Glynns Solicitors, specialists in medical negligence, to discuss your situation. You may be entitled to make a claim for compensation.

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