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What are the long-term risks of 3rd degree tears?

What are the long-term risks of 3rd degree tears?

3rd degree tears need to be diagnosed and treated promptly and effectively to avoid long-term damage and unpleasant effects. Where medical professionals fail to do this, leaving the new mother to suffer, it may be appropriate to make a claim for compensation.

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What is a 3rd degree perineal tear?

Perineal tears occur frequently and naturally during childbirth due to the stretching of the vagina and perineum necessary to allow the baby to emerge. 1st and 2nd degree tears are most common and affect the skin and muscle of the perineum (the area between the vagina and the anus). They are most likely to be repaired by the midwife with a few stitches. A 3rd degree tear is considerably less common but is more severe because the damage continues along the perineum to the anal sphincter (the muscle that controls the anus).

Classification of 3rd degree tears

Not all third degree tears are the same. The extent of damage can vary and the possible long-term effects may differ accordingly.

In an attempt to ensure accurate and comprehensive repair, The Royal College of Obstetricians and Gynaecologists has classified third degree tears in the following way:

  • 3a tear: less than 50% of the external anal sphincter thickness is torn
  • 3b tear: more than 50% of the anal sphincter thickness is torn
  • 3c tear: both external and internal sphincter are torn.

A woman experiencing a 3c tear is likely to suffer worse symptoms than a woman who has experienced a 3a tear. Therefore, if a woman receives an incorrect diagnosis and receives a 3a repair when in fact she has suffered a 3c tear, she may continue to suffer extremely unpleasant symptoms.

Anal sphincter damage

The internal and external anal sphincter muscles work together to control the opening of the bowels. A key part of their function is to prevent the involuntary leakage of faeces from the rectum. If they become damaged, therefore, the patient may lose control of the functioning of the bowel.

Why does a 3rd degree tear damage the anal sphincter?

Most women who suffer a birth tear, only experience a 1st or 2nd degree tear. In some circumstances, however, the woman may suffer the far more severe 3rd or 4th degree tear where the injury extends to the anus.

This degree of damage is more likely when a woman has undergone an instrumental delivery or when she is giving birth to a large baby. Women who are giving birth vaginally for the first time are also more susceptible to severe tears.

How should a 3rd degree tear be treated?

A 3rd degree tear should be identified immediately after the birth during a routine examination and repaired in an operating theatre under local (epidural or spinal) anaesthetic or a general anaesthetic by an experienced surgeon. The wound should be sutured with dissolvable stitches. You are likely to need a course of antibiotics to prevent infection of the affected area. You may need to use a catheter until you are able to walk to the toilet and may be prescribed laxatives to ease the passing of faeces (poo).

If a 3rd degree tear is dealt with promptly, a full recovery can be expected although the speed of recovery will depend upon the severity of the tear, the quality of the repair and the health and care of the patient. The stitches may dissolve and wound heal within two weeks, but pain and discomfort may continue for some months.

What are the possible long-term effects of 3rd degree tears?

Physical impact

If a 3rd degree tear is not identified or properly treated, it may mean that a defect remains in the anal sphincter or perineal muscle possibly causing the following symptoms:

  • wind (flatus) incontinence
  • faecal incontinence and urgency
  • pain during intercourse
  • pain when walking/sitting/standing for extended periods of time
  • repeated infections

These symptoms are likely to be permanent. Sometimes an attempt to repair the injury may be attempted at a later date but this may not be very successful. The tissue around the injury may have deteriorated and be less suitable to a repair. The woman may continue to suffer symptoms.

As the woman ages, it is possible that her symptoms may deteriorate.

Life-style impact

The day-to-day impact of anal incontinence on a woman's life can be utterly devastating.

The combined need to remain close to a toilet with the fear of bowel accidents can cause many women to become socially isolated, rarely leaving the home.

Returning to work can be very difficult and, in some cases, almost impossible. Where a woman's employment requires regular interaction with other people, such as teaching, nursing, retail and hospitality, the effects of anal incontinence can mean that she is unable to return to work, making her even more isolated. Inevitably, this can also cause considerable loss of income and financial strain.

Many women feel unable to support their children in social activities and can start to lose confidence in their success as a mother as a result.

Psychological impact

The distress at their condition, the embarrassment of their problems and the loss of social contact often leads to considerable emotional distress. Many women feel unable to talk about what has happened to them and the problems they face.

Personal relationships can suffer as a result.

Diagnosing third degree tears

Severe birth tears appear to have been increasing over recent years and numerous initiatives have been implemented to increase awareness of the problem amongst the medical profession.

Consequently, there should be a high awareness of the need to examine women who have given birth vaginally for any signs of damage.

A digital, rectal examination should be carried out. With the consent of the new mother, a medical practitioner will insert a gloved finger into the anus, in order to check for evidence of any anal damage.

If in doubt, further advice and expertise should be sought. Internal damage such as 4th degree tears or buttonhole tears are difficult to diagnose without such a procedure.

If anal sphincter damage is identified, it is also important that it is accurately classified according to the grades mentioned above.

Particularly close attention should be paid to those women who are more at risk of suffering a severe birth tear. As mentioned above, these include women giving birth vaginally for the first time, women who have undergone a forceps or ventouse-assisted birth and women giving birth to a large baby or where the baby has experienced shoulder dystocia. Women of Asian origin are also thought to be more at risk of suffering an anal sphincter injury such as a third degree tear.

Medical negligence

Failure to diagnose a 3rd degree perineal tear

Medical practitioners should be fully aware of the possibility of a 3rd degree tear during childbirth and ensure that an examination is carried out to check for such damage. If your 3rd degree tear was not diagnosed or you feel the repair may have been inadequate, call us to discuss a possible claim with a solicitor who specialises in birth injury claims.

Examples of 3rd degree tear negligence

  • when a 3c tear is diagnosed as a 3a tear and the internal damage is not noticed and, therefore, not repaired, allowing symptoms to deteriorate
  • when a 3rd degree tear is misdiagnosed as a 2nd degree tear and the anal damaged goes unrepaired
  • when a 3rd degree tear is diagnosed but the woman has, in fact, suffered a 4th degree tear, resulting in an inadequate repair
  • where there is no diagnosis of perineal damage at all, probably due to a complete failure to examine the new mother, leaving her with bowel symptoms
  • when a third degree tear is diagnosed but an internal buttonhole tear has been experienced, allowing the development of a fistula and associated symptoms
  • when a 3rd degree tear has been diagnosed but the quality of the repair is poor, leaving the new mother to continue to suffer appalling symptoms

Recent Glynns Solicitors Case Studies

Aliza's Story: A Missed Third Degree Tear

Aliza's third degree tear was missed by the midwife, causing her to develop faecal incontinence.

Because the injury was not diagnosed and repaired immediately, Aliza will continue to suffer incontinence for the rest of her life. She has had to adapt to this, and now everything she does revolves around her bowel movements. She avoids things that will make her symptoms worse, such as certain foods, drinks and walking. She wears baggy clothes and tries to remain close to a toilet.

This terrible outcome could have been avoided, had Aliza's third degree tear been diagnosed and repaired shortly after the birth. We helped her make a claim against the negligent hospital. She was awarded over £200,000 in compensation.

Click here to read further details on our case studies page.

Ruth's Story: Poor Repair of a Fourth Degree Tear

An instrumental delivery of her baby with no episiotomy led to Ruth receiving a severe anal sphincter injury. Despite prompt diagnosis, the subsequent repair was inadequate and Ruth continues to experience appalling bowel problems.

In order to try to ease her symptoms, Ruth then underwent further surgery to attempt a more effective repair of her sphincter muscles which control the bowel. Unfortunately, this also meant that Ruth had to be fitted with a stoma bag via a colostomy to assist in the emptying of her bowels.

Ruth's professional, social and personal life have been devastated by her negative experiences during the birth of her child. Had an episiotomy been undertaken before the instrumental delivery of her baby, it is quite possible that Ruth would never have suffered a 4th degree tear. Had her tear been repaired competently, she may have suffered no on-going symptoms at all.

Glynns supported Ruth in her claim for compensation for the poor quality treatment she received during the birth of her child, and she received in excess of £800,000 in compensation.

Read further details here.

Annie's Story: 2 Year Delay in Third Degree Repair

After suffering from incontinence of wind and faecal leakage, Annie was eventually told that she had an unrepaired third degree tear.

Annie was told that she needed an anal sphincter repair for the missed tear, and a perineoplasty to correct the skin which had been incorrectly stitched to the outside of the vagina. The surgeon who would perform the operation told Annie that he was very concerned about the care she had received as the tear should have been repaired shortly after the birth.

The surgeon also advised Annie that the longer a third degree tear remains unrepaired, the harder it is to fix. The operation was eventually performed more than two years after the birth. Sadly it has failed to fully resolve Annie's symptoms, and she remains incontinent of wind and leaks faeces, necessitating the constant use of incontinence pads.

We helped Annie make a claim for the negligent care she received. She was awarded over £150,000 compensation.

Read Annie's story on our case studies page.

Obstetric Anal Sphincter Injuries (OASI)

Obstetric anal sphincter injuries are not restricted to third degree tears. A perineal tear during vaginal childbirth can affect the anal sphincter in a variety of ways and the repair needs to suit the nature of the damage.

Fourth degree tears

A fourth degree tear causes more damage to the woman's anus than a third degree tear. It can potentially also cause more severe symptoms.

Whereas a third degree tear can damage either or both the external and internal sphincter, a fourth degree tear will not only damage both aspects of the anal sphincter but will additionally damage the internal lining of the anus.

This is potentially problematic as it can lead to the development of a fistula between the rectum and the vagina, thereby allowing wind and faeces to leak out via the vagina rather than through the anus as normal. If unrepaired, the woman cannot control this leakage which can be highly embarrassing and a cause of infection.

Buttonhole tears

A buttonhole tear is an injury to the lining of the anal canal without damage to the anal sphincter.

It can also cause a fistula to develop and requires prompt and accurate diagnosis and repair.

Managing the long-term symptoms

The MASIC Foundation is an organisation set up to support women who have suffered severe anal sphincter injuries. Their aim is to increase awareness amongst both the general public and the medical community of the occurrence and consequences of childbirth anal sphincter injuries. They also aim to bring about improvements in the management and prevention of these injuries.

Their website offers extensive advice about coping with the impact of a severe anal sphincter injury.

Making a Compensation Claim

If you are suffering the appalling, long-term effects of an undiagnosed or poorly-repaired anal sphincter injury, you may wish to consider making a claim for compensation.

In the first instance, either give us a call or contact us via our website and one of our specialist medical negligence solicitors will ring you. We are a friendly, caring and highly-specialised team and we have supported numerous women in making claims for negligent management of perineal damage over many years. We will be very happy to advise you.

Once we have discussed the circumstances of your injury and its impact with you, we will let you know whether we think it would be appropriate for you to make a compensation claim. This is only likely to be the case where there is a clear failure in the quality of care you were given at or around the time of your child's birth.

Don't worry that such advice will be costly. If we do not take on your case, there will be no charge. If we accept your case, there will only be a charge if we succeed in winning damages for you.

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