Did you tear?
That’s the common question we get after we see friends but specifically within our space as a pelvic floor physical therapist. It is part of my story and part of why I do what I do…
In fact, I remember the doctor telling me - “oh, it was just a second degree tear” after I had my daughter which at the time made me feel good. She gave me some type of cream and told me that it was normal to have pain with sex and that the healing wasn’t done yet. (now mind you - she never talked about what to do with the cream or why to use it or what else I could do to help with the pain OR even if it would ever go away…she simply said it was normal.)
I now know that saying “it was JUST” was the right thing to do. My story with my delivery is fairly uneventful but afterwards was when the pain and frustration continued. I remember laying in the bed thinking:
“Will he ever love me again? Will I every be able to enjoy him again? Will I even be able to have more kids? What happens if this never gets better? I’ll be the worst wife in the world.”
That little “second degree tear” was way more than I anticipated. The tissue took longer to heal than the original 6 weeks I was told. The pain lasted years longer because it was not “just skin” but most likely a large tear to a muscle no-one ever assessed until I got into this line of work as a pelvic floor therapist. As my story unfolds, the sex did get better but not because of what the doctor told me (which I am still upset about the lack of education…). What had happened was not just a little tear in the skin like I was thinking.
Ok? What does this mean for me?
So what that means is that if you have “just” a second degree tear you are tearing muscles around the opening or bottom of the vaginal opening. MUSCLES…and tearing!! I mean if this was a quad or a hamstring - I would have been sent to the physical therapist day ONE!!!!
What was happening to me was that the tissue was not healing as well which required it to be cauterized. This created more scar tissue…scar tissue is not inherently bad but it’s made to close a gap in the muscle and skin. It does not like to stretch but it can be remodeled and mobilized.
We can help this tissue heal better and I will talk about this soon.
What is a Tear?
First degree: skin on the back of the perineum
Second degree: vaginal opening into the pelvic floor muscles and can go close to the anus
Third degree: tearing from vaginal opening including muscles to the anus/external anal sphincter
Fourth degree: all the skin, connective tissue, and muscles are torn from the vaginal canal to the anus including the anal sphincter (muscle that closes the anus to keep feces inside)
Why do we have perineal tears?
We often see most tearing to be due to
quick delivery where muscles are not able to elongate as well or bearing down/valsalva maneuver on the pelvic floor instead of “breathing the baby out”
longer 2nd stage of delivery
forceps or use of vacuum to help with delivery
pelvic floor dysfunction prior to pregnancy
Understanding healing can help ease your mind and pain.
For women with pain after delivery in the perineum - I would encourage you to give yourself more time to heal. When we look at general healing time on tissues:
Skin: 7-10 days to heal
Muscle: 4-6 weeks to heal
Bone: 4-6 weeks
Fascia/connective tissue: several months (MOST orthopedic conditions take 12-16 weeks (think quad strains or ankle sprains that we traditionally would get rehabilitated for but we are expecting moms to lift and bounce right back within 6 weeks? what??)
AND thats with good healing potential and reduced pressure on an area. Now look back at the picture - when we have a tear with delivery - we have skin, connective tissue and muscle tearing. No wonder it hurts to sit?? There are several things that can affect healing potential and most of them we can help!!