Vaginal Laceration Repair

A Vaginal Laceration Repair is done to repair tears in the vagina or in the skin and muscle around the vaginal opening. Tears most commonly occur in the perineum. The perineum is the area between the anus and the opening of the vagina. Vaginal tears can cause heavy bleeding depending on severity of the tear. Tears can be intensely tender and interfere with normal activities of living.

DIAGNOSIS (Before the Procedure)

If the tear happened during childbirth, your caregiver can diagnose the tear at that time. To diagnose a vaginal tear that happened spontaneously or because of trauma, your caregiver will perform a physical exam. During the physical exam, your caregiver may also look for any signs of trouble that may need further testing. If there is hemorrhaging, your caregiver may suggest blood tests to determine the extent of bleeding. Imaging tests may be performed, such as an ultrasonography or computed tomography (CT), to look for internal damage. A biopsy may be need if there are signs of a more serious problem.

Vaginal Laceration Repair

First degree tears are superficial. They often do not require stitches and will heal naturally. Second degree tears are deeper into the tissue, require a few stitches, and then heal well afterward. Third and fourth degree tears require more stitches to be repaired correctly.

How is the stitching done?

If it’s a simple tear, you won’t need to leave the room where you’ve given birth. Your midwife or obstetrician will give you a local anesthetic to numb the area. Then she’ll quickly stitch up the tear. She’ll probably use a running stitch, which is one thread that goes from side to side, rather than several stitches. This should be more comfortable for you (Kettle et al 2002, Morano et al 2006).

If you have a third or fourth-degree tear you’ll be taken to an operating theatre, so an obstetrician can stitch your tear. You’ll have an anesthetic to stop you feeling any pain. This will probably be a local anesthetic, via a spinal or epidural, which will numb the area. Occasionally, a general anesthetic, where you’re put to sleep, will be needed (RCOG 2007: 4).
You’ll have a fine tube (catheter), passed into your bladder to collect your urine. This will make it easier for your perineum to recover. Painkillers will help you with pain relief once the anesthetic has worn off. You will need lots of rest for the 24 hours after your stitches are put in. You will be advised not to sit for long periods, though.

After a Vaginal Laceration Repair

• Take warm-water baths that cover your hips and buttocks (sitz bath) 2 to 3 times a day. This may help any discomfort and swelling.
• Only take over-the-counter or prescription medicines for pain, discomfort, or fever as directed by your caregiver. Do not use aspirin because it can cause increased bleeding.
• Do not douche, use tampons, or have intercourse until your caregiver says it is okay.
• A bandage (dressing) may have been applied. Change the dressing once a day or as directed. If the dressing sticks, soak it off with warm, soapy water.
• Apply ice or witch hazel pads to the vagina to lessen any pain or discomfort.
• Take a stool softener or follow a special diet as directed by your caregiver. This will help ease discomfort associated with bowel movements.

Risks

• Infection
• sharp, or intense pain or tenderness in the vaginal area
• .You have pus or unusual discharge coming from the tear or vagina.
• You notice a bad smell coming from the vagina.
• Your tear breaks open after it healed or was repaired.
• You feel lightheaded
• .You have increasing abdominal pain.
• You have an increasing or heavy amount of vaginal bleeding.
• You have pain with intercourse after the tear heals.