Postpartum

Perineal Tears: The Four Degrees, Explained

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Perineal tears are classified first to fourth degree by depth. First and second degree involve skin and perineal muscle; third and fourth degree reach the anal sphincter and rectal lining and are called OASIS. According to ACOG, the grade determines how the tear is repaired and how closely healing is followed.

Last updated: July 2026

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What do the four degrees of perineal tear mean?

Perineal tears are sorted into four degrees based on which tissues the tear reaches. A first-degree tear affects only the skin and the vaginal lining and often needs little or no stitching, while a second-degree tear extends deeper into the perineal muscles and is usually repaired with dissolvable sutures. A third-degree tear reaches the anal sphincter muscle, and a fourth-degree tear continues through the sphincter into the lining of the rectum 1.

According to ACOG, third- and fourth-degree tears are grouped together as obstetric anal sphincter injuries, or OASIS, because they need specialized repair. Roughly 9 in 10 people who deliver vaginally have either no tear or a first- or second-degree tear. Unlike a small skin cut, these are layered internal injuries, and our guide on when a cut needs stitches explains the general principle of matching repair to depth.

How is each degree repaired?

Repair depends heavily on the degree of the tear. First-degree tears may need only a few stitches or none, while second-degree tears are closed in layers with absorbable sutures, usually right after delivery. Third- and fourth-degree tears call for a more meticulous, layered repair of the anal sphincter and any rectal tissue, best done by a clinician experienced in OASIS repair to protect long-term bowel control 1.

According to the same ACOG guidance, antibiotics are often given for these deeper repairs to lower the risk of wound breakdown and infection. Recovery from a first- or second-degree tear usually feels manageable within 1 to 2 weeks, while OASIS repairs are followed more closely. Pelvic soreness and stinging with urination are common in the early days.

How does healing differ by degree?

Healing time and aftercare scale with the depth of the tear. First- and second-degree tears typically settle over 2 to 6 weeks, with soreness easing as the muscle knits, whereas third- and fourth-degree tears can take longer and need closer monitoring of bowel function. Sitz baths, cold packs, and stool softeners are commonly used to keep early healing comfortable and to avoid straining the repair.

ACOG postpartum guidance recommends checking in within the first 3 weeks so any tear problems are caught early 2. Starting gentle pelvic floor physical therapy once cleared can support recovery, and simple kegel exercises may help restore muscle tone.

Do tears affect the pelvic floor long term?

Most tears heal without lasting effects, but deeper tears can influence pelvic-floor health over the years. Third- and fourth-degree tears raise the long-term risk of urinary or fecal incontinence, and these effects can resurface decades later, as the pelvic floor weakens further during the perimenopausal transition and after menopause. A tear during a first vaginal birth also tends to be more likely than in later births, when the tissues have stretched before.

Pelvic floor muscle training lowers the odds of ongoing leakage in the months after birth, which is one reason it is recommended for postnatal recovery 3. For persistent leakage, options for urinary incontinence treatment range from pelvic-floor therapy to specialist care.

When a perineal tear needs a clinician

Certain symptoms mean a healing tear needs a clinician's attention rather than time. Increasing pain, spreading redness, swelling, foul-smelling discharge, or a fever can signal that the repair has become infected or is breaking down. New or worsening trouble controlling gas or stool, a feeling that stitches have given way, or pain that makes sitting or passing urine impossible are also reasons to seek review.

According to ACOG, follow-up after an OASIS repair matters precisely because these issues respond better when caught early 1. An obstetrician, midwife, or urogynecologist can examine the repair, treat infection, and refer for pelvic-floor rehabilitation if needed. Gale can help you prepare what to describe at that visit.

Common questions

A second-degree tear extends into the perineal muscle but not the anal sphincter, while a third-degree tear reaches the sphincter. That distinction matters because sphincter injuries need a more careful repair and closer follow-up.

First- and second-degree tears usually feel much better within two to six weeks. Third- and fourth-degree tears, which involve the anal sphincter, can take longer and are monitored more closely for bowel symptoms.

Most people recover well, but deeper tears raise the long-term risk of urinary or bowel-control issues, which can resurface around menopause. Pelvic floor muscle training helps, and persistent symptoms can be treated, so follow-up is worthwhile.

Some measures during labor may reduce the risk, and having had one tear does not guarantee another. Discussing what happened, and your options, with an obstetrician or midwife before the next birth is the most useful step.

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Perineal tear recovery: signs that need a clinician

  • —Increasing pain, spreading redness, swelling, or foul-smelling discharge at the repair is a reason to seek prompt clinician review for infection.
  • —New or worsening trouble controlling gas or stool is a reason to seek clinician review, ideally with a specialist in tear recovery.
  • —A feeling that the stitches have given way, or a wound that reopens, is a reason to seek urgent care.
  • —Heavy vaginal bleeding, a high fever, or fainting is a reason to call 911 or go to the emergency room.

Call 911 or go to the nearest emergency room for heavy vaginal bleeding, a high fever with severe pelvic pain, or fainting; seek urgent review for a repair that has opened or new loss of bowel control.

This article is general health education, not medical advice. The grade of a perineal tear and its recovery are best explained by the obstetrician or midwife who repaired it, or a urogynecologist for lasting symptoms.

References

  1. 1.American College of Obstetricians and Gynecologists (2018). ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002841 ✓ACOG defines the first- through fourth-degree classification of obstetric lacerations, groups third- and fourth-degree tears as obstetric anal sphincter injuries (OASIS), and describes layered repair and follow-up.
  2. 2.American College of Obstetricians and Gynecologists (2018). ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002633 ✓ACOG postpartum care guidance recommends early clinician contact within the first 3 weeks so healing problems, including tear complications, are caught early.
  3. 3.Woodley SJ, Lawrenson P, Boyle R, et al. (2020). Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD007471.pub4 ✓A Cochrane review found pelvic floor muscle training reduces the odds of urinary incontinence in postnatal women, supporting its role in recovery after perineal tears.

3 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy

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