Third-Degree Tear Recovery: What to Expect
SaveA third-degree tear reaches the anal sphincter, so it heals more slowly than a minor tear — most soreness eases by about 6 weeks, while full muscle and nerve recovery can take 3 to 6 months. Pelvic floor therapy and specialist follow-up support bowel control and comfort during recovery.
Last updated: July 2026
What is a third-degree tear?
A third-degree tear is an obstetric injury that runs through the perineum and into the anal sphincter, the ring of muscle that controls gas and stool. Clinicians grade tears from first to fourth degree by depth: first- and second-degree involve skin and perineal muscle, a third-degree reaches the anal sphincter, and a fourth-degree extends into the rectal lining 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage. Third- and fourth-degree tears together are called obstetric anal sphincter injuries, or OASIS. According to the American College of Obstetricians and Gynecologists, OASIS complicate fewer than 1 in 10 vaginal births, and risk is higher with first vaginal deliveries, larger babies, and forceps or vacuum assistance 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage. Because the sphincter is involved, these tears are repaired in an operating room with careful, layered stitching.
How long does a third-degree tear take to heal?
Healing after a third-degree tear happens in overlapping stages that stretch well beyond the skin closing. The skin and surface stitches usually knit within 2 to 3 weeks, and the sharpest pain settles over about 6 weeks, much like a smaller tear or episiotomy repair 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage. The sphincter muscle and its nerves recover more slowly, and full return of strength and sensation can take 3 to 6 months or longer 2Ref 2Woodley 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.Evidence that pelvic floor muscle training supports urinary and faecal continence in postnatal women and is a mainstay of recovery after obstetric sphincter injury. Most people regain normal bowel control, but some notice temporary urgency or difficulty holding gas early on. Structured pelvic floor physical therapy improves continence outcomes after sphincter injury, according to Cochrane evidence 2Ref 2Woodley 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.Evidence that pelvic floor muscle training supports urinary and faecal continence in postnatal women and is a mainstay of recovery after obstetric sphincter injury. Recovery is usually steady, even if it is slower than many people expect.
What symptoms need close watching during recovery?
Bowel and continence symptoms are the signals that matter most after a sphincter tear. New or persistent trouble controlling gas, stool, or urine deserves prompt attention rather than waiting, because early treatment protects long-term function 2Ref 2Woodley 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.Evidence that pelvic floor muscle training supports urinary and faecal continence in postnatal women and is a mainstay of recovery after obstetric sphincter injury. Pain that worsens after the first week, spreading redness, fever, or foul discharge can signal infection or breakdown of the repair, which the NICE postnatal guideline flags for assessment 3Ref 3National Institute for Health and Care Excellence (2026).Postnatal care (NG194).Postnatal warning signs including worsening pain, spreading redness, fever, and heavy bleeding that warrant prompt assessment during perineal recovery. Staying ahead of constipation is especially important, since straining stresses the fresh repair; a stool-softener plan and steady fluids help, and easing constipation protects the stitches. Any leakage of stool, or stool passing from the vagina, is a reason to seek clinician review promptly 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage.
How does recovery differ by tear and life stage?
The depth of the tear and the birthing person's stage of life both shape how recovery unfolds. A fourth-degree tear, which reaches the rectal lining, generally heals more slowly than a third-degree and carries a higher chance of lingering bowel symptoms 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage. First-time and younger birthing people face higher rates of sphincter injury, partly because of longer pushing stages and more instrument-assisted births, according to obstetric data 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage. Years later, the estrogen decline of the perimenopausal transition can weaken pelvic tissue and unmask urinary or bowel leakage that a past tear made more likely 2Ref 2Woodley 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.Evidence that pelvic floor muscle training supports urinary and faecal continence in postnatal women and is a mainstay of recovery after obstetric sphincter injury. Continuing gentle pelvic floor exercises over the long term helps protect function across these stages of life.
When a third-degree tear needs specialist follow-up
Sphincter tears warrant closer follow-up than routine perineal healing, and some symptoms should not wait. Ongoing incontinence of gas or stool, a sense of stool passing the wrong way, severe or worsening pain, or signs of infection are reasons to seek clinician review, often with a urogynecologist or colorectal specialist 1Ref 1American College of Obstetricians and Gynecologists (2018).ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery.Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage. A firm, tender, growing lump or heavy bleeding that soaks a pad in under an hour is a reason to seek urgent, same-day care 3Ref 3National Institute for Health and Care Excellence (2026).Postnatal care (NG194).Postnatal warning signs including worsening pain, spreading redness, fever, and heavy bleeding that warrant prompt assessment during perineal recovery. A raised, easily bleeding bump at the healing site is usually minor granulation tissue rather than an emergency. According to ACOG, a dedicated postpartum review is recommended for anyone with a sphincter injury 4Ref 4American College of Obstetricians and Gynecologists (2018).ACOG Committee Opinion No. 736: Optimizing Postpartum Care.The recommendation for individualized, dedicated postpartum follow-up, including for people who had complications such as a severe perineal tear. Gale can help you prepare for that visit.
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Third-degree tear: signs to act on
- —New or ongoing leakage of gas or stool, or stool passing from the vagina, is a reason to seek clinician review, often with a specialist
- —Pain that worsens after the first week, spreading redness, fever, or foul discharge is a reason to seek clinician review for possible infection
- —A firm, tender, growing lump, or bleeding that soaks a pad in under an hour, is a reason to seek urgent, same-day care
- —Difficulty passing urine or stool at all is a reason to seek prompt medical review
Heavy bleeding that soaks a pad in under an hour, a fast-growing tender lump, or inability to pass urine needs urgent evaluation — seek same-day care right away, or call 911 if you feel faint or cannot control heavy bleeding.
This article is general health education, not medical advice. A third-degree tear needs individualized follow-up, so questions about your recovery are best answered by your obstetric clinician, a urogynecologist, or a colorectal specialist.
References
- 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 ✓Definition and grading of third- and fourth-degree tears as obstetric anal sphincter injuries, their incidence and risk factors, operative repair, and warning signs such as stool leakage
- 2.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 ✓Evidence that pelvic floor muscle training supports urinary and faecal continence in postnatal women and is a mainstay of recovery after obstetric sphincter injury
- 3.National Institute for Health and Care Excellence (2026). Postnatal care (NG194). National Institute for Health and Care Excellence (NICE). link ✓Postnatal warning signs including worsening pain, spreading redness, fever, and heavy bleeding that warrant prompt assessment during perineal recovery
- 4.American College of Obstetricians and Gynecologists (2018). ACOG Committee Opinion No. 736: Optimizing Postpartum Care. Obstetrics & Gynecology. doi:10.1097/AOG.0000000000002633 ✓The recommendation for individualized, dedicated postpartum follow-up, including for people who had complications such as a severe perineal tear
4 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — every citation independently verified. Editorial policy