​What kinds of symptoms do patients experience before receiving treatment?

A perineal tear refers to a tear in the tissue between the vaginal opening and the anus (perineum) that can occur during childbirth. The severity of perineal tears can vary, ranging from first-degree tears (least severe) to fourth-degree tears (most severe). Common symptoms associated with perineal tears include pain, swelling, bruising, bleeding, difficulty urinating, flatus and/ or faecal incontinence and are at risk of developing co-morbidities including pelvic organ prolapse and vesicovaginal fistulas.

​What is the impact on patients’ lives of living with these conditions?

The impact of perineal tears on a woman's life can vary based on the severity of the tear. Some of the impacts of perineal tears include physical pain and discomfort that temporarily limits a woman’s ability to engage in daily activities, pain or discomfort during sexual intercourse; some women may experience postpartum depression and anxiety associated with perineal tears, combined with hormonal changes and the demands of caring for a newborn.

What cultural or regional factors affect the treatment of these conditions?

Perineal tears are considered to be one of the most common complications of vaginal births affecting 80% of women during childbirth. Overall, a third- or fourth-degree tear occurs in about 3 in 100 women having a vaginal birth. It is slightly more common with a first vaginal birth, occurring in 6 in 100 women, compared with 2 in 100 women who have had one or more vaginal births previously. The majority of women with untreated perineal tears are those in rural communities of Africa. Often they are unaware that the condition they are suffering from is known and treatable; they believe they are cursed. People often ridicule them because of the smell associated with urine/ faecal incontinence and stigmatise them and their families.

What does the treatment process look like?

For second and third-degree tears, the tears are repaired through stitching. Contrastingly, for fourth-degree tears and some third-degree tears, surgery is conducted, and both obstetricians and colorectal surgeons work together to repair and restore the anatomy and function of the anal sphincter.

What is the impact of this treatment on the patient’s life?

Relief from pain, discomfort, embarrassment, social stigmatization and discrimination. The patient is able to resume their normal life and perform tasks.

What potential side effects or risks come with this treatment?

While perineal tear repair is generally considered a routine and safe procedure, some potential risks and complications are associated with it, especially in more severe cases. Although rare, the side effects include delayed healing, scarring that results in pain and discomfort during intercourse, changes in sensation such as numbness, tingling, or altered sensitivity, and recurrence of tears; although uncommon, there is a risk of recurrent tears in subsequent pregnancies or during childbirth.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are few qualified facilities in the region to perform this procedure.

What are the alternatives to this treatment?

Episiotomy (a surgical cut made at the opening of the vagina during childbirth to aid a difficult delivery and prevent rupture of tissues) is protective against perineal tears in instrumental vaginal delivery. However, a woman having an episiotomy must be considered to have a second-degree perineal tear at a minimum since an episiotomy appears to be associated with at least the same risk of complications and chronic ailments as a spontaneous second-degree tear. Other methods include the application of warm compresses to the perineum during delivery or the use of antenatal perineal massage as protective factors, but these are mainly preventative and not treatment.