O70.22

Clinical Causes: Difficult or traumatic delivery, such as a large baby or rapid labor Use of forceps or vacuum extraction during delivery Obstetric maneuvers that increase perineal stretching Previous perineal tears or surgeries that weaken tissue Fetal malposition or a big head size

Key Symptoms: Severe pain during and after delivery Visible or palpable tear in the perineal area Bleeding from the tear site Swelling and bruising around the perineum Difficulty or pain during bowel movements Potential loss of continence if the injury isn’t properly repaired

Diagnosis Path: Diagnosis is typically made through a physical examination performed immediately after delivery. Healthcare providers assess the extent of the tear by visual inspection, often noting the involvement of the external anal sphincter and possibly the internal anal sphincter and rectal mucosa. In some cases, anal manometry or endoanal ultrasound may be used to evaluate sphincter integrity. Proper classification of the tear helps guide appropriate management and repair strategies.

Treatment Protocols: Treatment involves surgical repair of the tear, usually performed shortly after delivery. Repair procedures include suturing the torn muscles and tissues in layers to restore the anatomy and function of the perineum and anal sphincter. Post-operative care typically includes antibiotics to prevent infection, pain management, and stool softeners to facilitate bowel movements. In some cases, pelvic floor physiotherapy or specialized follow-up assessments are recommended to ensure proper healing and to monitor for potential long-term issues such as incontinence.