Women's Medical Negligence

Third and Fourth Degree Tears

✔️ What a 3rd or 4th-Degree Tear Involves

A 4th-degree tear is the most severe type of obstetric perineal tear. It involves:

The perineal skin
The vaginal wall
The perineal muscles
The anal sphincter muscles (EAS + IAS)
And the lining of the rectum

Because the anal sphincter is involved, even a well-repaired tear can leave bowel control problems, including:

Faecal incontinence
Urgency
Flatus incontinence
Perineal pain
Sexual dysfunction

✔️ When Incontinence After a 3rd or 4th-Degree Tear May Be Avoidable

Not every poor outcome implies negligence. But some red flags may raise clinical-care questions, such as:

🔸 During labour/birth:

Failure to recognise a risk of severe tearing (e.g., instrumental delivery, shoulder dystocia, persistent occiput posterior)
Inadequate episiotomy (if indicated)
Misuse of forceps or vacuum

🔸 At the time of repair:

Delay in repairing the tear
Repair by an inexperienced practitioner without supervision
Poor identification of the internal/external anal sphincter
No post-repair rectal examination to confirm correct repair

🔸 Postnatal care:

No follow-up with a perineal clinic or physiotherapy
Failure to investigate ongoing incontinence (endoanal ultrasound, manometry)
Dismissal of symptoms as “normal recovery”
No referral to a uro-/colorectal specialist when needed

If you need, I can help list common medico-legal breaches based on Irish practice standards.

✔️ If You’re Asking in a Medical Negligence Context

If you believe your symptoms were worsened by avoidable errors, these steps may help:

1. Request your full maternity records

Including labour notes, theatre notes, repair documentation, and follow-up clinic letters.

2. Keep a symptom diary

Especially incontinence episodes, pain, functional restrictions, and impact on employment/relationships.

3. Get a specialist review which we can help recommend

A consultant in:

Urogynaecology, or
Colorectal surgery (with pelvic floor interest)

Their findings are often central to your negligence case.

4. Speak to a us as we are experienced in birth injury cases

Obstetric injury
Perineal tears
Maternal pelvic floor trauma

Types Of Tears:

1^st degree tear – this can be a small nick or abrasion. They usually heal themselves and shouldn’t require a stitch. 2^nd degree tear – includes skin and muscle tissue damage. You may require stitches and it usually takes in or around 2 months to recover. An episiotomy is where the perineum is intentionally cut in order to facilitate delivery. An episiotomy involves the same muscle and tissue as a 2^nd degree tear. 3^rd degree tear – third degree tears is a tear or laceration through the perineum muscles and the muscles which surround the anus. Third degree tears can be further sub-divided into 3a, 3b and 3c tears, depending upon how far the injury extends into the anal sphincter:

3a: partial tear of the external sphincter involving less than 50% thickness
3b: tear of the external sphincter involving more than 50% thickness
3c: external and internal sphincter torn

4^thdegree tear – a fourth degree tear extends completely through to the anus, tearing the internal and external sphincter and, on occasion, the internal wall of the rectum or bowel.