What It's Like To Have A 4th Degree Tear In Childbirth

Painful sex. Fecal incontinence. Birth trauma. PPD. Misdiagnoses. Prolapse. Not being able to control flatulence. Shame and embarrassment. Emergency surgeries. Feeling unheard. Having to consider a temporary or permanent colostomy bag. Not being able to insert a tampon. 6 years to get a proper diagnosis. Feeling alone. Anxiety. Agoraphobia. PTSD. Fear. Pain, and more pain.

Recently, a group of moms who are part of a 4th degree tear and birth trauma Facebook support group reached out to Scary Mommy because they desperately wanted their stories to be told—for their stories of trauma to have a voice and a name, and to help others are in the same boat feel less alone. The descriptions from above are just some of the words and phrases these mothers used to describe their experiences of severe tearing in childbirth.

Most of us know that tearing during childbirth is quite common, and many of us who delivered vaginally had some degree of tearing. But 4th degree tears—the most severe kind, where the tear extends to the lining of the rectum or anus—are less common. And yet, they affect about 3 out of every 100 woman giving birth, according to The Royal College of Obstetricians and Gynaecologists (RCOG). This amounts to thousands of mothers each year.

What you may not know is that 4th degree tears can cause some of the most traumatic and life-altering postpartum conditions—both emotionally and physically. Pain and incontinence are most common, but other mothers experience ongoing pelvic issues, including rectal prolapse and painful intercourse.

Often caused by the delivery of large babies, malpresentations like “sunny side up” babies, or babies with shoulder dystocia, 4th degree tears almost always require surgery. But it seems to vary widely how well healed mothers feel after the surgery, with some bouncing back quickly, and other taking years to heal.

The mothers who shared their stories with Scary Mommy said that their symptoms and struggles lasted anywhere from a few months to a few years. Some mothers are forever changed.

Five years after she gave birth, one mom said she still suffers from fecal incontinence and severe perineum pain. “I was 25 when I gave birth, and have not been able to return to work since,” she shared. “My life has been shattered in a million different ways. I suffer from severe PTSD, depression and anxiety with agoraphobia. The pain and the scars, both physical and emotional, will be with me forever.”

These stories were hard to hear and process, but they are more common than you might think. And over and over, it became clear that it wasn’t just the physical trauma that scarred them, but the emotional trauma as well—the fear, shame, and loneliness they endured.

“I felt very alone in this because everyone around me seemed to heal fine from their tears if they had one at all,” one mother told us. “Having fecal and flatus incontinence is one of the most embarrassing, demoralizing, dehumanizing things I have experienced.”

After all, traumas like these—involving our most intimate parts, and at our most vulnerable times—are often cloaked in shame, and not shared with the general public. But these mothers know that they are not the only ones who have experienced these sorts of things. And they want this issue to come to the forefront.

In addition to the physical and emotional trauma, more than one mother relayed an experience of not being heard or believed by her doctors or caretakers. Some mothers were told initially by their healthcare providers they had less severe tears than 4th degree tears and they suffered months of incontinence and pain before they finally got surgery and treatment.

One mother shared the experience of what happened after she delivered her 9lb, 2.5 oz baby boy:

“I was repaired as a 2nd degree tear,” she recalled. “One day later I had flatulence come from my vagina. I expressed concerns but was told that it’s normal due to swelling. Over the next two weeks, I had varying degrees of fecal incontinence all of which passes through my vagina. I mentioned these discoveries, as well as my findings when I did a visual inspection of my perineum and I was told that due to weakness it was normal and I should do Kegels to rectify the issue.”

This mom finally demanded an inspection of her vaginal area, because she had solid fecal matter coming through her vagina. Thankfully, she finally got a proper diagnosis — but it wasn’t without a fight.

“Originally I was told it was a hole or fistula and I was being sent to a surgeon in the nearest big city,” this mom shared. “At four weeks postpartum, I saw a urogynocologist who diagnosed me as having an unrepaired 4th degree tear with a fistula.”

She is still not fully healed, though, and has been fighting for two years to get surgery for her condition.

“I have been referred to physiotherapy which I have had no improvements from. I have been trying to have surgery for the last two years, but I have been told the last six months that I can’t have surgery until my family is complete and I have been finished breast feeding for at least six months,” she said.

And while not every mother’s story is as tragic and difficult to hear as this one, most stories that were shared had a similar thread of women suffering in silence, without nearly enough help or compassion from their healthcare team or loved ones.

“Women injured traumatically during birth are overlooked, and as a result, feel overwhelmed. Told again and again that they’ll ‘forget the pain’ and to ‘enjoy the baby’ as they recover,” another mother shared. “That is our reality. And it needs to be talked about. It needs to be okay for us to accept this part of our lives. There are far more of us who suffer silently, too humiliated to reach out for help. If you have suffered a traumatic birth injury – you are not alone!”

Thankfully, more and more women like these warrior moms are opening up about the traumas that happen to them during birth. Chrissy Teigen, who never holds back in terms of brutal honesty (as well as humor!), recently took to Twitter to share her own experience with what sounds like a 4th degree tear that she suffered after the birth of her first child, Luna, back in 2016.

Listen, these are not easy topics to talk about. But we’ve all got to be honest as we feel comfortable being. We’ve got to tell our stories. We’ve got to de-stigmatize these things.

And we’ve got to make sure our fellow moms know they are not alone.

The brave women who shared their stories for this article started their own blog. You can follow along here, and check back as the days go on and they share more of their stories. And if you are looking for help or support with your own journey through 4th degree tearing, you are welcome to join their Facebook group, here.