Q: Why is there such a fuss around urgently seeing a physio after a 3A tear? Is it common to have issues after a 3A or am I lucky to have no issues so far?

A: Perineal tears during childbirth are described in degrees of tearing; from a first to fourth degree tear. First and second degree tears are more minor, but third and fourth degree tears extend down to involve the anus (back passage). A third degree tear involves the muscles around the anus, and a fourth degree tear extends into the anal lining. A third degree tear is then further classified into 3A, 3B or 3C, depending on how many anal sphincter muscle fibres have been torn.

The anal sphincters are really important for holding in poo or gas, until you’re in a socially appropriate place to let it out i.e. the toilet. Damage to these structures can cause incontinence, or leakage of poo or gas. Third and fourth degree tears can also cause pain with sex, or if not repaired properly, a fistula can form (an opening between the vagina and anus).

That’s really good news that you’re not having any of these symptoms after a 3A tear. At about three months post birth, we find that 5% of people with these tears are incontinent of poo, and 25% are incontinence of gas. When we look long term, at 30 years post birth, about 40% of people have anal incontinence. This worsening of symptoms over time is thought to be due to the hormonal changes of aging and menopause.

So, most people, like yourself, don’t have any incontinence issues after a third degree tear, which is great! Physiotherapy, which includes pelvic floor muscle training, can play a preventative role long term, and also help reduce symptoms significantly, in those who do have issues.