“Is This Normal?” Third and Fourth Degree Tear Recovery, Week by Week
Recovery from a third or fourth degree tear is slower than most women are told. Being sore and moving carefully for several weeks is common, and many women don’t feel close to normal until somewhere between three months and a year. What isn’t normal is pain that gets worse instead of better, a smell, stitches that open, losing control of your bowels or wind, or being left with no follow-up at all. This guide walks through each stage of recovery, what doctors check, the follow-up Australian guidelines say you should be offered, and when a difficult recovery can point to something having gone wrong.
It’s 3am, and a woman is sitting on the edge of the couch, tilted onto one hip because sitting square still hurts. Her baby has finally gone back to sleep. She is four weeks out from a 3b tear, and she has her phone in her hand, typing the same question she has typed most nights this week: is this normal?
Everything she finds is either a horror story or a breezy reassurance that she’ll be “back to normal by six weeks”. Neither sounds like her. No one at the hospital told her what to expect, and she can’t tell whether she is healing slowly, healing badly, or just healing.
If that is you, this guide is for you. I’m a lawyer, not a doctor, so I won’t tell you what is happening in your body. What I can do is set out, plainly, what recovery usually looks like, what the Australian guidelines say you should be offered, and the signs that are worth acting on, so that you can ask the right questions of the people who are meant to be looking after you.
- your stitches smell, feel hot, or the pain is getting worse instead of better
- you can see or feel that the wound has opened
- you have a fever, or feel shivery and unwell
- you’re bleeding heavily, or passing large clots
- you can’t control your bowels or wind, or poo or wind is coming from your vagina
- you can’t pass urine, or haven’t opened your bowels for several days despite laxatives
Call your maternity unit, your GP or your midwife. If you feel very unwell, go to your nearest emergency department or call 000.
What is a third or fourth degree tear?
Obstetric anal sphincter injury (OASIS)
A tear during vaginal birth that extends into the anal sphincter, the ring of muscle that controls the bowel. A third degree tear involves the sphincter. A fourth degree tear goes through the sphincter and into the lining of the bowel (the rectal mucosa).
In plain terms: it’s a tear that reaches the muscle that keeps you continent. That is why it needs a careful repair, why recovery takes longer, and why proper follow-up matters so much.
Third degree tears are graded further, and your grade is worth knowing because it shapes your recovery:
| Grade | What it means |
|---|---|
| 3a | Less than half of the external anal sphincter is torn. |
| 3b | More than half of the external anal sphincter is torn. |
| 3c | Both the external and internal anal sphincters are torn. |
| 4th degree | Both sphincters and the lining of the bowel are torn. |
The Queensland Clinical Guideline on perineal care tells staff to inform women about the extent and nature of their injury. If no one has told you your grade, you are entitled to know it. It should be written in your birth records, usually in the repair note. Our guide to getting and reading your birth records explains how to find it.
What recovery usually looks like, stage by stage
Everyone heals differently, and the grade of the tear doesn’t predict everything. Some women with a fourth degree tear feel well within weeks, and some with a 3a struggle for months. Healing also tends to come in leaps rather than a steady line: a few good days, a flat patch, then another step forward. What follows is what many women describe, alongside the things worth raising with your doctor, midwife or physio.
Stage 1The first week
Common
- Swelling, bruising and heavy pressure, “like sitting on a balloon”
- Lying down most of the day, and needing help in and out of bed
- Fear of the first poo (most women find it far less bad than they feared once stool softeners are working)
- Some numbness, or a strange partly deadened feeling, for the first few days
- Stinging when you wee
Raise it if
- pain relief isn’t touching the pain. You can ask for a review; you don’t have to tough it out
- you were sent home without antibiotics, stool softeners or a plan
- no one has told you what grade of tear you have
- you weren’t referred to a physiotherapist before you left hospital
Stage 2Two to four weeks
Common
- Sitting is still uncomfortable, and many women sit on one side, a cushion or the edge of a chair
- Short, slow walks are possible, but doing too much brings back heaviness or soreness the next day
- Itching as the stitches dissolve, and some pulling or tugging
- Crying often, and feeling anxious about whether you’ll ever heal
Raise it if
- pain is getting worse, not better
- there is a smell, green or yellow discharge, or a hot, throbbing feeling
- you can feel a gap, a raw patch or a lump where the stitches were
- you are leaking poo or can’t hold wind, and it isn’t improving
Stage 3Six weeks
Common
- The skin has often closed, but the deeper tissue is still healing
- Feeling “mostly better” but still tender, and not ready for sex or exercise
- Being told “you’ve healed” at the six week check while still feeling far from normal
Raise it if
- you are still bleeding from the wound, or there is a bright red, raw spot (often granulation tissue, which can usually be treated simply in clinic)
- you haven’t been offered an obstetric review or physiotherapy
- the examination was too painful to finish. You can ask for a gentler examination or a smaller speculum
Stage 4Three months
Common
- Most daily activities are possible again
- Scar tissue can still feel tight or sensitive with certain movements
- First attempts at sex are often uncomfortable, and many women wait longer than six weeks
- Pelvic floor physiotherapy is usually well under way
Raise it if
- you still have urgency, or can’t always make it to the toilet
- it still burns or aches after short walks
- you feel heaviness or a bulge, which can be a sign of prolapse
- sex is very painful, or the vagina feels narrowed or misshapen
Stage 5Six to twelve months
Common
- Many women feel close to normal, though some say it took around a year
- Occasional twinges in the scar with long sitting, long flights or weather changes
- A gradual return to running, lifting and high intensity exercise, guided by a physio
Raise it if
- you have any ongoing problem with bowel control, wind, urgency or pain
- you are thinking about another pregnancy and haven’t had your sphincter checked
- you feel low, numb or angry, or are having flashbacks about the birth
To put this in perspective, hospital information for women suggests that around six to eight in every ten women have no symptoms a year after a third or fourth degree tear. That is genuinely good news. It also means that two to four in ten women are still living with symptoms a year on, and they deserve proper care, not reassurance alone.
The follow-up Australian guidelines say you should be offered
This is the part most women never see, because it is written for clinicians. But it matters, because it is the yardstick for what good care looks like. The national Third and Fourth Degree Perineal Tears Clinical Care Standard expects that, after the repair, you are offered debriefing, physiotherapy and psychosocial support, and that after you go home you have individualised follow-up and referral for your physical, emotional, psychological and sexual health.
State guidelines and hospital procedures add the detail. For example:
- Queensland: the Queensland Clinical Guideline on perineal care recommends stool softeners for 10 days after the repair, a physiotherapy referral before discharge, a wound check around six weeks, a review with an obstetrician at 6 to 12 weeks, and a debrief with senior staff. It lists endoanal ultrasound and anorectal manometry as options where incontinence or pain persists.
- New South Wales: the Royal Hospital for Women in Sydney’s local procedure asks staff to refer women to physiotherapy at the time of the repair, have a senior doctor review them before discharge, offer a debrief, and book follow-up in its OASIS clinic at four weeks and four months.
- South Australia: the SA Perinatal Practice Guideline on third and fourth degree tears begins from the principle that accurate diagnosis of the injury gives the best chance of normal function.
- Internationally: the Royal College of Obstetricians and Gynaecologists’ Green-top Guideline No. 29, which RANZCOG publishes on its website, is the guideline most Australian units draw on for repair and follow-up.
Hospitals differ, and not every unit has an OASIS clinic. But if you were sent home with no physiotherapy referral, no review booked and no one to call, that falls well short of what these documents describe.
What doctors and physios usually check
When your recovery is reviewed, a doctor, midwife or pelvic health physiotherapist will usually:
- look at the wound to check it has closed, and look for infection, breakdown or granulation tissue
- ask about your bowels and wind: whether you can hold them, whether you get urgency, whether you have had accidents
- ask about your bladder, pain, sex and exercise
- examine the sphincter and pelvic floor, usually by gently checking muscle tone and strength
- arrange tests if you have symptoms, such as an endoanal ultrasound, which shows whether the sphincter has healed, or anorectal manometry, which measures how well it squeezes
- refer you on where needed, to a perineal or OASIS clinic, a continence service, a urogynaecologist or a colorectal surgeon
Questions to ask your hospital, GP or physio
It is hard to think clearly in an appointment when you are tired, sore and holding a baby. You might like to take this list with you, or copy it into your phone.
1. What grade of tear did I have (3a, 3b, 3c or 4th degree)? 2. Who repaired it, and where (birth suite or operating theatre)? 3. Was I given antibiotics and stool softeners after the repair? 4. Has a follow-up appointment been booked for me? When, and with whom? 5. Can I be referred to a pelvic health physiotherapist who has experience with third and fourth degree tears? 6. Is my wound healing as you would expect for this stage? Is there any granulation tissue or breakdown? 7. Should I have an endoanal ultrasound to check how my sphincter has healed? 8. Who do I contact if things get worse, or if I have problems with bowel control? 9. What should I know before planning another pregnancy? 10. Can I have a debrief about what happened during the birth and the repair?
If you would like to talk through the birth itself, our guide on how to ask for a birth debrief explains how to arrange one and what to ask.
When a slow recovery can point to something going wrong
Most third and fourth degree tears are not anyone’s fault, and a slow recovery does not, by itself, mean that care was poor. But a difficult recovery can point to a problem with care if, for example:
- the tear was missed or graded too low, so it wasn’t properly repaired in the first place
- a severe tear was repaired in the birth room by someone without the right training or experience, or without adequate light, anaesthesia or help
- you were never told you had a severe tear, or were sent home without antibiotics, stool softeners or instructions
- no one looked at the wound again, or your concerns about smell, pain or leaking were dismissed
- a wound that had broken down or become infected wasn’t picked up or treated in time
- you were never referred to physiotherapy, a perineal clinic or a specialist despite ongoing symptoms
How the law looks at it
In Australia, whether care was negligent is judged against what was widely accepted as competent professional practice at the time. In New South Wales, for example, section 5O of the Civil Liability Act 2002 (NSW) provides that a professional is not negligent if they acted in a way widely accepted by peer professional opinion as competent practice, unless that opinion is irrational. Other states have similar rules. That is why the guidelines above matter: they are strong evidence of what competent practice looks like, and they are what independent experts are asked to measure your care against.
Information and consent matter too. In Rogers v Whitaker (1992) 175 CLR 479, the High Court held that doctors must warn patients of material risks, meaning risks a reasonable person in the patient’s position would be likely to attach significance to, or that the doctor knows, or should know, this particular patient would. More recently, in Gawthrop v Bendigo Health [2026] VSC 157, the Supreme Court of Victoria found that a vaginal examination in labour had been performed without free and voluntary consent, and that the woman had not been properly warned about the limits of her birth plan. Consent in birth is not a formality, and the courts are treating it seriously.
Time limits apply. In New South Wales, a claim generally has to be started within three years of when you knew, or ought to have known, that you had been injured, that the injury was caused by someone’s fault, and that it was serious enough to justify a claim, with an outer limit of 12 years (Limitation Act 1969 (NSW) s 50C). Other states and territories have their own rules, so it is better to ask early than to wait.
Our article “It’s just part of having a baby”: when a severe perineal tear wasn’t your fault goes into the legal side in more detail. You can also see how these injuries connect to others on our birth injury map.
In my practice
The women I see after a severe tear rarely come to me first about the tear itself. They come because of what happened afterwards. The months of being told everything looked fine. The six week check that lasted four minutes. The feeling of being the only one who hadn’t bounced back, and of being treated as though she was making a fuss.
When we get the records, a pattern often appears. The grade is written down, but no one told her. There is no note of a rectal examination after the repair. There is no physiotherapy referral, or one was made and never followed up. The discharge summary says “perineal tear, sutured”, and nothing more. In my doctoral research on patterns of failure in medical negligence, this is one of the shapes that comes up again and again: not one dramatic mistake, but a series of small gaps that together leave a woman without the care she needed.
What I want every woman reading this to hear is that noticing something is wrong is not overreacting. You are the only person who lives in your body every day. If your recovery doesn’t match what you were told to expect, that is information, and it deserves to be taken seriously.
Drawn from the experiences of many women I have worked with, combined and changed so that no one can be identified. It does not describe any individual client.
What she noticed. She went home two days after the birth with a bag of pads, a leaflet and a box of paracetamol. By week three she still couldn’t sit except on one side, and there was a smell she was too embarrassed to mention. By week five she was planning every outing around where the nearest toilet was.
What she was told. That everyone heals differently. That it was probably haemorrhoids. That she should give it more time. At her six week check, a GP glanced at the area and said it had healed well. No one asked about her bowels, and no one mentioned physiotherapy.
What the records showed. When she finally asked for her records, she learned for the first time that she had a 3b tear. It had been repaired in the birth room late at night. There was no record of a rectal examination after the repair, no physiotherapy referral and no follow-up booked. An endoanal ultrasound months later showed a gap in the sphincter that hadn’t healed.
How she felt. “The worst part wasn’t the pain,” she said. “It was feeling like I was the only one who didn’t bounce back, and that everyone thought I was making a fuss.” Seeing it written in her records was hard. It was also the first time she felt she wasn’t imagining it.
Both/and: your recovery can be in the normal range, and your care can still have fallen short
Both things can be true. Your recovery might be slow but entirely within the range of what is expected, and you might still have been let down by the care around it: by not being told your grade, by not being referred, by having your concerns brushed aside. A slow recovery doesn’t prove negligence, and a recovery that turns out fine doesn’t mean your care was good.
Holding both lets you stop asking the impossible question, “am I overreacting?”, and start asking a more useful one: “have I had the care I should have had, and what do I need now?” You can go after the care you need today without first deciding whether anyone was at fault.
The bigger picture: why so many women fall through the gap
It is worth naming that this isn’t only about individual clinicians. In July 2026, RANZCOG’s Birth Trauma Roundtable Final Report described pelvic floor dysfunction as one of the most common and least recognised consequences of childbirth. It noted that Medicare funds a single postnatal attendance between four and eight weeks after birth, with no funded pathway for ongoing assessment, and that many women reported delayed diagnosis, inconsistent advice and no coordinated care. Its key message was simple: “pelvic health is maternal health.”
So if you have felt that the system wasn’t built around your recovery, you’re not imagining that either. That is part of why it is so important to ask, clearly and in writing, for the follow-up you need.
Practical things women say helped
These are general tips many women find useful. Please check with your midwife, doctor or physio about what is right for you.
- Stay on top of pain relief in the early weeks rather than waiting for pain to build, and ask for a review if it isn’t enough.
- Keep your poo soft with the stool softeners you were prescribed, plenty of water and, later, fibre. Resting your feet on a small step on the toilet can stop you straining.
- Lie down whenever you can, roll onto your side to get out of bed, and avoid “scooting” along the bed or couch.
- Use a peri bottle of warm water when you wee, and pat the area dry.
- Rest more than you think you need to. Many women say their biggest regret was doing too much too soon.
- See a pelvic health physiotherapist with experience in severe tears. If yours doesn’t have it, it is okay to ask for someone else. You can search on Choose Physio.
- Ask about treatments for slow healing, such as treatment for granulation tissue, scar massage, or vaginal oestrogen cream, which some women are prescribed while breastfeeding.
Support, so you aren’t doing this alone
- National Continence Helpline: 1800 33 00 66, free advice from nurse continence specialists, run by the Continence Foundation of Australia.
- PANDA (Perinatal Anxiety & Depression Australia): 1300 726 306, or panda.org.au.
- Birth Trauma Australia: birthtrauma.org.au, information and peer support for physical and emotional birth trauma.
- The Commission’s plain language sheet, Recovering from a third or fourth degree perineal tear.
Our guide to finding support after birth trauma has more options, including support for partners.
You are not too slow, too sensitive or too demanding. You had a serious injury, in the middle of the most physically demanding thing a body can do, while learning to care for a newborn. Healing from that takes the time it takes. You are allowed to ask for help, to ask again, and to expect answers.
With care,
Rosemary
Frequently asked questions
How long does it take to recover from a third degree tear?
The stitches usually dissolve within a few weeks, and many women feel “mostly better” somewhere between six weeks and three months. Feeling fully back to normal, including with sex and exercise, often takes six months to a year. Around six to eight in ten women have no symptoms a year after the birth.
Is it normal to still not be able to sit at four weeks?
Many women are still uncomfortable sitting at four weeks after a third or fourth degree tear, and sit on a cushion or on one side. What matters is the direction: it should be slowly improving. If sitting is getting harder, or there is a smell, heat or new pain, ask to be examined.
My six week check said I’d healed, but I don’t feel healed. What should I do?
The skin can close long before the deeper muscle has recovered. If you still have pain, leaking, urgency, heaviness or problems with sex, ask for a referral to a pelvic health physiotherapist and a perineal or OASIS clinic, and ask whether you should have an endoanal ultrasound. The Queensland guideline, for example, recommends an obstetric review at 6 to 12 weeks after an OASIS.
Is it normal to still be bleeding from the tear at six weeks?
Ongoing bleeding from the wound itself, as opposed to normal postnatal bleeding, can be a sign of granulation tissue or slow healing. It is common and usually easy to treat, but it needs to be examined, so ask your GP, midwife or hospital to look at it.
What is the difference between a 3a, 3b and 3c tear?
A 3a tear involves less than half of the external anal sphincter, a 3b more than half, and a 3c involves both the external and internal sphincters. A fourth degree tear also goes through the lining of the bowel.
Will I be incontinent forever after a fourth degree tear?
Not necessarily. Early urgency or trouble holding wind often improves over the following months, especially with physiotherapy. If problems continue, there are further tests and treatments, including specialist surgery, so ask for a referral rather than accepting it as permanent.
When can I have sex again after a third degree tear?
There is no set date. The six week mark is a check point, not a deadline. Many women wait three or four months or longer, and the first few times can be uncomfortable. Lubricant, patience and a pelvic health physio can help. If sex stays painful, raise it with your doctor.
Was my tear caused by negligence?
Most severe tears are not caused by negligence. But a tear that was missed, graded too low, poorly repaired or not properly followed up can be. Care is measured against what was accepted as competent professional practice at the time, which is why national and state guidelines matter. If you have ongoing problems and questions about your care, it may be worth getting advice, and time limits apply.
Questions about your care?
If your tear wasn’t recognised, repaired or followed up the way it should have been, we can talk it through with you. It’s confidential, and there’s no cost to find out where you stand.
- Is this normal? Recovery week by week (you are here)
- My stitches smell, came apart or feel open
- “Nobody told me how bad my tear was”
- “I can’t control wind after birth”
- I can’t hold it, or make it to the toilet in time
- Sex after a third or fourth degree tear
- Still can’t sit, months later
- Caesarean or vaginal birth next time?
- Could my tear have been prevented?
- “I feel broken, and no one understands”
- How much compensation for a third or fourth degree tear?
References
- Australian Commission on Safety and Quality in Health Care. Third and Fourth Degree Perineal Tears Clinical Care Standard. Sydney: ACSQHC, 2021. safetyandquality.gov.au
- Australian Commission on Safety and Quality in Health Care. Recovering from a third or fourth degree perineal tear (information for women). safetyandquality.gov.au
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Birth Trauma Roundtable Final Report. July 2026. ranzcog.edu.au
- Royal College of Obstetricians and Gynaecologists. The Management of Third- and Fourth-Degree Perineal Tears. Green-top Guideline No. 29, 2015 (published on the RANZCOG website). ranzcog.edu.au
- Queensland Clinical Guidelines. Perineal care. Guideline MN18.30. Queensland Health. health.qld.gov.au
- SA Health. Third and fourth degree tear management. South Australian Perinatal Practice Guidelines. sahealth.sa.gov.au
- Royal Hospital for Women, South Eastern Sydney Local Health District. Third and fourth degree tears: repair and management. Clinical Business Rule, 2023. seslhd.health.nsw.gov.au
- North Bristol NHS Trust. 3rd or 4th degree tear (patient information). nbt.nhs.uk
- Rogers v Whitaker (1992) 175 CLR 479; [1992] HCA 58.
- Gawthrop v Bendigo Health [2026] VSC 157.
- Civil Liability Act 2002 (NSW) s 5O.
- Limitation Act 1969 (NSW) s 50C.
Client stories in this article are composites drawn from many women’s experiences and have been changed so that no one can be identified. They do not describe any individual client.
Written by Dr Rosemary Listing, PhD (Law). Rosemary is a medical negligence lawyer and Of Counsel at Peter Evans & Associates. She has practised since 2013 and worked on many hundreds of claims, including for women injured during childbirth. Her doctoral research examined patterns of failure in medical negligence, and she is a Sessional Lecturer in Health Law at the University of Newcastle. She is responsible for all content published under her name.
Rosemary is not medically qualified. Clinical information in this article is drawn from, and checked against, the national Clinical Care Standard, RANZCOG publications and state clinical guidelines listed in the references. Legal information reflects the law as at the review date.
Last updated 27 October 2026. First published 27 October 2026. Next review April 2027.
Cite this article: Listing, R. (2026, October 27). “Is This Normal?” Third and Fourth Degree Tear Recovery, Week by Week. Reframe Legal. https://reframelegal.com/third-degree-tear-recovery-week-by-week/
This article is general information only. It isn’t medical or legal advice about your situation, and reading it doesn’t create a lawyer and client relationship. If you are worried about your health, please see your doctor, midwife or hospital. If you are in crisis, call 000 or Lifeline on 13 11 14. Legal services are provided by Peter Evans & Associates.
