“It Still Hurts to Sit Down”: Pain Months After a Third or Fourth Degree Tear
Some discomfort sitting is expected in the first weeks after a third or fourth degree tear, and it usually eases steadily over two to three months. Pain that has stalled, is getting worse, or is still stopping you from sitting through a meal months later has a cause, and deserves a proper examination. Common causes include problems with the scar, tailbone injury, nerve pain, an anal fissure, and prolapse or pelvic floor injury, and most can be treated. This guide explains each one, what to ask for, and when ongoing pain can point to a problem with care.
Seven months after the birth, she still sits on the edge of her chair at work, tilted onto her left hip. She has a cushion in the car. Long meetings are agony, and she has stopped going to the movies. When she mentioned it at her GP visit, she was told it was probably haemorrhoids and given a cream.
If sitting still hurts months after a third or fourth degree tear, or you are still using the donut cushion long after you thought you would be done with it, this guide is for you. Some discomfort can last a while after a severe tear. But pain that is not improving, or that stops you living your life, has a cause, and it deserves to be found. I’m a lawyer, not a doctor, but I can walk you through the most common causes women are eventually diagnosed with, what to ask for, and when ongoing pain can point to a problem with care.
How long is “normal”?
In the first weeks after a severe tear, sitting is usually uncomfortable, and many women sit on a cushion, on one side, or lie down instead. For most, this eases steadily over the first two to three months. Our guide to recovery week by week sets out what is typical at each stage.
The key is direction. Pain that is slowly getting better is reassuring. Pain that has stalled, is getting worse, or is still stopping you from sitting through a meal at three months or more is a reason to be properly examined, not to keep waiting.
- sitting is getting harder rather than easier
- there is a smell, heat, swelling or discharge from the scar
- you have bleeding or severe pain when you open your bowels
- you have new numbness, or problems controlling your bladder or bowel
See your GP or call your maternity unit, and say you had a third or fourth degree tear. If you feel very unwell, go to your nearest emergency department.
What it can mean
Women who are still in pain months later are often eventually diagnosed with one, or several, of the following. Only an examination can tell which applies to you.
Cause 1The scar or wound hasn’t healed properly
What women describe
- Pain right on the scar, often worse on one side
- A raw or bleeding spot, or a lump
- Pulling or tightness when sitting or walking
- A dip, gap or flap of skin
What it can be
- Granulation tissue, an area of wound breakdown, or a tight or uneven scar (see My stitches smell, came apart or feel open)
- Usually treatable: in clinic, with physiotherapy and scar massage, or sometimes with a surgical revision
Cause 2Tailbone (coccyx) pain
What women describe
- Pain right at the base of the spine when sitting
- Worse on hard chairs and getting up from sitting
- A bruised feeling that never quite goes
- Flaring on long flights, drives or meetings
What it can be
- Coccyx injury or coccydynia, which can happen during a difficult or assisted birth
- Often helped by pelvic health physiotherapy, a wedge or cut-out cushion, and sometimes injections or other specialist treatment
Cause 3Nerve pain
What women describe
- Burning, stabbing or electric pain
- Pins and needles or numbness in the vulva or perineum
- Pain worse sitting and better standing or lying
- Pain that doesn’t match what the scar looks like
What it can be
- Irritation or injury of the pudendal nerve or its branches, which supply the perineum
- Best assessed by a pelvic pain specialist, and managed with physiotherapy, medication and sometimes nerve blocks
Cause 4“They said it’s just haemorrhoids”
What women describe
- Pain with every bowel motion, like “passing glass”
- Bleeding on the paper
- Spasm or aching for hours afterwards
- Being told it’s “just haemorrhoids”
What it can be
- An anal fissure (a small tear in the lining of the anus), which is common after birth and very treatable
- Haemorrhoids, which are real and can be treated properly
- But also sometimes a missed problem with the sphincter or the repair, so it should be examined, not assumed
Cause 5Heaviness and pressure
What women describe
- A dragging or heavy feeling, worse at the end of the day
- Feeling like something is “falling out”
- A bulge you can feel or see
- Discomfort sitting that eases lying down
What it can be
- Pelvic organ prolapse, or an injury to the pelvic floor muscle itself (levator avulsion)
- Assessed by a pelvic health physiotherapist or urogynaecologist; managed with physiotherapy, a pessary, or sometimes surgery
Pelvic joint pain, such as sacroiliac joint or pubic symphysis pain, can also make sitting hard after birth, and often overlaps with the causes above. A good assessment looks at the whole picture, not just the scar.
What doctors and physios usually check
- Exactly where the pain is, what it feels like, and what makes it better or worse
- The scar, for granulation tissue, breakdown, tight bands or tender spots
- The back passage, for a fissure, haemorrhoids or a problem with the sphincter
- The tailbone and pelvic joints
- The pelvic floor muscles, for tension, weakness, injury or prolapse
- Nerve symptoms, such as numbness, burning or pins and needles
- Imaging or referral where needed, such as an endoanal or pelvic floor ultrasound, or referral to a pelvic pain specialist, colorectal surgeon or urogynaecologist
What can help
- A pelvic health physiotherapist experienced with severe tears and pelvic pain. Search on Choose Physio.
- The right cushion: many women find a coccyx cut-out or wedge cushion more comfortable than a donut once the early weeks have passed. Ask your physio.
- Treating the cause: granulation tissue treatment, fissure treatment, scar massage, a pessary for prolapse, or nerve pain management.
- Keeping bowel motions soft, so that straining doesn’t keep aggravating the area.
- A pain specialist if pain has lasted more than three months, because persistent pain can change how nerves process signals, and specialist treatment can help.
- Workplace adjustments, such as a standing desk, breaks, or work from home days. A letter from your GP can help.
Questions to ask
1. Where exactly is the pain coming from: the scar, the back passage, the tailbone, the pelvic floor or a nerve? 2. Is there granulation tissue, breakdown or a tight scar that could be treated? 3. Could I have an anal fissure rather than (or as well as) haemorrhoids? 4. Could my tailbone have been injured during the birth? 5. Could this be nerve pain? Should I see a pelvic pain specialist? 6. Could I have a prolapse or a pelvic floor muscle injury? 7. Should I have an ultrasound or other imaging? 8. Can I be referred to a pelvic health physiotherapist experienced with severe tears?
What the guidelines say you should be offered
The national Third and Fourth Degree Perineal Tears Clinical Care Standard expects individualised follow-up after discharge, with referral for your physical, emotional, psychological and sexual health. The Queensland Clinical Guideline on perineal care recommends an obstetric review at 6 to 12 weeks after a third or fourth degree tear, and lists endoanal ultrasound and anorectal manometry as options where pain or incontinence persists. Ongoing pain isn’t something you are expected to manage on your own.
When it can point to something going wrong
Long-lasting pain after a severe tear can happen even after excellent care. But it can point to a problem with care if, for example:
- the repair was poorly aligned, too tight, or left a defect, causing ongoing scar pain
- an infection or breakdown wasn’t recognised or treated promptly
- granulation tissue or a fissure was noticed but never treated
- your pain was put down to haemorrhoids without a proper examination, and something else was missed
- you were never referred to physiotherapy or a specialist despite months of pain
- an assisted birth caused an injury, such as a tailbone or nerve injury, in circumstances where a different approach should have been taken
How the law looks at it
Whether care was negligent is judged against what was widely accepted as competent professional practice at the time. In New South Wales, section 5O of the Civil Liability Act 2002 (NSW) provides that a professional is not negligent if they acted in a way that was widely accepted by peer professional opinion as competent practice, unless that opinion is irrational. Other states have similar rules. The national standard and state guidelines are strong evidence of what competent practice looks like. An expert is also asked whether better care would probably have made a difference to your pain (section 5D of the same Act deals with causation in New South Wales).
Chronic pain affects work, parenting, exercise and relationships, and those effects are part of what is assessed if a claim succeeds. Our guide to how much compensation for a third or fourth degree tear explains how.
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 could my tear have been prevented? explains the legal side in more detail, and our birth injury map shows how these injuries connect.
In my practice
“Just haemorrhoids” is a phrase I see in a lot of records. Sometimes it is exactly right. But sometimes it is written down without anyone having looked, and months later a specialist finds a fissure, a separated repair, a tailbone injury or a sphincter defect.
In my doctoral research on patterns of failure in medical negligence, one of the most consistent patterns is the early label that sticks. Once a symptom has an explanation in the notes, the next person tends to accept it, and the woman stops being examined. If your pain has outlasted the explanation you were given, it is completely reasonable to ask someone to look again, from the beginning.
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. Sitting was still painful at six months, sharpest on one side and at the base of her spine. Every bowel motion hurt and left her aching for hours. She had stopped going out to dinner, and dreaded long car trips to see family.
What she was told. At six weeks, that she was healing well. At three months, by a GP, that it was probably haemorrhoids, and to use a cream and a donut cushion. At five months, that some women just take longer.
What the records showed. A long second stage and a forceps birth, with a 3b tear repaired in the birth suite. No note of the perineum being examined again before discharge. When she was finally referred, a colorectal surgeon found a chronic anal fissure and a tender, uneven scar, and a physiotherapist identified coccyx pain.
How she felt. “I felt like I was making it up, because everyone said it should be better by now,” she said. Finding out there were three separate, treatable reasons made her cry with relief, and then with frustration that no one had looked sooner.
Both/and: recovery can be slow, and pain still deserves answers
Both things can be true. Healing from a severe tear can be slow, and some discomfort can last for months. And ongoing pain is still a symptom with a cause, one that deserves to be examined and treated, not explained away. You don’t have to choose between being patient and asking for help.
The bigger picture
RANZCOG’s Birth Trauma Roundtable Final Report (July 2026) heard from women describing chronic pain, delayed diagnosis and no coordinated care after birth, and recommended expanded pelvic health physiotherapy and national standards for post-birth assessment and referral. One woman told the roundtable: “I didn’t have a disability sticker, even though I was disabled.” If that resonates, you are not alone, and your pain is real.
Support
- 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.
- Our guide to finding support after birth trauma.
Being unable to sit through a meal, a meeting or a car trip months after giving birth is not a small thing, and it is not something you should have to quietly put up with. Keep asking until someone finds the reason. You deserve to sit comfortably in your own life again.
With care,
Rosemary
Frequently asked questions
Is it normal to still have pain sitting months after a third degree tear?
Some discomfort can last a while, but it should be steadily improving. Pain that has stalled, is getting worse, or is still stopping you from sitting normally at three months or more is a reason to be examined, because it usually has a treatable cause.
Why does my tailbone hurt after giving birth?
The coccyx can be bruised or injured during birth, especially a long or assisted birth. Tailbone pain is usually worse sitting on hard surfaces and getting up. A pelvic health physiotherapist can assess it, and a cut-out cushion often helps.
The doctor said it’s haemorrhoids, but it isn’t getting better. What else could it be?
Pain with bowel motions after a tear can also be caused by an anal fissure, a problem with the scar, or an issue with the sphincter repair. If treatment for haemorrhoids hasn’t helped, ask for a proper examination and, if needed, a referral to a colorectal surgeon.
Should I still be using a donut cushion?
Donut cushions can help in the first weeks. Months later, many women find a coccyx cut-out or wedge cushion more comfortable. If you still need a cushion to sit at all, ask to be assessed.
Can nerves be damaged during birth?
Yes. The pudendal nerve and its branches, which supply the perineum, can be stretched or irritated during birth. Nerve pain is often burning, stabbing or tingling and worse sitting. A pelvic pain specialist can assess and treat it.
Is ongoing perineal pain a sign of negligence?
Not necessarily. It may point to a problem if the repair was poorly done, an infection or breakdown wasn’t treated, symptoms were wrongly put down to haemorrhoids without examination, or you were never referred. Time limits apply.
Questions about your care?
If months of pain are linked to how your tear was repaired or followed up, we can talk it through with you, confidentially. There’s no cost to find out where you stand.
- Is this normal? Recovery week by week
- 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 (you are here)
- 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
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Instrumental Vaginal Birth. C-Obs 16, 2020. ranzcog.edu.au
- Civil Liability Act 2002 (NSW), including ss 5D, 5O, 12, 15, 16 and 33.
- 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). “It Still Hurts to Sit Down”: Pain Months After a Third or Fourth Degree Tear. Reframe Legal. https://reframelegal.com/still-cant-sit-months-after-birth/
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.
