This leaflet explains:
- What an OASI is.
- What to expect during recovery.
- How to care for yourself at home.
- When to get medical help.
- Where to get support.
What is an obstetric anal sphincter injury?
An obstetric anal sphincter injury (OASI) is a tear that can happen during birth. An OASI may also be called a third- or fourth-degree tear. Your doctor or midwife should tell you what type of tear you had and what this means for you.
The tear affects the muscles around the back passage (anus). These muscles help control wind and bowel movements.
The tear is repaired with stitches soon after birth.
You should recover well with the right care and support.
What symptoms are normal after birth?
It is normal to have:
- Pain or soreness around the stitches.
- Swelling or bruising.
- Mild bleeding from the vagina.
- Discomfort when sitting or walking.
- Tiredness.
These symptoms should slowly improve over the first few weeks.
When should I seek urgent medical advice?
Please contact maternity assessment centre via telephone on 0113 392 6731 (open 24 hours), if you experience any of the following symptoms:
- Heavy bleeding.
- Increasing pain or swelling.
- Fever or flu-like symptoms.
- Bad-smelling discharge.
- Difficulty controlling wind or bowel movements.
- Leakage from the wound.
- Difficulty passing urine.
- Redness or opening of the wound.
If you have constipation, then please contact your GP.
Looking after your stitches
Keep the area clean
- Wash your hands before and after using the toilet.
- Shower or take a bath every day. This is safe as soon as you feel able to after your repair.
- You may find it helps to rinse the area with warm water after using the toilet. You can use a clean jug or a shower head.
- Pat the area dry gently with a clean towel or toilet tissue.
- Change maternity pads regularly.
Help reduce discomfort
- Take pain relief regularly (at least for the first 3-5 days) as advised by your doctor or midwife.
- You may be offered an ice pack wrapped in a towel for short periods during the early days in hospital. You can also use one at home if this helps your symptoms.
- Rest when you can.
- Avoid standing for long periods.
Pain relief
Pain relief can help you move, rest and care for your baby. While you are in hospital, staff should offer you pain relief. Before you go home, staff should tell you what pain relief you can take and how often.
Take pain relief exactly as advised.
Common pain relief medicines after birth may include:
- Paracetamol.
- Ibuprofen.
Please ask your midwife, doctor or pharmacist before taking medicine if:
- You have allergies.
- You have stomach problems or asthma.
- You are breastfeeding and unsure about medicines.
Going to the toilet
Opening your bowels
It is important to avoid constipation.
You should be given medicine to help make your poo softer. This can make it easier and less painful to open your bowels.
To help prevent constipation:
- Drink plenty of water.
- Eat fruit, vegetables and high-fibre foods, such as wholegrain cereal and bread, porridge and beans.
- Stay as active as you comfortably can.
- Do not strain when opening your bowels.
When opening your bowels:
- Sit with your feet on a small footstool if possible.
- Lean forward slightly.
- Try to relax and breathe normally.
Passing urine
It may sting when passing urine at first.
Pouring warm water over the area while passing urine may help.
Tell your healthcare team if you:
Doing pelvic floor muscle exercises
Pelvic floor exercises should begin within the first 2-3 days after childbirth, or as soon as it feels comfortable to do so.
The muscles that support your bladder and bowel may feel weaker after having a baby and you can do some exercise (called pelvic floor exercises) to help make these stronger over time.
There are two different exercises to improve pelvic floor muscle tone, it is recommended you do both.
Type I – this can be done in any position. It is easier to start in a lying or sitting position and progress to a standing position
- Squeeze around the back passage as if trying to stop wind escaping, at the same time squeeze your front passage as if trying to stop the flow of urine.
- You should feel a squeeze and lift, a drawing up feeling inside – this is a pelvic floor muscle contraction.
- Hold this squeeze and lift for a few seconds (up to 10), then relax and repeat a few times (up to 10).
Type II – Quick contractions
- Do the same squeeze and lift but relax immediately. Repeat up to 10 times.
- Allow a few seconds for the muscles to completely relax.
- in-between contractions.
- When completing pelvic floor exercises try and keep all other muscles relaxed including your bottom muscles and abdominals. Try not to hold your breath.
- Stopping the flow of urine in midstream can be used to check you are exercising the correct muscles but it is not recommended to continue to do this as long term it can cause bladder problems.
Activity and recovery
Your body needs time to heal.
In the first few weeks:
- Avoid heavy lifting where possible.
- Rest when you can.
- Increase activity slowly.
- Avoid high-impact exercise until advised.
Walking gently can help circulation and recovery.
Sex and intimacy
You can start having sex again when:
- You feel physically and emotionally ready.
- Your stitches have healed.
- Bleeding has stopped.
You may notice discomfort at first.
Use lubrication if needed and take things slowly.
Speak to your GP if sex remains painful.
Emotional wellbeing
Recovering from birth and an OASI can affect emotional wellbeing.
You may feel:
- Upset.
- Anxious.
- Embarrassed.
- Low in mood.
- Frightened about future births.
These feelings are common.
Talk to:
- Your community midwife.
- GP.
- Health visitor.
- Physiotherapist.
- Family or friends.
Please ask for support if you are worried about how you feel.
Being open and honest about your care
After an OASI, you may have questions about what happened. Your midwife or doctor should explain your injury, your repair, your recovery and your follow-up care.
An OASI can happen during vaginal birth, and we are sorry that this happened to you. It does not always mean that something went wrong, but we will still review the care you received.
Your healthcare team should:
- Explain what happened during your birth.
- Answer your questions honestly.
- Say sorry for the distress this may have caused.
- Explain the treatment and repair you received.
- Discuss your recovery and follow-up care.
- Give you the chance to talk about any concerns.
You can ask questions at any time. If there is anything you do not understand, please speak to your healthcare team.
As part of good clinical care, we also review the care provided during labour and birth to ensure that all recommended steps and communication were followed appropriately. This includes checking whether any additional discussions or support processes were needed at the time of your care.
This review does not necessarily mean that something has gone wrong. It is part of our commitment to openness, learning, and providing the best possible care and support for service users after childbirth.
If we find that we need to explain anything more to you, we will contact you. This may be by letter or by a follow-up conversation (this can take some months).
What happens next?
You should be offered a follow-up appointment with the specialist team to check how you have healed. This is usually 3-4 months after birth.
At this appointment you may discuss:
- Healing and symptoms.
- Bowel control.
- Pelvic floor recovery.
- Future pregnancies and births.
- Any worries or questions.
Please do not wait for this appointment if you are worried. Ask for help sooner if you have pain, signs of infection, problems controlling wind or poo, problems passing urine, or worries about how you feel.
Future pregnancies and births
Many people have future pregnancies and births after an OASI.
Your healthcare team in a future pregnancy will discuss:
- Your recovery.
- Any ongoing symptoms.
- Options for future birth.
Useful contacts
Maternity Assessment Centre
Emergency
Remember
- Healing takes time.
- You should recover well after an OASI with the right support, rest, and follow-up care.
- If you are worried about your recovery, please ask for help.
- You are not alone.