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Management of Third and Fourth Degree Perineal Tears
(GTG 29 - Jun 2015),…
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Degrees of Perineal Injury
1st degree: Injury to perineal skin and/or vaginal mucosa
2nd degree: Injury to perineum involving perineal muscles but not involving anal sphincter
3rd degree: Injury to perineum involving anal sphincter complex
3A: Less than 50% of external anal sphincter thickness torn
3B: More than 50% of external anal sphincter thickness torn
3C: Both external and internal anal sphincters torn
4th degree: Injury to perineum involving anal sphincter complex (external and internal) and anorectal mucosa
Rectal buttonhole: Tear involving rectal mucosa with intact anal sphincter complex
(If in doubt, classify to the higher rather lower degree)