Fourth-degree vaginal tears are the most severe. They involve the perineal muscles and anal sphincter as well as the tissue lining the rectum. Fourth-degree tears require surgical repair and usually heal within several months. However, complications — such as fecal incontinence and painful intercourse — are possible.
Your health care provider will evaluate your recovery at your postpartum checkup. If you experience complications from a severe vaginal tear, you may need to consult a colorectal surgeon or other specialist.