Mount Sinai Perineal (OASIS) Clinic

 A perineal tear refers to damage that can occur in the area between the vagina and anus during childbirth. These tears are categorized in severity, from first to fourth degree. 

Third and fourth-degree tears involve deeper injury to the muscles around the anus and are referred to as obstetrical anal sphincter injuries (OASIS). 

We provide comprehensive care to those who are dealing with the challenges caused by these more severe perineal tears.

Learn more about perineal tears and how they are treated. 

What to expect

If you have experienced a third or fourth-degree tear during a birth at Mount Sinai, you will receive an appointment for an early assessment with your own obstetrician or at our perineal clinic, usually within two weeks of the delivery.

At your appointment, a gynaecologist will ask you about your symptoms and perform a physical exam to make sure the area is healing and there are no signs of infection. This is also an opportunity for you to talk about your birth and ask any questions you may have.

The gynaecologist will then work with you to design a care plan that is specific to your needs. Your treatment may include any of the following:

• Antibiotics to treat infections
• Pain-relieving drugs such as acetaminophen and anti-inflammatory medicine
• Use of an ice pack if your perineum is bruised or swollen
• A gentle laxative to make it easier and more comfortable to move your bowels
• Sitz baths for soothing the affected area
• A high-fibre diet to prevent constipation
• Use of an air-donut pillow or two rolled up towels placed parallel to each other to ease pressure on your perineum
• Avoidance of heavy lifting, pushing or pulling
• Pelvic floor muscle exercises to strengthen the muscles of the perineum and pelvic floor
• Emotional and mental health support
• Surgery to repair the anal sphincter if deemed necessary

Our clinic team may recommend follow-up appointments at our early assessment clinic to monitor your recovery. A routine postpartum check up with your midwife or primary care provider is recommended six weeks after delivery.

If your recovery progresses well after a few weeks, we may suggest scheduling an appointment with a physiotherapist specializing in the pelvic floor. While there may be a fee for this service, many insurance policies cover it. It is important to make sure that your pelvic floor muscles are functioning correctly to prevent bladder and/or bowel problems. Visit Pelvic Health Solutions to find a provider near you.

At three or four months postpartum, you can schedule a "delayed assessment" appointment, including a specialized ultrasound of the anal muscles. This kind of ultrasound may be uncomfortable, but should not be painful. The information from the ultrasound will tell us if your muscles have healed properly and help us understand the cause of any lingering symptoms you may have. It can also help with planning for your future pregnancies and births.

Please note we are a teaching hospital, so you may see a medical students, residents, fellows or other medical trainees as part of your care. Learners are supervised by other members of our dedicated care team who work together to provide you with comprehensive care. 

What to bring

• Health (OHIP) card or valid health-care coverage
• Hospital card
• A list of current medications
• A list of questions you want to ask 

How to access our services

You need a referral from a health-care provider to be seen at our clinic. Visit our referral criteria for more information.