Buttonhole tears & OASI injuries during childbirth

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What are Buttonhole tears & OASI injuries?


Many mums who have a vaginal birth experience some type of tear, whether that is from an episiotomy or when it happens on its own (spontaneously). Most tears are minor and will repair on their own without any complications. However, some tears need specialist attention and it’s vitally important they are identified early.

A rectal buttonhole tear is when the anal sphincter itself does not tear, but there is a hole between the vaginal opening and the back passage. It can cause wind and faeces coming through the vagina instead of the anus. This can understandably be incredibly distressing and debilitating, having an impact on all aspects of a mum’s life. It is a rare complication but can result in life changing symptoms including anal incontinence (AI).

Management of OASI and buttonhole tears

Perineal injuries are commonly referred to as OASI. This stands for an Obstetric Anal Sphincter Injury and include third and fourth degree tears. They can occur in 6 out of 100 births for first time mothers and less than 2 in 100 births for women who have had a vaginal birth previously. Whilst they are rare, the repercussions can be serious if left untreated. A third or fourth degree tear is complex and should be repaired by an experienced clinician. Therefore, it is important for your midwife or obstetrician to check carefully for tears following delivery.

A buttonhole tear is an internal injury and so a visual examination alone is not sufficient. A rectal or digital examination is required to confirm or rule out the presence of this type of injury.

If an OASI or buttonhole tear is identified, you will require stitches to repair the tear between your vagina and anus. You should also be provided with antibiotics to prevent infection.

However, there are occasions when things do go wrong, and the standard of treatment should have been better.

Examples of this include:

  • A failure to recognise an increased risk of a tear, and then take preventative measures which could have avoided or reduced the extent of the injury.
  • A failure to identify damage to the anal sphincter or rectum at the time of the delivery. This then causes delay or failure in repairing the injury which can impact on the extent of the recovery.
  • An inexperienced clinician may attempt the repair and perform this incorrectly.
  • The standard of the surgery was negligent, failing to repair the correct layers of tissue.
  • A failure by a GP to identify and refer at post-natal appointments.

Our solicitors and trusted experts are experienced at reviewing each case and providing an opinion as to whether our client’s injuries were likely to have been preventable.

Long-term impact

After being discharged home, it can often take time for a mum to realise that what is happening to them is not normal. This is especially the case when you are also dealing with the aftermath of an often difficult and traumatic birth and are caring for your new baby. Often, reassurance is given without an examination being undertaken and it can be difficult or feel embarrassing to talk about.

A delay in repairing a tear can result in any repair surgery being much less successful or failing completely. In some severe cases, it can eventually result in a stoma being required. There are other treatment options that can be explored, such as a nerve stimulator implant that can assist with some women regain their continence. These therapies can be costly but can be funded by the claim in successful cases.

How we can help you?

We have a dedicated team of solicitors with extensive experience supporting mums that have suffered injuries such as these. We know how hard it is to talk about some of the symptoms so we have partnered with Masic Foundation, a charity supporting mums overcome injuries and remove the stigma associated with some of the symptoms.

If you or your loved one has suffered an injury and would like to understand more about your options, one of our experts would be happy to have a free, confidential chat with you or if easier answer any of your questions over email. Give us a call on 0800 044 8488 or fill in our contact form.

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