Grade 4 Perineal Tear

Fourth-degree vaginal tears are the most severe. They extend through the anal sphincter and into the mucous membrane that lines the rectum (rectal mucosa). Fourth-degree tears usually require repair with anesthesia in an operating room — rather than the delivery room — and sometimes require more specialized repair. Healing also might take longer than a few weeks.
Complications such as fecal incontinence and painful intercourse are possible. If these problems occur, talk to your health care provider.