For further information please contact: Therapies and Dietetics Department Barnet Hospital Woodlands Unit Wellhouse Lane Barnet Herts EN5 3DJ Tel: 020 8216 4720 Chase Farm Hospital C2A Physiotherapy The Ridgeway Enfield Middlesex EN2 8JL Tel: 020 8375 3295 Physiotherapy advice following a perineal tear Produced by Therapies and Dietetics Department Version 1 produced June 2013 to be reviewed June 2015 Version 1 1 Introduction Perineal tears commonly occur during childbirth either spontaneously or as an extension to an episiotomy. Up to 90% of women tear to some extent during childbirth. Why is physiotherapy treatment important? It is important to have an assessment of your pelvic floor muscle strength and function after a perineal tear. A personalised pelvic floor exercise programme and advice will help to prevent bladder and bowel incontinence both now and in the future. What is the difference between an episiotomy and a tear? An episiotomy is an incision made through the vaginal wall and perineum by your midwife or doctor to enlarge the vaginal opening. A tear happens as the baby stretches the vagina during childbirth. What are the types of tears that occur during childbirth? Most tears occur in the perineum, which is the area between the vaginal opening and the back passage (anus). The extent of the tear can vary. First degree tears – small skin deep tears which usually heal naturally. Second degree tears – deeper tears affecting the muscles of the perineum. These are usually repaired with stitches. Third degree tears – similar to a second degree tear, but involves the anal sphincter, the muscle that controls the anus. Fourth degree tears – tears extending further up the anus into the rectum 2 What are the long term effects of a third or fourth degree tear? Most women make a good recovery. During recovery some women may have: • • • • • Pain or soreness in the perineum Fears and anxiety about returning to sexual intercourse A more urgent need to empty their bowels Difficulty controlling bowels or flatus (passing wind) Fear about future pregnancies and births Should you have any concerns about these or other worries, contact your GP, Obstetrician or Women’s Health Physiotherapist. Helpful tips for performing pelvic floor exercises • • • • • Perineal anatomy Aim for five sessions a day Try to do the exercise without tightening your buttocks, without holding you breath and without squeezing your legs together Pelvic floor muscle exercises can be practised anytime, anywhere and in any position – try to set reminders during the day, such as do them when you feed your baby, have a drink, brush your teeth, watch TV Avoid trying to interrupt your flow of urine when emptying your bladder, since this can increase your risk of developing a urine infection, and is not the correct way for your bladder to work Try to tighten the pelvic floor and lower abdominal muscles* together when you are bending, lifting or walking as they work together to provide support to the pelvis and lower back. *Lower abdominal muscle action Place your fingers just in from your hip bones. Gently draw in your lower stomach and feel the muscles tighten and draw inwards towards your spine. Perineal tears For many women pregnancy or childbirth can be the start of problems associated with weak pelvic floor muscles. Practising pelvic floor muscle exercises can be a simple and effective way to strengthen the muscles, which help to control both the bladder and bowel. It can take up to six months or longer to improve muscle strength. The more regularly you practice, the better the results. Pelvic floor muscle exercises should be a part of your daily routine from now onwards… 3 What can you do to help? • • • • • • • Pelvic anatomy Do regular pelvic floor exercises Maintain adequate pain relief Keep the perineal area clean Avoid constipation o Drink two to three litres per day o Eat a healthy balanced diet (fruit, vegetables, cereals, wholemeal bread) o Take laxatives only if they have been prescribed Avoid straining to empty your bladder and bowels Avoid heavy lifting, high impact exercise and prolonged standing for six to eight weeks Adopt the correct position for opening your bowels: The basic pelvic floor muscle action Perform the exercise either standing tall or sitting tall. Imagine you are trying to stop yourself passing wind and at the same time stop the flow of urine. The feeling is one of ‘squeeze and lift’. You should feel your vagina and back passage drawing up inside, and your lower abdominal muscles should also be working gently. • Continue the ‘squeeze and lift’ for as long as you can (up to 10 seconds), release and rest for a few seconds. Repeat as many times as you can with the same strength and length (up to 10 repetitions at a time). This will help to build up the endurance of your pelvic floor muscles. • It is also important to be able to activate these muscles quickly. Try to ‘squeeze and lift’ strongly and quickly and then release. Repeat several times in a row (up to 10 times). 4