Tears of (a Bundle of) Joy: Perineal Tear and Episiotomy

You might find yourself having difficulty doing simple things like sitting, and unable to enjoy social activities or intimacy after giving birth. The pelvic floor muscles, which act like a sling from the pubic bone to the tailbone, play a vital role in sexual, bladder, and bowel functions. After childbirth, especially with perineal tears or episiotomies, the pelvic floor may become weak or too tight, contributing to discomfort, especially if constipation is a concern.

While it is a natural process, childbirth can present challenges. Among these, perineal tears or episiotomies during vaginal birth are common.


Image: mypfm.com


  • Grade 1: Laceration of the vaginal mucosa or perineal skin only.
  • Grade 2: Laceration involving the perineal muscles (equivalent to an episiotomy).
  • Grade 3: Laceration involving the anal sphincter muscles, further subdivided into:
  • 3A: <50% of the external anal sphincter torn.
  • 3B: >50% of the external anal sphincter torn.
  • 3C: Both external and internal anal sphincters torn.
  • Grade 4: Laceration extending through the anal epithelium, resulting in communication between the vaginal and anal epithelium.


Evidence indicates that issues resulting from perineal tears or episiotomy can be effectively addressed with a personalised pelvic health program supervised by a women’s health physiotherapist. If the wound hasn’t healed within the initial six to eight weeks, it is advisable to consult with a gynaecologist/obstetrician and request a referral to a women’s health physiotherapist.

Your physiotherapist will:

  • Perform a thorough assessment, often including a pelvic floor examination.
  • Provide management advice which may include hands-on therapy on the tear or wound, ultrasound, massage, and stretching techniques.
  • Teach you how to wee (voiding dynamics) and poo (defecation dynamics) better.
  • Prescribe a pelvic floor muscle training program to strengthen the sphincter and pelvic floor muscles.

Improvement in symptoms may be noticeable after four to six sessions, with motivation and dedication playing a crucial role in achieving your goals. Experiencing a perineal tear or episiotomy during labour is common for many women, but ongoing pain and issues with bladder and bowel function after delivery are not considered normal.

Seeking help from a women’s health physiotherapist can make a significant difference in addressing and managing these challenges. If you are recovering from a perineal tear or episiotomy and require care, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg to make an appointment.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.


  1. https://www.embracephysio.sg/how-to-heal-pelvic-pain-and-dyspareunia-in-women/
  2. https://www.embracephysio.sg/what-is-the-pelvic-floor/
  3. https://www.embracephysio.sg/what-is-a-pelvic-floor-exam/
  4. https://www.mypfm.com/post/perineal-tears
  5. https://www.physio-pedia.com/Perineal_Laceration#:~:text=Perineal%20tears%20can%20be%20classified,the%20fourchette%2C%20the%20perineum%2C%20the
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