What is a Perineal Tear and Episiotomy?

Despite the fact that childbirth has occurred since the inception of mankind, we know that it may not be as straightforward in some situations. Perineal tears and episiotomy are common with vaginal birth and can contribute to pain, bladder and bowel control problems, and sexual difficulties.

You might find yourself having difficulty with simple things like sitting, and unable to enjoy social activities or intimacy.

The pelvic floor muscles attach from the pubic bone in the front to the tail bone at the back, much like a sling. These muscles play an important role in sexual, bladder and bowel function. A well functioning pelvic floor can contract and relax. Following pregnancy and a perineal tear or episiotomy your pelvic floor may be weak or too tight. And if you are constipated, this can just make things a little more uncomfortable.

Image: mypfm.com

 

WHAT ARE THE DIFFERENT PERINEAL TEARS?

  • Grade 1- Laceration of the vaginal mucosa or perineal skin only
  • Grade 2- Laceration involving the perineal muscles (this is equivalent to an episiotomy)
  • Grade 3- Laceration involving the anal sphincter muscles, being further subdivided into
  • 3A- where <50% of the external anal sphincter is torn 3B- where >50% of the external anal sphincter is torn
  • 3C- where the external and internal anal sphincters are torn
  • Grade 4- Laceration extending through the anal epithelium (resulting with a communication of the vaginal epithelium and anal epithelium)

HOW CAN A WOMEN’S HEALTH PHYSIOTHERAPIST HELP ME HEAL?

Evidence shows that you can successfully treat these problems through a personalised pelvic health program designed and managed by a Women’s Health Physiotherapist.

I often say to patients that if your wound hasn’t healed within the first 6-8 weeks, to discuss it with your Gynaecologist/Obstetrician and ask for a referral to a Women’s Health Physiotherapist.

Your Physiotherapist will:

  • Perform a thorough assessment which in most instances will involve a pelvic floor examination.
  • Provide advice on management which may include hands-on therapy on the tear or wound, ultrasound, massage, and stretching techniques.
  • Help 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.

It may take 4-6 sessions to see an improvement. Motivation and adherence are important factors in achieving your goals.

Many women experience a perineal tear or episiotomy during labour. However, pain and bladder and bowel problems after delivery are not normal. Remember, help is available.

If you are recovering from a perineal tear or episiotomy and require care, please call/WhatsApp on 9780 7274 or get in touch over email to book an appointment or discuss your concerns.

You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.

 

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