For further information please contact:

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
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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
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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:
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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
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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…
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What can you do to help?
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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).
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