Reducing perineal tears
Your perineum is the area between your vaginal opening and back passage (anus). It is common for the perineum to tear to some extent during childbirth. Tears can also occur inside the vagina or other parts of the vulva, including the labia.
Up to nine in every ten first time mothers who have a vaginal birth will experience some sort of tear, graze or episiotomy. It is slightly less common for mothers who have had a vaginal birth before. For most women, these tears are minor and heal quickly.
For some women (3.5 out of 100) the tear may be deeper. Third or fourth degree tears, also known as obstetric anal sphincter injuries (OASI), extend into the muscle that controls the anus (anal sphincter). These deeper tears need repair in an operating theatre.
From 35 weeks onwards, you may choose to try perineal massage until your baby is born, which has been shown to reduce the risk of tears. This is particularly beneficial for first-time mothers. You may wish to ask your partner to help with this.
Top tips:
- Warm bath: Sit in a warm bath before you start. This may help you to relax before the massage and loosen the muscles around your perineum.
- Short nails: The tissues in your vagina and perineum are very delicate. Make sure your nails are short to prevent scratching the skin, or any discomfort to the area.
- Comfortable position: You need to be relaxed during the massage, so it's important you find a comfortable position. The best place to perform this massage is in bed. Prop yourself up with pillows to support your back and bend your knees.
- Lubricant: Use a lubricant like vitamin E oil, almond oil or olive oil.
- Thumbs: Hold your thumbs in the position shown in the resources linked below. Press down towards the anus and to the sides of the vagina walls. Hold your thumbs in this position for about 1 minute. You will begin to feel a stretching sensation. Breathe deeply.
- Gentle massage: Gently massage the lower half of your vagina using a U shaped movement for two to three minutes. Repeat this two to three times.
- Repeat daily or when possible: It may take a couple of weeks of daily massage before you notice more elasticity in your perineal area.
If you sustain a third or fourth degree tear you will be supported by the physiotherapy team. You may be visited on the ward by a member of the team and given some information and advice (if your stay falls over a weekend this will be posted out to you at your home) and your first physiotherapy outpatient appointment will be made for around four weeks after your baby is born. This appointment will be a one to one session with a specialist physiotherapist and clinics are held within the antenatal clinic at King’s Mill and main outpatients at Newark Hospital..
This appointment is very important and the care and support you will receive during your physiotherapy sessions following your third or fourth degree tear aims to reduce the symptoms of pelvic floor dysfunction (such as leaking wee or poo) that can be common after this type of birth injury.
We are a very friendly team of expert physiotherapists and all of the team are female. We have a large and private clinic room and you are welcome to bring your new baby along to your appointment.
We will ask you many questions that can be quite personal and sometimes embarrassing to talk about. We understand how challenging this can be but we are here to listen and support you. We will be able to give you lots of tips and advice to help you to manage any symptoms you are having.
During your first appointment (at four weeks postnatal) we may ask for your consent to examine your external vagina – this is to allow us to ensure your scar is healing well.
Your second appointment will fall around six to eight weeks after your baby is born. A key part of our physiotherapy assessment is to offer (which is optional) an internal vaginal examination at this time. This helps us to understand what is happening with your pelvic floor muscles and be able to guide you on how to do your pelvic floor exercises correctly. Many people who attempt pelvic floor exercises may be doing them incorrectly or not as effectively as they could be. This can be due to there being a problem but often it is because it is not something that has been tried before and needs some practise, which is also made harder by not being able to see them.
Be reassured. If you can’t or don’t want to have an internal vaginal examination, this does not mean your treatment will be limited. There are lots of alternative ways for us to help you.
For any queries about existing physiotherapy appointments or to make any changes to your appointment please telephone King’s Mill Hospital, clinic ten, on 01623 672384
If you sustained a third or fourth degree tear during the recent birth of your baby and you have NOT been offered a physiotherapy appointment within six weeks of the birth, please urgently contact Therapy Services on the number above and a member of the physiotherapy team will be in touch as soon as possible.
The following weblinks, leaflet and videos will give you lots of information and advice about perineal tears and practical advice to help reduce your risk of tearing/look after yourself after a tear.
