The perineum is the area between the vaginal opening and the anus (back passage) and the place that is encouraged to be massaged prior to vaginal birth. The jury's out on whether or not perineal massage is helpful in reducing the risk of tears or episiotomy during birth and that actually birthing position may play a more pivotal role in preventing this from happening i.e. more upright or forward leaning birthing positions or left side lying.
A perineal tear is something that can happen during childbirth as the baby is navigating through the vaginal canal and passing the vaginal opening. There are different levels of perineal tear category depending on the depth of the trauma through the perineum.
The tissue involved in the trauma will indicate the degree of the tear and whether or not you need to have stitches/surgery to aid in the healing. This also depends on your midwife/medical professional too.
1st degree - involves the skin (usually no stitches required)
2nd degree - involves the skin and muscles of perineum (usually stitches required)
3rd/4th degree - extends in to the muscles of the anal sphincter (surgical intervention required)
Usually during labour if the healthcare professional aiding in your birth feels the need to make an episiotomy then this will also need stitches too. An episiotomy is a controlled tear essentially and is used to avoid damage of the perineum during labour if the birth needs to happen quickly or instruments such as forceps or vacuum assistance are required.
Tears can also happen inside the vagina or the labia as well and can be classed as grazes which usually heal by themselves.
Physiotherapy can help in your postnatal check by encouraging massage of the area (much like with perineal massage) to aid in full healing, reducing the risk of pain particularly when re introducing penetrative sex or exercise like cycling where this can be uncomfortable initially. Massage also helps in releasing tension around the scar which can free up the pelvic floor muscles and allow for better function during rehab.
If you have had a tear in the past and are having any discomfort, pain or issues in your pelvis or body that you can’t shake then don’t hesitate to book a session as it’s never too late to explore this area.
DON’T JUST LIVE WITH IT!
Book in for a Pelvic Health Consultation or a Mummy MOT with Sarah