Maternity Information Leaflet Care of the Perineum (including Pelvic Floor Exercises) Version 2
Pelvic Floor Exercises The pelvic floor muscles are located between your legs, and run from your pubic bone at the front to the base of your spine at the back. They are in the shape of a sling and hold your bladder and urethra (the tube that urine comes out of) in place. The pelvic floor muscles are designed to give you control over your bladder and are used to urinate. They relax at the same time as the bladder contracts (tightens) in order to let the urine out. Keeping pelvic floor muscles strong Women who have given birth may find they have weaker pelvic floor muscles. Weakened pelvic muscles can cause problems, such as urinary incontinence (being unable to control when you pass urine) and reduced sensitivity (feeling) during sex. Stress incontinence is a type of urinary incontinence where small amounts of urine leak out during an activity. However, doing pelvic floor exercises can help to improve stress incontinence by keeping your pelvic muscles strong. How to do pelvic floor exercises Sit comfortably and imagine trying to stop the flow of urine when you wee. This will help you locate your pelvic floor muscles. Once you have found them you can exercise them by tightening them. Start with 5 squeezes 5 times a day, increasing to 10 squeezes 5 times a day if you can. Try to do a mixture of slow and fast squeezes by: 1. Squeezing your back passage as if stopping a bowel movement 2. Squeezing your urethra as if stopping urine 3. Drawing in your vagina as if you were gripping a tampon. Try to get into a routine of doing your pelvic floor exercises at the same time every day so that they become part of your life; not just whilst pregnant! 2
Where is my perineum and what happens during childbirth? Your perineum is the area between your vaginal opening and your anus. This area stretches during childbirth and sometimes it can have a tear. 3
Perineal Massage Perineal massage in pregnancy (from 34 weeks) aims to gradually soften and stretch the vagina and perineum in preparation for birthspeak to your midwife. What will help me to reduce tears to my perineum during the birth of my baby? Tearing during the birth of your baby is normal. Long term problems associated with tearing are rare. When you reach the second stage of labour (fully dilated at 10 cm) and are feeling the urge to push your baby out, your midwife will offer advice on techniques that may help to reduce the risk of tearing. What is a perineal tear? There are different degrees of tearing; some will require stitching. Your midwife will advise you. How will my perineum be repaired if a tear occurs? Stitching of a tear will be performed under local anaesthetic and undertaken by a midwife at home following homebirth; or in the hospital. Large tears will need to be sutured by a doctor in a hospital theatre. Your tear should be healed by 6 weeks after birth, when you will be seeing your GP for the 6 week postnatal check. It is important to keep this area clean. Your Community Midwife will visit you at regular intervals for the first ten days, or longer if required after the birth of your baby, and will check that your perineum is healing well. 4
Episiotomy An episiotomy is a deliberate cut in the perineum (an area of skin and muscle between the vagina and anus) that is done during delivery of a baby. Why is it done? When a baby is born, its head stretches the opening of the vagina. It can be a very tight stretch, because the head is large in proportion to the baby's body. The walls and skin of the vagina will often stretch without tearing. But it can take several minutes for the vaginal tissue to stretch fully, and if there's a need to deliver the baby urgently, the midwife may decide to do an episiotomy to speed up the delivery. If you need a forceps delivery (delivering the baby using special tongs), the doctor will need to do an episiotomy to make room for both the forceps and the baby's head. How often is it done? In the past, up to 90% of women in labour in the UK had episiotomies. Doctors now believe they're not of great benefit and are unnecessary for most women, except when the baby is in distress or the mother is having a forceps delivery. In 2006-2007, 13% of women had an episiotomy in England. Having an episiotomy can increase the risk of a third-degree tear (a tear that extends into the anus). 5
Sex and contraception There are no rules about when to start having sex again. Don t rush into it. If sex hurts, it won t be pleasurable. The first time, you may want to use a lubricating jelly (available from pharmacies) because hormone changes can make your vagina feel drier than usual. It might be some time before you want to have sex. Until then, both of you may feel happier being loving and close in other ways. If you or your partner have any worries, talk about them with your GP or health visitor. You can get pregnant even if you haven't started your periods again or you're breastfeeding, so start using contraception as soon as you start having sex again. Your midwife or doctor will talk to you about contraception before you leave hospital, and again when you have your six-week postnatal check. Or you could talk to your midwife or health visitor when they visit you at home, or go to your GP or community contraceptive clinic. 6
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Further Information 1. NHS Choices Website www.nhs.uk 2. National Institute for Clinical Excellence www.nice.org.uk 3. Royal College of Obstetricians and Gynaecologists www.rcog.org.uk Contact details: St Richard s Hospital, Spitalfield Lane, Chichester, West Sussex, PO19 6SE Labour ward: 01243 831433 Antenatal Clinic: 01243 788122 ext. 2871 Worthing Hospital, Lyndhurst Road, Worthing West Sussex, BN11 2DH Labour Ward: 01903 285138 Antenatal Clinic: 01903 205111 ext. 84371 We are committed to making our publications as accessible as possible. If you need this document in an alternative format, for example, large print, Braille or a language other than English, please contact the Communications Office by: email: Communications@wsht.nhs.uk Or by calling 01903 205 111 ext 84038. www.westernsussexhospitals.nhs.uk Department: Maternity Issue date: January 2014 Review date: November 2016 Author: Joint Obstetric Guideline Group 8