Pelvic floor muscle injury in labour

Recovering after 3^rd and 4^th Degree Tears

Unfortunately, during birth, women can experience perineal tearing. The perineum is the area between the vaginal opening and the back passage. A woman can suffer from varying degrees of tearing, with some short term, but also long term effects on pelvic floor function. This can include bowel and bladder issues or ongoing pain. The worse of these tears are called 3rd & 4th degree perineal tears are also known as Obstetric Anal Sphincter Injuries (OASIS), because the perineal tear extends into the anus.

The varying tears are grouped according to the extent or length of the tear:

• First degree tears — small skin deep tears which heal naturally
• Second degree tears — deeper tears affecting the muscles of the perineum. These are usually repaired with stitches.
• Third degree tears — deeper tears that involve the anal sphincter muscles.
• Fourth degree tears — tears extending further up the anus into the rectum

Some long terms effects of perineal tears and OASIS can include:

• bowel urgency
• difficulty controlling wind
• difficulty controlling bowel matter
• painful sex

What can I do if I have suffered from a perineal tear?

After 6 weeks, and once the perineal area has healed you can begin to do some exercises to strengthen the area and reduce or prevent anal incontinence. You will usually have a pelvic floor or women's health physio helping and guiding you along the way, and they will teach you the following exercise types. Mind the anus chat to come!

Pelvic Floor Exercises with an Anal Cue

These anal sphincter muscles need to be retrained as part of your pelvic floor, because the perineal injury can cause them to become lazy or switch off. It is easy to focus on this part of the pelvic floor sling. Lying on your back with a neutral pelvis

• Breathe in to relax your pelvic floor down.
• Breathe out as you squeeze and lift your pelvic floor muscles focussing on the anus being pulled up towards your lower back.
• Breathe in to relax the pelvic floor muscles back down.
• Repeat 10 times.
• Repeat another set in active neutral sitting.
• Repeat another set in active neutral standing.

Pelvic Floor Elevator with an Anal Cue

You need to be able to control these muscles at different points so that you are able to control your wind and bowel movements and prevent accidental leaks or accidents. Visualise your anal canal (from your anus to your rectum to the centre of the dimples in your lower back) as 3-storey building with an elevator in it.

• Tighten your anus and pull it up a third of the way — bring the elevator from Ground Floor to Level 1.
• Tighten your anus further and pull it up two thirds of the way — bring the elevator to Level 2.
• Tighten your anus as much as you can and pull it up all the way — bring the elevator to the Roof.
• Slowly release the elevator down to Level 2, then Level 1 and back down to Ground Floor.
• Repeat 3 times.

Anus Quick Flicks

You need your anal sphincter muscles to get stronger in their fast-twitch fibres and especially down at the exit, to help you overcome or manage bowel urgency. Visualise the anus at the exit of your bottom as a circular muscle. Imagine trying to pull up a pea through the anus just 3 mm and back out again.

• Do 10 quick flicks as fast as you can in a pulsing manner as you tighten the circular anus closed and release again.

I need more help...

If you have suffered from a perineal tear after birth, it is important to see a trained women's health physiotherapist as she can help prescribe even more specific exercises, as well as help you to heal from the injury faster.

Women's health physiotherapists at The Fix Program physios will help you recover from any birth issues, and perineal tears often require gentle scar tissue massage to release the tissues and muscles that can tighten up after tears. If you are experiencing any bowel issues, your women's health physiotherapist will help you overcome these issues.

Research shows physiotherapy for just 2 months can significantly improve anal sphincter control and strength to minimize or prevent any wind or fecal incontinence. Your physiotherapist will also discuss important bowel habits advice with you and prescribe you individualized exercises.