Postpartum perineal rehabilitation

Post-partum perineal reeducation (after childbirth)

What is the role and function of the female perineum?

Theperineum is a muscular structure made up of several layers of muscle and connective tissue (such as ligaments) located on the pelvic floor. It plays a crucial role in several essential bodily functions. Here are the main functions and roles of the perineum:

• Pelvic organ support: The perineum supports the organs located in the pelvis, such as the bladder, uterus and rectum. It forms a kind of hammock that holds these organs in place.

• Control of urinary and fecal continence: The perineal muscles are involved in the voluntary control of the urinary and anal sphincters, allowing urine and faeces to be retained until the person is ready to evacuate them.

• Sexual function: The perineum plays a role in sexual function, contributing to sexual satisfaction. It also contributes to lubrication and the sensation of pleasure during intercourse.

• Childbirth: For women, the perineum is extremely stressed during childbirth. It stretches to allow the baby to pass through the vaginal canal.

• Stabilization and posture: The perineum is an integral part of the system of muscles that stabilize the pelvis and trunk, playing a role in posture and body movement.

What is perineal rehabilitation for women?

Perineal rehabilitation, also known as pelvic floor retraining, is a series of exercises and therapeutic techniques designed to strengthen and improve the function of the perineal muscles. It is commonly recommended for a variety of medical reasons and can benefit different populations, including women after childbirth, people with continence disorders or pelvic pain. Here's an overview of the key aspects of perineal rehabilitation:

Objectives of Perineal Rehabilitation :

Mucular :

Improve pelvic floor muscle strength, endurance and coordination to better support the pelvic organs and prevent prolapse.

Prevention and treatment of incontinence :

Treat urinary incontinence (stress, mixed...) and fecal incontinence by increasing muscle control.

Improved sexual function:

Increase tone and sensitivity of the perineal muscles, leading to improved sexual satisfaction and helping to treat dysfunctions such as dyspareunia (pain during intercourse).

Post-Partum Rehabilitation:

Help women regain perineal functionality and strength after childbirth, minimizing the risk of prolapse and post-partum incontinence.

Pelvic pain management :

Reduce chronic pelvic pain by releasing pelvic floor tension, improving perineal muscle flexibility and body awareness.

In short, perineal rehabilitation is a treatment aimed at improving the health and function of the perineum, offering significant benefits for patients' quality of life.

Why undergo perineal rehabilitation after vaginal delivery?

Perineal reeducation after vaginal delivery is strongly recommended for several important reasons linked to the mother's health and well-being. Here are the main reasons:

• Strengthening the perineum: The perineum, the group of muscles and tissues between the pubis and coccyx, is put under great strain during vaginal delivery. Rehabilitation helps to strengthen these muscles, which can be weakened or damaged by childbirth.
• Preventing urinary and anal incontinence: A weakened perineum can lead to urinary or anal incontinence. Re-education helps tone perineal muscles for better bladder and bowel control.
• Reduced pain and discomfort: After childbirth, some women may experience pain or discomfort in the perineal area (which may be due to the presence of a tear or episiotomy). Rehabilitation can help relieve these symptoms by improving blood circulation and tissue flexibility.
• Preventing prolapse: A prolapse occurs when pelvic organs (such as the bladder, uterus or rectum) move downward from their normal position due to a weakened perineum.
• Improved sex life: A toned perineum can improve sexual sensations and pleasure for some women. Re-education helps restore good muscle tone, which can contribute to greater sexual satisfaction.
• Comprehensive postpartum recovery: Perineal rehabilitation is an integral part of post-partum recovery, helping women regain their strength and confidence after childbirth.
• Preparation for future pregnancies: A stronger perineum is beneficial for future pregnancies and childbirth. It can reduce the risk of complications during a subsequent delivery.

Post-partum perineal rehabilitation can include exercises to contract and relax the perineal muscles, breathing techniques, and sometimes the use of specific devices to help strengthen these muscles.

Why undergo perineal rehabilitation after a Caesarean section?

Even after a caesarean section, perineal rehabilitation is often recommended for several important reasons:

Impact of pregnancy on the perineum : Pregnancy itself, regardless of the mode of delivery, puts considerable pressure on the perineum. The weight of the baby, amniotic fluid and hormonal changes can weaken the pelvic floor muscles.

Preventing bladder and bowel incontinence: Pregnancy can cause a weakening of the pelvic muscles, which can lead to problems of urinary and/or anal incontinence. Perineal rehabilitation helps strengthen these muscles, reducing the risk of incontinence.

Prevention of lower back and pelvic pain: Weak pelvic muscles can contribute to pain in the lower back and pelvic region. Rehabilitation helps stabilize and support these areas, thereby reducing pain.

Improved sexual function: Pregnancy can affect pelvic floor muscle tone, influencing sexual function. Rehabilitation can help restore the strength and sensitivity of these muscles, thereby improving sex life.

Prevention of prolapse: The risk of pelvic organ prolapse is present even after a Caesarean section, due to the effects of pregnancy on the muscles and ligaments of the pelvic floor.

Preparation for future pregnancies: Strengthening the pelvic floor after a Caesarean section is beneficial for future pregnancies and births. It reduces the risk of pelvic complications in subsequent pregnancies.

In short, even if a woman doesn't give birth vaginally, pregnancy itself can affect the perineum, making perineal rehabilitation beneficial for recovery and overall postpartum health.

In conclusion, perineal rehabilitation is an integral part of post-partum recovery, helping women to regain their strength and self-confidence after childbirth, whatever the method.

Please visit our gynecological physiotherapy page for more information.

Article written by Perrine RAYBAUD,physiotherapist specializing in pelvic-perineal rehabilitation