Perineal Trauma During Birth

By E-Lynn Tan, Pelvic Health Physiotherapist

The perineum is the area between your vagina and anus. Perineal traumas can happen during the birthing process where the baby’s head is either too large for the vagina or the vaginal opening doesn’t stretch enough to let the baby’s head through. It can also be as a result of an an episiotomy performed by your doctor.

Perineal tears can be classified as the following:

1. First degree : Injury to the skin or vaginal epithelium only
2. Second degree : Injury to the perineum involving perineal muscles but not involving the anal sphincter
3. Third degree : Injury to perineum involving the anal sphincter complex
   • 3a: Less than 50%of external anal sphincter (EAS) thickness torn
   • 3b: More than 50%of EAS thickness torn
   • 3c: Both EAS and internal anal sphincter (IAS) torn

4. Fourth degree : Injury to perineum involving the anal sphincter complex (EAS and IAS) and anal epithelium

Third and fourth degree tears are collectively known as obstetric anal sphincter injury (OASI) and are surgically managed immediately after delivery of your baby.

What can a pelvic health physiotherapist do to help?

Antenatal period
Studies have shown that massaging the perineum during the late pregnancy usually from 35 weeks onwards allows the perineum tissues to expand more easily during birth. This can help to reduce trauma requiring stitches and the need for an episiotomy. Your pelvic health physiotherapist can help with performing a perineal massage in clinic in the lead up to your delivery date and also teach you how to do it yourself at home.

Postnatal period

The waves from therapeutic ultrasound treatment can assist in reducing swelling and pain around the perineal area post-delivery. The light massage coupled with the application of a therapeutic ultrasound head can help in minimising sensitivity around the perineal area.

Prevention of constipation or straining when opening your bowels is also important after a perineal trauma. Your physiotherapist will discuss strategies to prevent this from happening which may include advise on diet, laxatives and positioning and support on the toilet.

Tissue damage from perineal trauma may result in pelvic floor dysfunction leading to urine or feacal incontinence or even pain with sexual intercourse in the long term. Your physiotherapist will be able to assess your pelvic floor health and prescribe a specific program for your to suit your needs.