10 Things You Need To Know AboutYour Perineum and Pelvic Floor
As always none of this information should be taken as advice. Always consult your healthcare provider with any questions or concerns about your health.
1. What is your perineum?
Our bodies and how they work are not sufficiently covered in ‘A level Biology’, let alone sex education at schools, by the time many people become pregnant they may have never really looked at their own vulva. The vulva is the name for the outside area of the genitals, it is often confused with the vagina. The vagina is the tube of muscle inside; it goes from the opening in between the tiny, almost invisible hole where pee comes out (urethra) and the bum hole (anus), all the way up to the cervix -the opening to your womb (aka medically as your uterus.) Your perineum is the area between your vaginal opening and your anus.
2. Your vulva is unique
If you possibly can, it can be great to take time alone to get acquainted with your unique vulva Why? Well, aside from it being scientifically fascinating, knowing your vulva and what’s normal for you can help break down taboos that we may hold deep within us, those taboos that can hold us back from knowing our bodies are amazingly capable of the most incredible bodily processes, like giving birth. Granted it takes a little effort to take a look at your own vulva; a mirror, good light or a torch will help. The effort is worth it: the more acquainted you become, the better your awareness & connection to your body. As a result of this, the better your ability to know if an issue arises that needs the support of a health or medical care provider.
3. You might want to consider massaging your perineum while you're pregnant.
Massaging your perineum can help you become aware of just how stretchy your skin and your vagina are. Using a warm base oil (such as almond or olive for example) will provide some lubrication and make this easier. If you want to know more about the evidence on the benefits of this check out this episode of the Evidence Based Birth Podcast
4. What is your pelvic floor?
Your pelvic floor is a group of muscles and ligaments that support the bladder, uterus (womb) and bowel. Whether you birth vaginally or abdominally, your vulva and pelvic floor can benefit from some thought and postpartum care. Becoming familiar with your vulva; what you can see outside your body, and your pelvic floor; what you can learn to feel, engage and relax, is fantastic birth preparation. It’s also fantastic for recovering and healing from childbirth.
5. Your pelvic floor, like your other muscles, gets stronger when you work out.
Many people have never been provided with instructions for pelvic floor and/or core exercises that work for them. There are many people living with symptoms of not being educated and supported with their pelvic health. We need to seek out different assistance or ask more questions when something is not making sense. The problem is all that people are often told is "make sure you do your pelvic floor exercises" - like we should magically know what they are. Some great resources to learn more about this are ‘Why Did No One Tell Me? How to Protect, Heal & Nurture your body through Motherhood’ by Emma Brockwell (@physiomumuk on Instagram) which is jammed packed full of useful info, exercises & resources. And ‘Stronger: The honest guide to healing and rebuilding after pregnancy and birth.’ by Megan Vickers (@meganvickersphysio on Instagram). It's also important to learn how to relax your pelvic floor as well as how to strengthen it.
6. If something is not quite right you can be referred to a pelvic floor physiotherapist on the NHS.
If you're feeling like everything isn't working properly even after you have good information on how to exercise your pelvic floor or if you're experiencing incontinence you don't have to accept that's "just a normal part of being someone who has given birth". You can be referred to an NHS pelvic floor physiotherapist.
7. There are things you can do during labour to reduce the chances you will tear your perineum during birth.
Some birthing positions are more protective of your perineum. Positions such as hands and knees or leaning over a birth ball may help prevent tearing as the perineum is less stretched. These positions may also allow other things that may help to be done more easily. For example, in a kneeling position, it's easy for you or your midwife or support person to reach your perineum with a warm compress (such as a flannel of warm water). It can be really helpful to make sure your baby's head isn't born too fast. If your baby's head comes through the vagina gradually the skin and muscles around the area have the chance to stretch gradually and gently. To help with this your midwife may offer to place a hand over your baby's head to help slow the process, or you may prefer to do this for yourself. Some studies have shown that having a waterbirth may reduce the likelihood of tearing or at least of more significant tears. Presumably, this is likely because the water is warm and provides support over the area.
8. After you give birth you will be offered a check of your perineum.
Like all checks/tests/interventions, the perineal check is optional. Unfortunately, offers of care & medical assessment, are often worded in such a way that they sound far from an offer, and more like a compulsory action. The truth is, YOU decide if you would like a midwife/doctor to check your vulva, vagina, perineum and rectum. The perineal check is offered after you have birthed your placenta.
The examination’s purpose is to assess whether there are any areas of the tissues/muscles that could benefit from attentive & cautious repair. There are many birthing people that feel fully able to assess for themselves without medics, and there are also those that can feel that something needs attention & repair. You can take your time to decide if and when you would like the assessment. If you do decide you would like the check and you need a bit of alone time with your baby/babies and your placenta(s) before any checks, you can ask for this and it should be respected by any health care professionals.
You can keep your baby on you skin to skin during the check if you so wish. You can ask for gas and air/entonox for any part of the examination, right from the start to finish. Remember you can stop and/or pause the examination at any point.
The exam begins with your midwife’s visual assessment: they will gently clean the area with warm water to be able to clearly see the vulva & perineum externally. The condition of the perineal skin externally can give an indication of any damage that might have occurred. You should be given information on what they can see.
You will be offered an internal examination of the vagina to check for any internal tears that are not visible externally and to assess the extent of a visible external tear internally. It's now also standard practice for you to be offered an internal exam of your rectum, though if there’s no vaginal, or labial damage or it’s very limited many people choose to decline this. It’s very unlikely there’s damage in this area if there’s no, or very minimal damage elsewhere.
9. Any tears will be "graded" to help decide if you should be offered stitches.
Any tears are graded by the midwives (1 being least severe, 3 and 4 being most severe) and they can explain the extent of any grazes or tears and what your options are for any repair you might be offered. They can provide you with answers as to whether any tears/grazes etc are superficial/cosmetic, or if they pose a chance of long-term physical difficulties. They can provide you with their medical opinion on whether stitches are necessary, and why. You can ask all the questions you need to, in order to be able to make an informed choice for yourself. There is some controversy as to whether stitching grade 2 tears is better than allowing them to heal without stitches. However, it’s clear that repairs to grade 3 and 4 tears are beneficial to long-term pelvic health. If you’re birthing at home and assessment indicates that you have severe tears (3 or 4) you will generally be offered repair in the hospital and will be calmly & quietly transferred by ambulance. If you have a grade 2 tear, at a home birth you are likely to be offered repair at home. Sometimes the most severe tears will be repaired in the operating theatre where you can have a spinal block anaesthetic.
10. You may not have your perineum routinely checked at any point in the postnatal period.
Your healthcare professionals may assume that you will heal well after having stitches. If you are at all concerned you can always ask for someone to check your stitches either your midwife if you're still seeing them or your GP if you've been discharged by your midwife.
And one extra free tip
If you're finding it stings to go for a wee you might find a squeezy bottle (you can buy specific ones but a regular sports top one will do) of water over your perineum while you're on the loo is very soothing.