Perineum care after childbirth

Your perineum (the area between the vagina and back passage) may be particularly painful or uncomfortable following vaginal delivery, even if you did not need stitches. There might also be bruising and swelling. Start gentle pelvic floor muscle exercises early but wait until the catheter is removed (see pelvic floor muscle exercises below).

Reducing pain

• If you are uncomfortable while sitting, try to change your position regularly.
• When sitting down lower yourself gently using your arms for support.
• You may wish to use a pressure relieving cushion, or you may use two rolled up towels under each buttock to limit pressure on the perineum.
• If you are uncomfortable lying on your side, try to use a pillow between your knees to take away any pressure between your legs.
• Ice packs can relieve pain and help reduce swelling. Run a maternity pad under the tap and place this in the freezer in a slight curve. Alternatively you can use crushed ice, frozen peas or gel frozen pads. The pad or bag must be wrapped in a clean damp cloth or flannel to prevent a skin to ice contact. Place this against the perineum for five minutes. This can be repeated three to four times a day, until the pain and swelling has reduced.

Healthy bladder tips

• After having a baby it is important to return to normal bladder habits. Try to empty your bladder every couple of hours until your bladder function has normalised. You should seek advice if your bladder feels uncomfortable and you have not emptied your bladder for six hours.
• When emptying your bladder, make sure you have emptied it completely. You can do this by altering your position. A good position is with your feet flat on the floor, and sitting well supported on the seat. Try not to hover over the toilet as this can stop the bladder emptying fully.
• If you are struggling to pass urine, try pouring a jug of warm water over the area whilst sat on the toilet. This will also help keep the perineum clean.

Hygiene

It is important to care for your perineum to aid healing and prevent infection. Avoid using soap or wipes as these may cause irritation. After cleaning you may wish to pat dry the area using a tissue. Remember to change your sanitary pads regularly and wash your hands before and after.

Bowels

When you feel you want to open your bowels, try not to ignore the feeling. This is the best time to go.

• Sit on the toilet with your feet on a small step or on tip toes, lean forward with arms resting on your knees. Relax your body and pelvic floor muscles.
• Do not pull in your abdominal muscles; relax and let them bulge forward and to the side as you breathe out.
• Pass air through your mouth as you increase effort.
• Opening your bowels may seem worrying at first. Many women feel more comfortable if you support your perineum with a clean sanitary pad/hand wrapped in tissues.
• Keep your bowel movements soft and avoid constipation. Many women find eating well and drinking lots of water helps.

Pelvic floor muscle exercises

Pelvic floor muscles are important for bladder and bowel control and support of the pelvic organs.

• To do pelvic floor muscle exercises, imagine that you are trying to stop yourself passing urine or passing wind. Try to ‘squeeze and lift’ the pelvic floor muscles.
• Start gently and rhythmically, you may not feel that much is happening at first but keep trying. Hold the squeeze for a few seconds and relax fully, try not to hold your breath. A good way of remembering to do pelvic floor muscle exercises is to do them every time you feed your baby.
• Gradually increase the holding time and the number that you do until you can hold a squeeze for 10 seconds and repeat 10 times (long squeezes), try to do these three or four times a day.
• In addition to these it is important to do 10 short squeezes, pulling the muscles up strongly and letting go completely.

Aim to do 10 long squeezes, holding each one for 10 seconds, followed by 10 short squeezes. Relaxing between each contraction is as important as the tightening.

• The knack is a technique where you tighten your pelvic floor before an activity that increases intra-abdominal pressure (increased pressure in the tummy which can cause a strain onto the pelvic floor muscle) such as cough, sneeze or lifting.

We have further advice available on our pelvic health page.

• Pelvic floor muscle exercise video to help support correct technique.
• The pelvic floor muscles – a guide for Women.

If you are experiencing any:

• Leaking of urine with activity, sneezing or coughing (stress urinary incontinence).
• Urgency where you suddenly need to go to the toilet and may result in leaking before getting to the toilet.
• Unable to control wind.
• Urgency with bowels, unable to delay.
• Faecal incontinence.
• Sensation of pelvic heaviness, pain or feeling something coming down vaginally (prolapse).
• If you are unsure if are completing your pelvic floor muscle exercises correctly.

Please complete a self-referral form available on the website provided above or contact us via our helpline if you have any questions or concerns.

For further physiotherapy advice

If you have any problems you can leave a message for the Rosie physiotherapists on 01223 217422.