 This fact sheet is available as a print friendly PDF in: English
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Immediate management of your perineum
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Rest – It is important to get as much rest as you can during the first 3 days following birth. Lying down on your bed or couch is best. This will minimise swelling and discomfort. Try to rest for an hour each morning and afternoon during the first 6 weeks after the birth of your baby.
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Ice – It is extremely important that you continue to use ice for as long as you feel swelling or pain around the perineum. Place the ice pack inside your pad and apply for 20 minutes every 2-3 hours that you are awake. After the first week a combination of ice packs and salt baths may be used for pain relief.
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Compression – Firm supportive underwear that lift up under your perineum will help to support the area and minimise swelling.
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Exercise – Pelvic floor exercises help stimulate blood supply to the perineum which is important for healing. These exercises can be safely started 1-2 days after the birth of your baby provided there is no increase in your pain.
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Pelvic floor muscle exercises
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The pelvic floor muscles are a small but important group of muscles particularly in women. They lie deep inside the pelvis and act to support the pelvic organs and control emptying of the bladder and bowel. During birth these muscles have been stretched and torn. It is extremely important that you retrain these muscles to prevent problems such as incontinence developing.
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Gentle program – days 2 to 5
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Lie down on your back with your knees bent up and supported or lie on your side. Gently tighten the muscles around your vagina and back passage so you feel as though you are closing these openings, but stop if you feel any pain. Hold the muscle tight for up to 3 seconds then slowly release. Relax for 5 seconds and then repeat. Try to do 6 repetitions, stop if you feel muscle fatigue. Repeat this exercise at least 3 times each day.
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Getting stronger – days 5 to 14
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You will now feel more confident exercising your pelvic floor muscles and can begin to work harder with each exercise. As well as lying in the position above you can also exercise while sitting or on your hands and knees. Tighten the muscles around your vagina and back passage as much as you can, you should feel the pelvic floor lift. Hold for 3-6 seconds then let go. You should feel a definite release; relax for 5 seconds, do 8-10 repetitions. Repeat this exercise 3 times a day.
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Recovery program – weeks 3 to 6
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Progress your exercise program to tighten more strongly, hold for longer. Aim to hold for 5-10 seconds and repeat 10 times. Repeat this exercise 3 times a day in different positions, such as sitting and standing. Also incorporate pelvic floor tightening when coughing or lifting.
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Normal bowel function
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It is important to avoid constipation and straining when on the toilet as this can further weaken your pelvic floor muscles. Good bowel habits help you to protect your pelvic floor and minimises the risk of both bladder and bowel incontinence.
Prevent constipation by:
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- Eating plenty of high fibre foods (e.g. fruits, vegetables, whole grains, prunes and natural fibre supplements such as psyllium)
- Drinking 1.5-2 litres of water a day (water is preferable to tea and coffee)
- Being as active as you can and enjoying some daily exercise such as walking.
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How to help the bowel empty
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- Don’t ignore urges to use your bladder or bowel.
- Take your time on the toilet so you completely empty your bladder and bowel.
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To avoid straining the best toilet position is:
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- Use a foot stool so that your knees are above your hips.
- Sitting leaning forward, with your feet apart and your elbows on your knees.
- Allow your tummy to relax.
- Don’t hold your breath. Sigh out deeply or make a hissing sound.
- Support your stitches with your hand particularly when opening your bowels.
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Follow-up appointments
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These routine follow up appointments will be organised for you by the Perineal Clinic:
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- 6 week Physiotherapy appointment
- 3 month Physiotherapy and Medical appointments
- 6 month Physiotherapy and Medical appointments
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Please contact the Perineal Clinic if you do not receive your appointment times.
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For more information contact the following services at the Royal Women’s Hospital
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Physiotherapy Department
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Tel: (03) 8345 3160
Monday to Friday 8.30am–5.00pm
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Perineal Clinic
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Tel: (03) 8345 3144
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Disclaimer
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The Royal Women’s Hospital does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided in this fact sheet or incorporated into it by reference. We provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
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Published April 2011
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