Episiotomy and perineal tear

Episiotomy

We speak of episiotomy when a minor surgical procedure is done during birth to create a vaginal opening that allows the baby to pass. It is a surgical incision that may include skin, mucosa, perineal muscles and even nerve endings.

Tear

A tear is a laceration that occurs spontaneously in the perineum, when the tissue is traumatised because the baby’s head is too large for the vaginal opening and the muscles do not have enough elasticity to allow the baby through.

In both cases healing follows as with any wound, but it is important to give them attention to avoid later complications such as:

• Perineal oedema
• Bleeding
• Inflammation
• Haematoma
• Infection
• Fibrosis and adhesions, which may lead to urinary and faecal incontinence, muscle hypertonia causing dyspareunia and vaginismus, scar retraction, and pelvic pain.

As physiotherapists specialised in pelvic floor and abdomen, our aim is to help prevent episiotomy or tear, working with the patient even during pregnancy with techniques such as:

• Perineal massage: stretches that give tissues and muscle appropriate elasticity; it also improves body awareness. It can be done at home; both mother and father are shown how.
• Vibrator: vibrators and dilators are used to improve tissue elasticity.
• Myofascial trigger points: work on points in the musculature that are causing retraction.
• Exercise: it is also important to work pelvic muscle strength, as these muscles help with the baby’s expulsion.

Postpartum

It is important to work toward the best possible recovery of perineal tissues and muscles and their function, improving healing and easing pain, with techniques such as:

• Tecar therapy: improves blood flow and tissue oxygenation and thus regeneration.
• Manual techniques such as transverse, deep and traction massage, to work scar retraction and myofascial release.
• Myofascial trigger points and vibrator for tension points caused by scar retraction.

And continuing specific exercises to maintain muscle strength and adequate posture.

If this article describes you, contact us and book an assessment.