Perineal Tear & Episiotomy
Your perineum is the area between your vagina and anus. Perineal injuries or trauma, tear or episiotomy are common with vaginal birth.
Perineal tears - occur spontaneously as the baby stretches the vagina and perineum during childbirth and can range from first degree, affecting skin only, to fourth degree, extending into the anus.
An episiotomy - is a surgical cut made during childbirth to widen the vaginal opening and make childbirth easier.
Around 80% of Australian women experience some type of perineal trauma, tear or episiotomy during their first vaginal birth. Episiotomies are perfomed on about 24% of women during vaginal birth.
Perineal tears and episiotomy can contribute to pain, bladder and bowel problems and sexual difficulties. Left untreated, it can impact many aspects of your life - like caring for your baby, exercise, social activities and intimacy.
Help is available.
Fortunately, there’s good news. Perineal trauma can be treated, so there’s no need to suffer in silence. Most people experiencing this condition can be helped. And at Pelvic Health Matters, we’re here to help you.
Around 80% of Australian women experience some type of perineal trauma, tear or episiotomy during their first vaginal birth. Physiotherapy can help with recovery from perineal trauma
Common signs & symptoms of perineal tear & episiotomy
Everyone is different, but if you suffer from perineal trauma, you’re probably familiar with some of the following:
- Pain in the vulva or vagina, often with sitting
- Bladder leakage with sneeze or cough
- Rushing to the toilet and leaking before you get there
- Difficulty holding onto wind or rushing to the toilet for a bowel action
- Fear of having a bowel motion
- Feeling of vaginal dragging, heaviness or bulge
- Feeling worried about resuming sex
- Pain with sex
- Avoiding exercise, socialising or doing things you enjoy due to perineal discomfort or poor bladder and bowel control
Types of perineal tear & episiotomy
First-degree tear
Small tear affecting only the skin, usually heals quickly without treatment.
Second-degree tear
Tear affecting the skin and muscle of the perineum, usually requires stitches.
Third and fourth-degree tears
Deeper tears that extend into the anal sphincter, and usually require repair in an operating theatre.
Risk factors & causes of perineal tear & episiotomy
- Vaginal birth, especially with forceps or vacuum
- Birthweight over 4 kilos
- First vaginal birth
- Baby position during the second stage
- Epidural analgesia
Our Proven Pathway for Treating Perineal Tear & Episiotomy
Discover what matters
You’re assessed as a whole person
We start by taking the time to learn all about you as a whole person, not just a patient. So, your postgraduate qualified pelvic health physiotherapist will gather the following information:
- QUESTIONNAIRE: You’ll complete a pelvic health questionnaire online before your first visit. This helps us understand your history, current health concerns and what matters to you.
- 1-on-1 CONSULTATION: Here, we’ll take the time to learn about you and your perineal trauma and symptoms. We believe a holistic approach enables us to understand how your specific physical, emotional and lifestyle factors influence your pelvic health.
- THOROUGH ASSESSMENT: This includes a perineal and pelvic floor examination, bladder diary and bowel diary, and questionnaires to understand thoughts, feelings and environment.
- CONNECTING THE DOTS: Now that we’ve discovered so much about you and your perineal trauma, we can explore how it all fits together. This may include understanding that fear of reinjury can impact sexual confidence and pain – and that it is not uncommon for women to experience emotional distress after perineal trauma.
- SET GOALS: We’ll help you set meaningful pelvic health goals such as:
- Sit comfortably so I can breastfeed my baby with ease
- Feel confident I can get to the toilet on time
- Enjoy pain-free sex
Restore what matters
You’ll have a personalised pelvic health plan.
This is where we get to work. Together, we’ll choose the best research-proven treatment options for your lifestyle. You’ll learn how your birth injury has impacted your perineum and pelvic floor, what may not be working and what you can do to improve your symptoms.
Next, we’ll start Pelvic Floor Muscle Training. You’ll learn new skills and connect with hidden muscles that you might not know you had. We'll give you an individualised program based on your needs. And we’ll help improve the strength and endurance of your pelvic floor muscles.
We'll also arm you with strategies to address pain, prolapse and any bladder, bowel or sexual symptoms, including bladder retraining, bowel emptying and strategies for intimacy. And finally, we’ll give you excellent resources and tools to help you with your progress. You’ll be armed with all the things!
ABOUT YOUR APPOINTMENTS: Together, we’ll work out how often we should see each other. We’ll agree on what works best for you, your commitments and your finances.
Enjoy what matters
You’ll be living your best life.
The last step is about ensuring you achieve all the meaningful goals you set at the beginning of your journey. You might also find you can take on new possibilities that you hadn’t considered, such as being the active mum you always dreamt of being (and finally feeling like yourself again). You’ll be equipped with the skills to manage all of your symptoms – without always having to come back to see us.
Sometimes, though, life’s ups and downs might mean you need to return for a reset. You may have decided to try a different activity. Or perhaps you’ve fallen pregnant again and are worried about the birth experience. Whatever the case, we’ll always be here to help you.
Read about Fiona 38 yrs, Sophie 34 yrs, Courtney 38 yrs
More info on early parenthood
Other Related Conditions
Pelvic Health Matters
New name.
Same exceptional care.
Formerly known as Women’s & Men’s Health Physiotherapy, our new name reflects both what we believe in and what we do. We have an unwavering belief that pelvic health matters for everyone, at every stage of life.
Same phone number: 03 8823 8300
New email: physio@pelvichealth.com.au