What is the perineum?
The perineum is the area of tissue between the vagina and anus. It connects to the pelvic floor muscles. Stretching or tearing of the perineum In childbirth can reduce support to the vaginal walls and a weak pelvic floor can increase the risk of incontinence and prolapse. Trauma to the perineum can also lead to discomfort during sex.
What is perineal massage?
Perineal massage is thought to prepare the perennial tissues for childbirth. Research shows that women who perform perineal massage prior to labour significantly reduce the risk of having an episiotomy (cut) and the risk of perineal pain following the birth. The risk of 3rd or 4th degree tear is greatest with your first vagina birth: about 6%. This reduces to 1.7 % if you have had a vaginal birth before and did not have a 3 rd or 4 th degree tear. If you have had a 3rd or 4th degree tear previously, the risk of having another one is about 6%. Your consultant will discuss the best type of delivery in your individual case; if you have any symptoms of poor bowel control (leakage from the bowel) this advice might include delivery by caesarean section. Do not be embarrassed to disclose problems with bowel leakage.
Technique of perineal massage
The massage should be performed from 34 until at least 37 weeks of your pregnancy and you can continue beyond this if you wish, each time for approximately 5 minutes, three times a week. Your partner can carry this out for you if you find it awkward or difficult to reach.
- Comfortable Positions
- Supported with pillows on the bed or sofa
- Reclining in the bath
- Sitting on the toilet
- Standing with one leg on a stool
1) Using bio-oil or similar nut-free and nonperfumed lubricant start by firmly massaging the perineum (the area between the vagina and the anus) using a circular motion with your fingers.
Continue for two minutes.
2) Using your thumb or fingers in the entrance of the vagina, stretch the perineum in a sweeping motion, pressing down and outwards from one side to the other, from 3:00 o'clock to 9:00 o'clock. Continue for about 2 minutes.
3) With the thumb inside the vagina and your forefinger on the perineum (or vice versa), firmly knead the skin between; again continue for about 2 minutes.
Relax the muscles beneath your fingers as much as possible during the massage. Perineal massage should be firm but not painful. Stop if you feel more than just firm pressure. Do not perform the massage if you have:
- active genital herpes
- Thrush or other vaginal infection
Further Advice
Try to make sure that you avoid constipation by drinking enough water and by getting enough soft soluble fibre in your diet from foods such as pears and other fruits, linseeds, oats and a variety of vegetables. If your stools remain hard and difficult to pass, ask your GP to prescribe a suitable laxative for you.
Useful Websites
Pelvic, Obstetric and Gynaecological Physiotherapy: https://thepogp.co.uk
References
Beckman MM and Stock OM Antenatal perineal massage for reducing perineal trauma.
Cochrane Database of Systemic Reviews 2013 Issue 4
Edwards H, Grotegut C, Harmanli OH, Rapkin D, Dandolu: Is severe perineal damage increased in women with prior anal sphincter injury?
J Matern: Fetal Neonatal Med. 2006 Nov; 19(11):723-7
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