Image 3 shows a side view of your pelvic floor muscles. Image 3: Side view and anatomy of the pelvic floor. You may feel that initially you have very little sensation in your pelvic floor, but this should improve the more you do your exercises. If the sensation does not improve, you may need further treatment such as physiotherapy, particularly if you experience any bladder or bowel incontinence. Physiotherapy will include teaching you how to correctly squeeze and strengthen your anal sphincter muscles to help reduce incontinence.
Anal incontinence is when you have problems controlling your bowels. Symptoms include sudden, uncontrollable urges to open your bowels and not being able to control passing wind.
You may also soil yourself or leak faeces. Most third- or fourth-degree tears heal completely, but some women may experience these symptoms. It is important to talk about any concerns you have. Women with anal incontinence will be referred to a specialist team for treatment, which may include physiotherapy or surgery. If you have had a third- or fourth-degree tear, you should avoid strenuous activity or heavy lifting for weeks.
After weeks, you can gradually increase your general activity. Looking after a newborn baby and recovering from an operation for a perineal tear can be hard. Support from family and friends can really help you while your body gradually adjusts and gets better. If you continue to experience symptoms after 6 months, see your healthcare professional. Experiencing complications when giving birth can be very distressing and disturbing, and for some women there is a risk of post-traumatic stress disorder PTSD.
Following a perineal tear, if you are developing anxiety, have low mood or feel that you need additional support, you should talk to your healthcare professional.
Many women are worried by the thought of having sexual intercourse again after they have given birth, particularly when they have experienced a third- or fourth-degree tear. Once your stitches have healed and bleeding has stopped, you can have sex again when it feels right for you and your partner. It is important that you choose and use a suitable method of contraception as it is possible to get pregnant very soon after giving birth, even before you have a period.
You can discuss your contraception options with your healthcare professional. Perineal massage, either on your own or with your partner, may help you feel more comfortable before you begin having sex again. You may notice your vagina feels drier than usual, particularly if you are breastfeeding. A water-soluble lubricant may be helpful. Sex may be uncomfortable and feel different at first but the discomfort should not persist. You and your partner may be anxious and talking about these feelings may help, as it is important that you both feel ready and relaxed.
If you continue to experience pain or discomfort, you should raise these concerns with your healthcare professional. You may be offered a follow-up appointment at the hospital weeks after you have had your baby to check that your wound is healing properly. You will be asked questions about whether you have any problems controlling your bowels. You may be referred to a specialist if you do.
You will also have the opportunity to discuss the birth and any concerns that you may have. After having any tear or an episiotomy, it is normal to feel pain or soreness around the tear for two to three weeks after giving birth, particularly when walking or sitting.
Passing urine can also cause stinging. Continue to take your painkillers when you go home. Most of the stitches are dissolvable and the tear should heal within a few weeks, although this can take longer.
The stitches can irritate as healing takes place and uou may notice some stitch material fall out, both are normal. To start with, some women feel that they pass wind more easily or need to rush to the toilet to open their bowels. Most women make a good recovery, particularly if the tear is recognised and repaired at the time.
Six to eight in ten women will have no symptoms a year after birth. It is best to resume sex after the stiches have healed and the bleeding has stopped but there is no right or wrong time.
For some people, it is within a few weeks but for others it can be when they feel ready. Then if you take a break and go back, it takes less time to build your muscles again.
The same thing happens with your pelvic floor. However, an episiotomy will not prevent tearing to, and through, the anal sphincter.
In an ideal situation, your doctor will accurately identify the severity of your tear and request a surgical repair by an obstetrician who has experience with third- and fourth-degree tears. In rare cases, a fourth-degree tear is misdiagnosed, which happened to mother Nicki during the delivery of her third child.
It was my first bowel movement and it came through the vagina, so I knew there was a major problem. The surgeon recommended a sphincteroplasty and fistula repair to fix her damaged anal sphincter muscles. Pain, including pain during intercourse, and urinary incontinence are common side effects of any vaginal delivery, especially in the first four to six weeks. Women who experience third- and fourth-degree tears also have trouble holding in gas. You could require the repair of a rectovaginal fistula or additional surgery if your muscles are severely damaged.
Richards also notes that she sees vaginal and rectal prolapses because support to the bowels is decreased when a tear goes to the anus. A posterior vaginal prolapse is where the front wall of the rectum bulges into the back wall of the vagina. The six-month period after childbirth is key to a good recovery. Your doctor will likely recommend pain medicines, including ibuprofen Advil , naproxen Aleve and acetaminophen Tylenol , or a morphine derivative if required, but never codeine.
Your doctor will prescribe stool softeners and plenty of fluids, which can help prevent the pain of passing hard stools. Breastfeeding women are already at risk for constipation because they have to take in a couple of extra ounces of fluid for every ounce of breast milk they produce, says Giesbrecht. Even if you hate getting up to go the bathroom constantly or find it painful, do not restrict your fluids.
One of the most important ways to improve recovery is to work with a pelvic health physiotherapist, says Giesbrecht. The program involves deep-core activation and breathing exercises that mobilize the scar from day one. Then, at six weeks, she continues to teach her patients how to mobilize again, connect with their pelvic floor and strengthen their muscles, she says. She also works on massaging out scar tissue, so they get full mobility and their muscles can contract and act like they should.
The ice can help with inflammation while heat can help soothe your discomfort. Do not apply ice or heat directly — wrap it with a towel or cloth first.
Take time to get off your feet as much as possible, especially soon after delivery. You may want to create some time in the morning and in the afternoon to take it easy. The same goes with sitting and laying down.
Try sleeping on your side or sitting atop a donut-shaped pillow. Constipation and hard stool can be very uncomfortable during the healing period. If your bowels are slow moving, chat with your doctor about stool softeners.
Once your doctor gives you the all-clear, ask about doing pelvic floor exercises. Working your muscles will promote blood flow to the area and help with your overall healing. A basic Kegel can be performed by squeezing the muscles in your vagina and anus as if you are trying to stop the flow of urine.
Start by doing just a few and holding for 10 seconds and work your way up to doing 3 sets of 10 per day, according to the UK advocacy group National Childbirth Trust. These signs might include:. Your doctor may refer you to a physical therapist who specializes in rehabilitating the pelvic floor muscles. So, prevention is difficult. That said, the number of people who have fourth-degree tears with a second, third, or other subsequent birth does decrease from 6 percent to 3 percent , as mentioned earlier.
The main factor that seems to increase chances of a second fourth-degree tear is the weight of the baby, according to a study. You may have heard that an episiotomy a cut your doctor makes between the vagina and anus will help prevent tearing. Perineal massage after 35 weeks into your pregnancy is one possible option. It may help soften the tissues, making them more elastic before delivery. The very thought of tearing can be scary and unpleasant. Be sure to stay in touch with your doctor about your recovery, share any concerns you have, and follow up with a physical therapist as needed for pelvic floor rehab.
A birth plan is a document that lets labor and delivery staff know some of the specifics you want followed during the birth of your baby.
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