How Perineal Tearing Affects Your Pelvic Floor

Perineal tearing is a common side effect of childbirth. It refers to tearing of the perineum, a part of the body often known as a section of skin found between the anus and the vaginal opening. However, there’s more to the perineum and perineal tearing than meets the eye. 

Within the pelvis and further behind that patch of skin is what’s known as the perineal body. The perineal body is actually a diamond-shaped fibromuscular structure that separates the anterior (front) and posterior (behind) sections of your pelvic floor. 

The pelvic floor is a group of muscles that interconnects with many structures and organs within your pelvis. It is responsible for supporting your pelvic organs, providing stability to the body, supporting sexual function, maintaining continence, and much more. The perineal body is a part of your pelvic floor, and so its health and function is very important!

So, how does all this relate to perineal tearing? Perineal tearing can be divided into four stages of severity:

As you can see, damage to the perineal body can affect more than just a patch of skin on the outside of your body—it can extend deeper to important pelvic floor muscles and other structures. When the pelvic floor and perineal body are affected in this way, it can result in pelvic floor dysfunction, which encapsulates a wide variety of unideal symptoms.

For individuals with first-degree perineal tearing, symptoms are light, such as feeling some burning during urination. Healing is also a bit simpler—stitches aren’t always required, and the skin will be healed after a few weeks.

Second-degree perineal tears and beyond will require stitches. More severe tears will also be at risk of infection and will need to be monitored more closely. This is especially so as postpartum individuals are at risk of experiencing incontinence of both the bowels and the bladder.

This means that an individual with more severe perineal tears may have a leakage of urine or fecal matter during their healing period.

Perineal tears will heal with proper care, but what comes after that? Your perineum may be left with restrictive scar tissue, which can create tightness and discomfort.

This can affect your bowel movements, urination, experience during sex, and more—all of which are symptoms of pelvic floor dysfunction. This scar tissue can also make pelvic exams more uncomfortable, or menstrual items such as cups or tampons more difficult to use.

This is combined with the fact that your pelvic floor has already experienced trauma and stress during the childbirth process (from stretching to allow a baby to pass through the vaginal canal) and even during pregnancy (supporting your body’s new weight and shift in posture).

These effects can last several months or even years postpartum, so it is important to pay attention to your body and watch for any lingering symptoms.

In other words, perineal tearing is just another aspect of childbirth that can contribute to pelvic floor dysfunction during postpartum. Luckily, this isn’t something you just have to live with! Pelvic floor physical therapy can help rehabilitate your pelvic floor after childbirth, alleviate your symptoms, and get you back to feeling great and pain-free.

There are a lot of different factors that can contribute to perineal tearing—some of which you don’t have much control over. These factors can include the following:

• The size of the baby
• Your vagina’s ability to stretch
• Whether a birth is difficult or prolonged 
• If a birth required the assistance of forceps or a vacuum
• If this is your first delivery
• The direction the baby was facing during delivery
• If you had an epidural

It is impossible to predict what will occur in the delivery room—so perineal tearing isn’t necessarily preventable. However, being prepared and educated about perineal tears can help you better understand what to expect during labor and postpartum. 

Additionally, preparing your pelvic floor before delivery can help prevent prolonged or difficult labor (caused by excessive tension or muscle incoordination) and reduce your risk of tearing. We’ll discuss prepping your body and perineum for labor next!

The best way to prepare your body before childbirth is to work with a professional who specializes in the pelvic floor. Whether you need virtual or in-person physical therapy, I am available to help!

Rest assured that I am very experienced in all things relating to the pelvic floor, including providing childbirth preparation treatment. Additionally, each and every one of my patients receives a comprehensive care plan that is curated to their unique needs—no cookie cutter treatments here!

In order for me to provide a curated and holistic treatment experience, your first session will start with an evaluation. This can involve a discussion of your symptoms and medical history, as well as an examination with your consent.

Why is an examination necessary? Well, the first step of childbirth preparation is to identify if you already have pelvic floor dysfunction present, which is very common during pregnancy. An examination can help me identify your unique type of pelvic floor dysfunction—but rest assured that I will work with your individual comfort level during treatment!

Once I’ve gotten familiar with your individual needs, I’ll be able to create a treatment plan that will address your unique type of pelvic floor dysfunction. Pelvic floor dysfunction can present itself as a combination of muscle weakness, tightness, inflexibility, and incoordination, and can look different for each person.

When your pelvic floor has dysfunction, you may have trouble pushing during labor, and labor may be more difficult due to tension or weakness in your pelvic floor. These factors can also increase your risk of perineal tearing.

Therefore, by addressing your pelvic floor dysfunction beforehand, your pelvic floor will be able perform its best during labor.

While each person’s treatment plan can vary, you can expect treatments that will reduce pelvic floor tension, increase pelvic floor strength and coordination, and improve your control of these important muscles. This includes treatment methods such as:

• Manual therapies: Hands-on muscle manipulation to improve flexibility and reduce tension.
• Neuromuscular re-education and biofeedback: Improves your understanding of your pelvic floor’s ability to contract and relax.
• Exercises and stretching: Improves the strength and flexibility of your pelvic floor and surrounding areas.
• Behavioral modification: Education on what habits may further impact your pelvic floor (lifting techniques, posture, restroom habits).

Your pelvic floor physical therapy treatment may not be limited to these techniques, but they may give you a general idea of what to expect! However, it is important to know that your care plan won’t solely consist of treatment for pelvic floor dysfunction. I can help you prepare for childbirth in other ways too, such as teaching you breathing techniques and pushing mechanics. 

While it’s impossible to predict what will happen during labor, preparing your pelvic floor beforehand only offers benefits! You’ll have better comfort, reduced symptoms, and a better chance of smoother post-labor outcomes. However, labor puts a lot of strain and trauma on your pelvic floor. Therefore, pelvic floor physical therapy can also be extremely beneficial for postpartum rehabilitation, too!

No matter when you come in for treatment, I want you to feel comfortable and confident. I’ll be sure to provide plenty of pelvic floor related education, answer any questions you have, and always request consent before any treatment or examination. I also accept patients of all gender identities and ages—because everyone deserves accessible and sincere pelvic floor care! 

If you’re ready to get started, book an appointment! I offer both virtual and in-person sessions. Or if you have further questions, consider a discovery call.