During a vaginal birth, it is common for the area between the vagina and your back passage (anus) to be torn or grazed. Here we explain what you can do to protect yourself.

Protecting your pelvic floor

About your pelvic floor

Your pelvic floor is layers of muscles. These stretch, like a hammock, from the pubic bone at the front of the pelvis (hip joint) to the bottom of the backbone.

The pelvic floor:

  • helps to hold the bladder, womb (uterus) and bowel in place
  • closes the outlets of the bladder and back passage, preventing incontinence – leakage of urine (pee) and faeces (poo).

Pelvic floor exercises

Why the exercises are important

Pregnancy and childbirth can cause pelvic floor muscles to weaken and sag, so they give less support. This can lead to incontinence. After giving birth, around a 1 in 3 women leak urine and up to a 1 in 10 leak faeces.

Like any muscle, the more you use and exercise it, the stronger the pelvic floor will be. Women that do pelvic floor exercises during pregnancy report less urine leakage in late pregnancy and in the first few months after birth.

When to do them

Begin exercising as soon as you can in pregnancy.

Continue them as soon as possible after your baby is born. This is regardless of the type of birth you had. This will aid healing and reduce any swelling, and help guard against or reduce incontinence.

Do not be worried about re-starting the exercises. Most women find it less sore than they expect.

Note: if you have a catheter, wait until this is out and you are passing urine normally before re-starting your pelvic floor exercises.

How to do the exercises

Your pelvic floor is made up of two kinds of muscle. So, it is best to exercise both types to improve strength and stamina.

Remember though, quality is better than quantity. So, begin with as many as you can hold strongly. Then aim to increase repetitions up to around 10 of each type.

Try to do these three to five times per day as part of your daily routine, perhaps when you use the toilet or feed your baby.

Continuing them for the rest of your life will also help to prevent further problems such as uterine, bladder or bowel prolapses.

Pelvic floor exercises instructions

Short squeezes for strength (helps your muscles react when you cough, sneeze or laugh):

  1. Get comfortable. Sit or lie with your knees slightly apart.
  2. ‘Squeeze and lift’ as if trying to stop yourself from passing wind as well as stopping the flow of urine.
  3. Hold for no more than one or two seconds, rest for one or two seconds, then repeat.

Long squeezes for stamina:

  • Repeat the squeezes, but hold them for four seconds with a break of three seconds between each one.
  • As these exercises become easier, hold each squeeze for longer, up to around 10 seconds.

Whether doing the short or long squeezes:

  • do not hold your breath
  • do not pull your stomach muscles excessively
  • do not squeeze your legs together
  • do not tighten your buttocks.

Protecting your perineum

Perineal massage is recommended to prevent trauma to your perineum.

The perineum is the area between the vagina and the anus.

Perineal trauma

The perineum can be damaged during childbirth. This trauma can be caused by natural tearing or an episiotomy (a deliberate cut made to the perineum to make space for the baby to come out and to prevent tearing).

Up to 85 out of 100 of women will have perineal trauma during the birth of their baby.

Perineal trauma can cause short-term and long-term problems. The main problem is pain. This can, in turn, affect breast-feeding and make it hard to enjoy or participate in sex.

Perineal massage

It is thought that massaging makes the perineum stretch better during child birth. This is particularly the case for women over the age of 35. 

You should begin the massage from when you are 34 weeks pregnant until you deliver.

Perineal massage means you are:

  • less likely to have perineal trauma that needs stitches
  • less likely to need forceps or ventouse suction cup during the birth
  • less likely to need an episiotomy cut.

Perineal massage instructions

Carry out the following every day if you can, but at least three to four times per week.

Do it for 10 to 15 minutes, if possible. A good time is after a bath or shower.Illustration of perineal massage

If you are having trouble reaching your perineum, you could ask your partner to help you.

  1. Get comfortable so that you or your partner can reach your perineum. Try lying against pillows in bed with your knees bent up.
  2. Use a vegetable based massage oil (such as sweet almond oil). Rub this on the perineum using your fingers and thumb.
  3. Place your fingers (or thumbs if that is easier) approximately 5cm into the vagina
  4. Press down towards the anus and then move your fingers in a U-shaped motion, stretching the area. You may feel some burning or tingling.
  5. Hold the stretch for 30 to 60 seconds. Release and then repeat.

Contact information

Maternity department

Kingston Hospital

Galsworthy Road

KT2 7QB

Telephone:

 

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