Giving birth is a life-changing event for a woman that has a long-term impact on her physical and mental health. It is the most joyous experience for her and her entire family, but several complications in the postnatal period, such as perineal pain, constipation, breast engorgement, cracked nipples, fatigue, backache, and headache, can cause the mother severe physical and psychological distress and lower her quality of life.
Mothers may also experience discomfort during the physiological process of uterine involution in the postnatal period. Mothers require special attention because they are dealing with all of these issues at the same time.
What is Episiotomy or a Perineal Tear?
Episiotomy, commonly known as perineotomy, is a popular surgical surgery for women
The risk of a first- or second-degree tear is heightened by a forceps delivery and a prolonged second stage of labor.A third-degree tear involves injury through the muscles and fascia of the perineum as well as the anal sphincter complex. A fourth-degree tear is an injury to the perineal fascia and muscles, the external and internal anal sphincters, and the anal epithelium.
Common symptoms after an episiotomy or perineal tearing include pain, swelling, redness, bleeding in the perineal area and urinary or fecal incontinence.
Physical Therapy for an Episiotomy or Perineal Tear
Physical therapy is an effective treatment for perineal tearing or an episiotomy, using pelvic floor rehabilitation to restore function and strength to the pelvic floor muscles.
Pain management :
1. Ice /cold pack: Place the ice pack on the perineum area and begin gentle diaphragmatic breathing. This helps to reduce swelling.
2. Transcutaneous nerve stimulation(TENS) : A TENS machine sends small electrical impulses to the affected area, which can reduce pain signals to the brain and spinal cord.TENS are applied for 30 minutes near the episiotomy site. This can help relieve pain and relax muscles
Pelvic floor rehabilitation:
This physiotherapy method will help women to restore function and strength to the pelvic floor and minimize perineal pain.
1. Manual therapy with Soft tissue massage: Massaging the tissue around the scar
2. Pelvic floor muscle exercise:
● Kegel exercises – Find a comfortable position, empty your bladder, and locate your pelvic floor muscles. Tighten the muscles and hold for 3–5 seconds, then relax for the same amount of time. Repeat 10 times, 3 times a day.
● Breathing exercises – Lying down and Sitting- Lie on your back with pillows / Sit with your legs hanging. Place one hand on your upper belly and the other on your chest. Inhale slowly through your nose, feeling your belly rise. Exhale slowly through your mouth, feeling your belly move down.
Retraining Core and Hip Muscle :
A physiotherapist can also help with retraining core and hip muscles and sensory.
1. Half Planks
– Lie on your front with your toes under your ankles and elbows under your shoulders. Engage your core muscles by pulling your stomach in. Lift yourself up so that your shoulders, hips, and knees are in a straight line. Maintain this position for as long as you can without losing form.
2. Bridging
– Lie on your back with your knees bent and feet shoulder-width apart. Inhale, then exhale while rolling your pelvis back onto the mat, lifting your bottom off the floor. Inhale at the top, then exhale while lowering yourself back down. Repeat 10–15 times.
Physiotherapy is an essential part of post-episiotomy recovery, offering personalized care to promote healing and restore function. With a focus on pelvic floor rehabilitation, pain management, and improving mobility, physiotherapy helps women recover more effectively and reduces the risk of long-term issues. This comprehensive approach not only addresses physical recovery but also supports emotional well-being, ensuring a smoother transition to postpartum life. Prioritizing physiotherapy after an episiotomy can make a significant difference in a woman’s overall recovery and quality of life.
Prepared by
Santhini Shanmugam
Your Physio Subang Jaya