Patient Information

Pelvic floor and perineal massage


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Protecting your pelvic region during and after pregnancy

What is the pelvic floor?

Layers of muscle stretching from the pubic bone at the front of the pelvis (hip joint) to the bottom of the backbone, like a hammock.

What does it do?

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

Why exercise the pelvic floor muscles?

Pregnancy and childbirth can cause pelvic floor muscles to weaken and sag, reducing their ability to give support. This can produce incontinence, with around a third of women leaking urine and up to a 10th leaking faeces after giving birth. Like any muscle, the more you use and exercise it, the stronger the pelvic floor will be. Evidence shows that doing pelvic floor exercises ante and postnatally can reduce the risks of incontinence by up to 40%.

When should I exercise them?

Begin exercising as soon as you can in pregnancy. Continue to do so as soon as possible after delivery of your baby regardless of the type of delivery you have. This will aid healing and reduce any swelling, and help guard against or reduce incontinence.

Don’t be worried about re- starting them – 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 recommencing your pelvic floor exercises.

How do I do the exercises?

Since your pelvic floor is made up of two kinds of muscle, 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 and 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.

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

  • Get comfortable – sit or lie with your knees slightly apart.
  • ‘squeeze and lift’ as if trying to stop yourself from passing wind as well as stopping the flow of urine.
  • Hold for no more than one or two seconds, rest for one or two seconds, then repeat.
  • Try not to hold your breath, pull your stomach muscles excessively, squeeze your legs together or tighten your buttocks.

Long squeezes for stamina:

  • Repeat as per short squeezes; however, hold the squeeze for four seconds with a break of three seconds between each one.
  • Remember, try not to hold your breath, pull your stomach muscles excessively, squeeze your legs together or tighten your buttocks.
  • As these exercises become easier, hold each squeeze for longer, up to around 10 seconds.

Perineal massage to prevent perineal trauma                                    

What is the perineum?

The area between the vagina and the anus.

What is perineal trauma?

Damage to the perineal area of skin caused during childbirth either from natural tearing or an episiotomy.

How likely am I to experience this trauma?

Up to 85% of women will suffer some form of perineal trauma during the delivery of their baby.

What are the consequences of perineal trauma?

It can cause both short and long term problems, the main complication being pain. This can in turn cause sexual dysfunction and also affect breastfeeding.

How can I reduce it?

Perineal massage has been shown to reduce the incidence of perineal trauma requiring suturing. It is thought that massaging enables the tissue to better stretch during delivery. This is particularly the case for women over the age of 35. Perineal massage has also been shown to reduce the rates of instrumental deliveries and episiotomies.

When should I start perineal massage?

From when you are 34 weeks pregnant until you deliver.

How do I do perineal massage?

Carry out the following daily if possible for 10-15mins, but at least three to four times per week. After a bath or shower can be a good time. If you are having trouble reaching your perineum, you could ask your partner to help you.

  • Get comfortable – try lying against pillows in bed with your knees bent up allowing you or your partner to reach your perineum.
  • Use a vegetable based massage oil e.g. sweet almond oil. Rub this on the perineum using your fingers and thumb.
  • Place your fingers (or thumbs if that is easier) approximately 5cm into the vagina, press down towards the anus and then move your fingers in a U-shaped motion, stretching the area. You may feel some burning/tingling similar to when your baby’s head crowns.
  • Hold the stretch for 30-60 seconds, release, and then repeat.
Diagram showing perineal massage

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