What is the perineum?

The perineum is the area of skin between the opening of the vagina and the anus. It is typically between 2 and 5 centimetres long. The perineum connects with the muscles in the lower pelvis (referred to as the pelvic floor muscles). During childbirth, the perineum stretches to make room for the baby.

What do the pelvic floor muscles do?

Pelvic floor muscles support the organs of the pelvis, which include the bladder, uterus and bowel. A woman's pelvis has bones and ligaments that move or stretch as the baby travels into the birth canal to prepare for birth. The pelvic floor muscles help control the bladder and bowel. If the pelvic floor muscles are weak or become damaged through pregnancy and childbirth, there can be involuntary loss of urine (referred to as urinary incontinence) or faeces (referred to as faecal incontinence), that may at times persist beyond pregnancy.

What techniques can prepare the perineum and pelvic floor muscles for childbirth?

Perineal massage can be used to stretch the perineum, which helps reduce the risk of tears. Massage is usually started at around week 34 of pregnancy, continuing right up until the birth, and should be done daily to get the best results.

Safety tip: Perineal massage is not suitable for women who have a low-lying placenta (placenta praevia) or who have infections, including vaginal thrush (candida), herpes or open cuts or infection on the hands or fingers.

The pelvic floor muscles can also be exercised to improve their strength. This can include regular gentle exercise, such as walking.

What problems can affect the perineum during childbirth?

Sometimes the perineum can spontaneously tear during childbirth. Often these tears are not serious and will heal naturally. More serious tears will sometimes occur and can affect the pelvic floor muscles or the muscles around the rectum, which complicates recovery.

In some situations — but only with the mother's consent — the doctor or midwife may cut the perineum during childbirth using pain relief to numb the area. This is called an episiotomy and is used to make the opening of the vagina wider, so the baby has more space to emerge. Your doctor or midwife may recommend an episiotomy in order to prevent a traumatic tear to the perineum.

The perineum after childbirth

Any damage to the perineum can cause pain or soreness during recovery but will usually heal after 2 to 3 weeks. Smaller perineal tears can heal on their own, but often tears need dissolvable stitches. The doctor or midwife will usually do the stitches soon after the birth, and will give a local anaesthetic to avoid pain before the procedure. They will also make sure pain-relief medicines are available after the procedure too.

Women who experience perineal tears are at increased risk of developing involuntary loss of urine or faeces (incontinence).

A perineal tear or cut should heal within a few weeks.

Recovering from a perineal tear or cut

Your midwife will guide you on how best to recover from a perineal tear or cut.

Good hygiene is important, and includes bathing every day and washing hands before and after using the toilet. Regular bowel motions are also important, and laxatives may be recommended to help you avoid straining.

You might be prescribed a course of antibiotics to reduce the risk of infection. Gently cleaning the perineal area with clean lukewarm water after using the toilet – no soap or disinfectant necessary – and changing sanitary pads every 2 to 3 hours will also help.

Remember that a majority of women recover fully from childbirth, with no lasting damage or pain to the perineal region. This is true whether or not the perineum was torn or cut during labour. If you are experiencing ongoing perineal pain, see your doctor or maternal health service.