Anatomy of pregnancy and birth - perineum and pelvic floor

Your pelvic floor lies across the bottom of your pelvis. It includes a group of muscles, called the levator ani muscles, as well as connective tissue.

Your levator ani are broad muscles that are made up of 3 pairs, with one of each pair on each side of your pelvis. They are important for supporting your bladder, bowel and uterus.

Your perineum is below your pelvic floor. In females, it is the area of tissue between the opening of your vagina and anus.

Your pelvic floor:

• prevents prolapse of your uterus, bladder and bowel by keeping your organs in their place
• helps you control your bladder and bowels and prevents incontinence
• helps with sexual function

During pregnancy and childbirth, your pelvic floor can become weak, stretched, strained or damaged.

Damage to your pelvic floor can sometimes lead to urinary or bowel incontinence (problems controlling your wee and/or poo) during and after your pregnancy. Incontinence can range from a small leak to a complete loss of control of your bladder or bowel. This can affect your mental health and wellbeing.

See your doctor if you have problems controlling your bowel or bladder or if it is affecting your mental health. They may refer you to a specialist physiotherapist for assessment and a pelvic floor exercise program.

Your doctor may also assess your mental health to check if you need support.

To find a physiotherapist, doctor or maternal, child and family health service near you, use the Pregnancy Birth and Baby Service Finder tool.

During a vaginal birth, as your perineum stretches, it can tear. Often these tears are not serious and will heal naturally.

Your midwife or doctor may offer you a warm compress to place on your perineum when it starts to stretch during childbirth. This can help reduce your risk of having a severe tear.

More severe tears can affect your pelvic floor muscles or the muscles around your anus. This can make your recovery more difficult.

Episiotomy

In some situations your doctor or midwife may ask you if they can make a cut in your perineum during childbirth. This is called an episiotomy and is used to make the opening of your vagina wider. This gives your baby more space to come out.

If your doctor or midwife recommends an episiotomy, they will explain the procedure. Your consent is needed before the procedure is done.

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

Read more about birth injuries.

Read about shared decision making and understanding informed consent and your rights when having a baby.

You can help prepare your pelvic floor and perineum for pregnancy and childbirth by doing muscle training or massaging your perineum. These can help prevent problems afterwards.

Pelvic floor muscle exercises

You can exercise your pelvic floor muscles to improve their strength. You can do these exercises before you get pregnant, during and after pregnancy.

In fact, all people are recommended to exercise their pelvic floor muscles every day to improve their strength.

Ask your physiotherapist for advice about which exercises are right for you.

Perineal massage

Perineal massage can help stretch your perineum and reduce your risk of tears during childbirth.

If you are planning a vaginal birth, you can start perineal massage at around week 34 of your pregnancy. It's continued right up until the birth.

Speak with your doctor or midwife for guidance if you would like to start doing perineal massage.

• The Royal Australia and New Zealand College of Obstetricians and Gynaecologists has an informative handout about exercises for a strong pelvic floor.
• Learn about practising perineal massage during your pregnancy with The Royal Women's Hospital handout.
• Read about self-care for expecting and new parents at PANDA.
• Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available from 7 am to midnight (AET), 7 days a week (including public holidays).

Aboriginal and/or Torres Strait Islander peoples

• You can find out more about Aboriginal and/or Torres Strait Islander pregnancy health on Stronger Bubba Born or watch the How to Have a Safer Pregnancy video.
• Continence Health Australia has a brochure for Aboriginal and/or Torres Strait Islander people about leaking urine (wee) after having a baby.

Sexually and gender-diverse families

• PANDA provides inclusive and appropriate support for LGBTIQA+ expecting and new parents.