From the Guidelines
Pelvic floor physical therapy is a highly recommended treatment for perineal tears after childbirth, as it can significantly improve healing, reduce morbidity, and enhance quality of life. This specialized therapy should ideally begin around 6-8 weeks postpartum, once clearance from a healthcare provider is obtained 1. A trained pelvic floor physical therapist will assess the specific condition and develop a personalized treatment plan that may include gentle manual therapy techniques to promote tissue healing, exercises to gradually strengthen weakened muscles, biofeedback training to improve muscle coordination, and education on proper body mechanics.
Key Benefits of Pelvic Floor PT
- Addresses scar tissue formation, reducing pain and inflammation
- Restores proper muscle function
- Improves blood flow to the injured tissues
- Reduces the risk of long-term complications such as pelvic organ prolapse and incontinence
Treatment typically involves weekly sessions for 6-12 weeks, though this varies based on the severity of the tear and progress 1. It's essential to note that perineal tears can lead to ongoing issues like pain during intercourse, urinary or fecal incontinence, and pelvic organ prolapse if not properly rehabilitated. The prevalence of perineal injury is high, occurring in up to 90% of nulliparous and 70% of multiparous women 1.
Importance of Early Intervention
Early intervention with pelvic floor physical therapy can mitigate these risks and improve outcomes. For best results, consistency with the home exercise program between sessions and open communication with the therapist about symptoms and progress are crucial. By prioritizing pelvic floor physical therapy, individuals can significantly reduce the risk of long-term morbidity and mortality associated with perineal tears, ultimately enhancing their quality of life 1.
From the Research
Pelvic Floor Physical Therapy and Perineal Tears
- Pelvic floor physical therapy may help prevent perineal tears after childbirth, as shown in a study published in 2017 2, which found that a pelvic floor training programme reduced the risk of episiotomy and severe perineal trauma in primiparous women.
- The study found that women who participated in the pelvic floor training programme had a 31.63% reduction in episiotomy and a higher likelihood of having an intact perineum compared to those who received standard care.
- However, another study published in 2020 3 found that surgical treatment was more effective than pelvic floor muscle therapy in relieving symptoms related to a poorly healed second-degree perineal tear in women presenting at least 6 months postpartum.
- A review of the evidence on pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women, published in 2019 4, found that pelvic floor physical therapy can improve or cure symptoms of urinary incontinence, pelvic organ prolapse, and other pelvic floor disorders.
Effectiveness of Pelvic Floor Muscle Training
- A systematic review and meta-analysis published in 2022 5 found that pelvic floor muscle training was not effective in preventing perineal laceration during vaginal delivery.
- The review included nine studies and found that the prevalence of perineal laceration had a wide range and information on laceration degree was limited.
- Another study published in 2001 6 found that pelvic floor physical therapy is considered to be effective in the management of functional urogenital and anorectal disorders, and that coordinated release of the sphincters within a supporting extensible levator ani allows complete and effortless emptying.
Key Findings
- Pelvic floor physical therapy may help prevent perineal tears after childbirth, but the evidence is not consistent across all studies.
- Surgical treatment may be more effective than pelvic floor muscle therapy in relieving symptoms related to a poorly healed second-degree perineal tear.
- Pelvic floor physical therapy can improve or cure symptoms of urinary incontinence, pelvic organ prolapse, and other pelvic floor disorders.
- Further studies are needed to investigate different protocols and interventions for pelvic floor muscle training and perineal laceration prevention.