The Flow On Effect

Ep 08: Perineal tears and episiotomies - The Flow On Effect Podcast

Perineal tears and episiotomies

PODCAST EPISODE #08

CHARLOTTE CONLON AND HEIDI BARLOW ARE WOMEN’S HEALTH PHYSIOTHERAPISTS FROM FLOW PHYSIO CO, BASED IN THE SUTHERLAND SHIRE.

In today’s episode Charlotte and Heidi talk through perineal tears and episiotomies.

What is the perineum and what causes it to tear?

The perineum is the area between the vagina and the anus. 

Tears are generally sustained in childbirth.

9/10 first time mothers will experience some sort of perineum tear following childbirth - Grade 1 and 2 tears are the most common, it’s the nasty grade 3 and 4 tears we are aiming to prevent.




What are the different degrees of tearing? 

1st degree - a tear of the perineum skin 

2nd degree - tearing of the perineum skin and into the pelvic floor muscle 

3 a - <50% external anal sphincter torn 

3 b - >50% external anal sphincter torn 

3 c - external and internal sphincters are torn 

4th degree - tear through entire epithelium 




Who stitches these up, what is the process here? 

1st and 2nd degree tears are generally stitched up in the delivery suite by Dr/Obs.

3rd and 4th degree tears require you to be taken to theatres after birth to be stitched up by a team of gyno/colorectal surgeons.




What are the risk factors for tearing? 

According the the Royal Australian and New Zealand College of Obstetricians and Gynaecologists:

  • First delivery 

  • Asian ethnicity 

  • VBAC (Vaginal birth after C-Section)

  • <20 years old 

  • Shortened perineal body length of less than 25mm (we measure this in the clinic) 

  • Baby bigger than 4kg 

  • Shoulder dystocia 

  • Posterior position of bub 

  • Instrumental delivery (forceps, vacuum) 

  • Prolonged pushing stage in labour > 60 mins 

  • Epidural use 

  • Delivery in deep squatting position 

  • Midline episiotomy 




What is an episiotomy and how is this different to a tear ? 

An episiotomy is where the Dr will make the decision to cut the perineum usually off to the side. It is usually done if they need to get the baby out in a hurry, if they are using instruments that need to fit in the vagina such as forceps or if they think you are likely to suffer a nasty tear.. Often healing is a little more painful with this.




Can you have both a tear and episiotomy ? 

Unfortunately, yes. It is not very common but it does happen as you can tear in a different place to where the episiotomy is done.




Can anything else tear? 

Yes, anything in the vulva area can tear.

The labia is also a common place to tear.




What do you do in the early days postpartum if you have a tear or episiotomy?  

  1. Manage bowels (fluid, diet, laxatives, stool softeners) - no straining, wait for natural urge 

  2. Supporting the area when defecating

  3. Ice 10 mins on 10 mins off 

  4. Wear comfortable maternity pads that do not irritate the area such as TOMS organic brand 

  5. Keep the area clean 



Does this management differ between the grades of tears? 

3rd and 4th degree tears need more specific care, likely the surgeons will tell you not to use toilet paper and to use a spray bottle and dab clean instead.



What is the follow up care on tears?

Everyone should have a follow up after birth, no matter whether you tear or not. 

Generally if you have a 3rd or 4th degree tear you will get a referral to a physio in the hospital and also have endoanal scans at 6 months to track how it is healing. You will also have follow ups with both your GP/obstetrician and colorectal surgeons. 




When should women see a pelvic floor physiotherapist? 

The general rule is at around 6 weeks post partum, after seeing your GP/Obstetrician. This is when we can perform an internal vaginal or rectal examination to check your pelvic floor muscles. However, we can still see women before this time if they are having any issues or concerns.




Do tears/episiotomies have long term issues ? 

Generally, no, but some can. The main complaint is of pain or increased sensitivity along the scar. Pain with intercourse can also be an issue as the partner hits the sensitive scar tissue.



Is there anything that can help with the pain ? 

We teach women scar tissue massage that women can start from 6 weeks to try and desensitise the area.

Therapeutic ultrasound and TENS can also help to reduce the scar tissue sensitivity and pain in the area.

Sometimes the area can become really dry and sore due to low Oestrogen while breastfeeding and if this is the case, your GP can prescribe an Oestrogen cream that can be applied to the area to help with this.



Is the management different for 3rd/4th degree tears ?

The initial management is much the same in the initial weeks after birth. However, because the anal schincters are involved, some women experience fecal urgency, they have have the inability to hold wind in or a feeling that wind escapes without their control, and they may experience fecal incontinence. At one year follow up 20-40% of women with these 3rd and 4th degree tears have fecal and wind incontinence.



Why does this fecal urgency and incontinence happen? 

Our internal anal sphincter which is made of smooth muscle which we have no active control over, is responsible for 70% of our rectal control when there is a stool inside. 

Our external anal sphincter which is made of skeletal muscle which we can voluntarily contract, is responsible for 30% of control. 

Therefore, if there is damage to the external sphincter muscles we can lose up to 30% of our ability to control our bowels. That’s why pelvic floor exercises are crucial. 



When should women start pelvic floor exercises? 

Straight away! Once you have emptied your bladder for the first time after giving birth, light gentle squeezes can help with reducing swelling and gaining the connection back to the pelvic floor. 




Does having a tear affect future deliveries? 

For 1st and 2nd degree tears and episiotomies, there is generally no implication provided the recovery has been fine and they are not experiencing any long term issues.

For 3rd and 4th degree tears, the advice normally is not to give birth vaginally again. However, if it is something you really want, normally your care team can try and accommodate. 




What can we do to prevent tearing and episiotomy ? 

  1. Perform perineal massage starting from 36 weeks in pregnancy

  2. Use of the Epi-No device - an alternative to doing perineal massage is using a device to help stretch the entrance.

  3. Ensure the pelvic floor muscles are able to relax well

  4. Use a wet washer for heat compression inbetween contractions/pushing in labour 

  5. Maintain mobile hips in pregnancy 

  6. Trying to avoid giving birth in a deep squat position 

Thank you for listening!

Thanks for joining us for this episode. We’d love to hear if you have any questions or feedback! Let us know in the comments section below.

If you enjoy listening to this podcast, please share or leave a review for us. We’d love to know what you think.

Materials and information shared are for educational purposes only.

Ep 07: Pain with sex - Dyspareunia

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PODCAST EPISODE #07

CHARLOTTE CONLON AND HEIDI BARLOW ARE WOMEN’S HEALTH PHYSIOTHERAPISTS FROM FLOW PHYSIO CO, BASED IN THE SUTHERLAND SHIRE.

In today’s episode Charlotte and Heidi talk through Dyspareunia (or pain with sex), including:

What is dyspareunia? 

How common is dyspareunia? 

Is it just about pelvic floor muscle tightness? 

What is vaginismus?

What are the symptoms of vaginismus? 

What causes the muscles to be tight? 

What are the treatment options for vaginismus?  

What is vulvodynia? 

What causes vulvodynia? 

Does this make treatment harder?

What are the treatment options for vulvodynia? 

Why do some women experience dyspareunia post-partum?

Treatment options for women who have dyspareunia post partum

Thank you for listening!

Thanks for joining us for this episode. We’d love to hear if you have any questions or feedback! Let us know in the comments section below.

If you enjoy listening to this podcast, please share or leave a review for us. We’d love to know what you think.

Materials and information shared are for educational purposes only.

Ep 06: Pelvic Girdle Pain - The Flow On Effect - A Women's Health Physio Podcast

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PODCAST EPISODE #06

CHARLOTTE CONLON AND HEIDI BARLOW ARE WOMEN’S HEALTH PHYSIOTHERAPISTS FROM FLOW PHYSIO CO, BASED IN THE SUTHERLAND SHIRE.

In today’s episode Charlotte and Heidi talk through Pelvic Girdle Pain, including:

What is included in the term pelvic girdle pain and where does it present in the pelvis?

So why are these conditions so common in pregnancy?

What symptoms might someone present with in pregnancy that would lead us to think they have PGP?

When does it normally come on in pregnancy ?

How do we treat PGP?

How can women modify what they are doing day-to-day to help reduce the irritation through the joint?

Is it likely to get better in pregnancy?

What exercise is safe to do?

Can it stay around after you have given birth?

What can be done if it does hang around? 


Thank you for listening!

Thanks for joining us for this episode. We’d love to hear if you have any questions or feedback! Let us know in the comments section below.

If you enjoy listening to this podcast, please share or leave a review for us. We’d love to know what you think.

Materials and information shared are for educational purposes only.

Ep 05: Overactive Bladder with Women's Health Physiotherapists Charlotte Conlon and Heidi Barlow

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PODCAST EPISODE #05

CHARLOTTE CONLON AND HEIDI BARLOW ARE WOMEN’S HEALTH PHYSIOTHERAPISTS FROM FLOW PHYSIO CO, BASED IN THE SUTHERLAND SHIRE.

In today’s episode Charlotte and Heidi talk through an overactive bladder (OAB), including:

  • What is overactive bladder (OAB)? 

  • What exactly is urgency ? 

  • How does this differ from a “strong urge”?

  • What happens when a normal bladder is filling compared to when the bladder is overactive?

  • What are the symptoms?

  • What age do people get OAB? 

  • What is a normal amount of times to go to the toilet daily?

  • Possible causes

  • Treatment options

Thank you for listening!

Thanks for joining us for this episode. We’d love to hear if you have any questions or feedback! Let us know in the comments section below.

If you enjoy listening to this podcast, please share or leave a review for us. We’d love to know what you think.

Materials and information shared are for educational purposes only.