The female perineum, what it is and why it is important to train it

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Catherine Le Nevez
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Perineum

La perineal gymnastics it is very important for pregnant women or those who have had an episiotomy done. It allows you to train the pelvic floor muscles and the perineum and to reduce the risk of mild incontinence and prolapse. But let's go deeper.





What is female perineum

The perineum is the external part of the pelvic floor, a band of muscles located in the genital area which, thanks to its tone, keeps the various orifices closed, preventing the loss of stool and urine. In practice, it is that muscular area that "holds" the bladder and the anal canal.



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Perineum anatomy

The perineum is, therefore, that set of soft parts which close the lower opening of the pelvis and which form a kind of diaphragm. The jolts hormonal that occur following a pregnancy, childbirth, menopause can change the condition of the perineum.

La pregnancyIn fact, puts a strain on the perineal tonicity, especially in the last trimester when the weight of the fetus and the amniotic fluid are such as to be able to weaken the muscles leading to a release of the sphincters, also due to an increase in progesterone which tends to relax the muscles. During this period, it is good for the mother to monitor her weight carefully, not to hold the urine for too long and to avoid carrying excessive weights.

Il delivery causes a change in the appearance of the genitals, when the baby's head passes into the birth canal there is a stretching of the muscles, a dilation and distortion of the sphincters that can lose tone. If we go then to add the possibility of lacerations spontaneous more or less serious and the possibility of undergoing an episiotomy, we understand well how the pelvic floor may need a good re-education.

Exercises

To cope with these discomforts and to improve one's perineal tone, small and simple exercises are enough that can be practiced both during pregnancy that after childbirth:

  • Sedetevi on the floor or on your bed with your legs apart, place a hand in the genital area so that you can clearly see the movement you are performing, then contract the perineum avoiding squeezing the buttocks. Maintain the position for 5 seconds and then release while exhaling through the mouth, wait about ten seconds and repeat the operation. The exercise should be repeated about 10 times in the morning and in the evening.
  • After a few weeks, start repeating the exercise with faster movements alternating a rapid contraction of the muscle with a slight relaxation.
Read also: Perineal massage how to do it

Being a muscle the perineum it can be trained and made more elastic by favoring:

  • A better one expansion of the tissues at the time of expulsion thus avoiding lacerations, a greater influx of blood in the rectal area avoiding the risk of the appearance of hemorrhoids due to expulsive thrusts.
  • Increased pleasure sexual as it tones the vaginal muscles making them less rigid and reducing pain during penetration
  • Reduces the risk of uterine and uterine prolapse incontinence as age advances.

Perineal gymnastics after childbirth

After childbirth, it is important to perform some exercises that are used to re-educate the pelvic floor and strengthen its muscles, which have been strongly tested by childbirth.

The ideal is to start about a month after giving birth, when any points of the episiotomy or suture of the laceration have been more or less absorbed and the discomfort has more or less disappeared. It is also good to wait for this period to allow time for the abdominal and pelvic organs to resume their position within the abdominal cavity and for the abdominal muscles to regain tone and elasticity. It is important, however, that the exercises and re-education must be carried out before 5-6 months have passed since the birth.

The exercises must be performed consistently. At the beginning it could be difficult, especially the identification and awareness of the muscle area to be exercised, since they are not muscles that we use realizing them in everyday life and the area is always considered a little off limits. It is important to involve your partner, especially in this first phase, as it may help you later, at home, when you are doing the exercises alone.

  • Sit or lie down in a comfortable position, relax the muscles of the thighs, buttocks and abdomen;
  • Touch the area of ​​the perineum with your fingers or look at it with a mirror, in order to observe its rise during the contraction phase;
  • Contract the muscle ring around the anus as if you were controlling a diarrhea stimulus. Then relax it. Do the exercise several times until you are sure you are exercising the right muscle. Remember not to squeeze your buttocks;
  • Contract the muscle surrounding the urethra as if you were to stop or hold the pee. Then relax it. Do the exercise several times until you are sure you are exercising the right muscle, trying not to squeeze your buttocks;
  • When you pee, try to stop the flow in the middle, then start it again. Do the exercise until you have learned to recognize the muscles that come into play and then do it no more than once or twice a day, just to check your progress, as it may interfere with proper bladder emptying. When you feel ready, when you think you have become aware of the perineal muscles that you will have to exercise, then you can move on to the next exercises.

Strengthening and toning exercises.

  • Empty your bladder. Get into a comfortable position where you can easily relax the muscles of the thighs, buttocks and abdomen. Make sure you are not disturbed during the exercises.
  • Contract and pull in the muscles around the anus, vagina and urethra at the same time, lifting them upward inward (it may help to imagine that you have an elevator inside you that has to go up to the top floor and you have to pull it up). Try to hold the contraction firmly for five seconds and then release and let go of the muscles.
  • Repeat the contraction and lifting exercise and relax. About 10 seconds should pass between one contraction and the next. If you can hold the contraction easily, try holding it longer, even 10 seconds. In this case the pause must last 20 seconds.
  • Repeat the exercise as many times as possible up to one (max 8-10 times), always letting 10-20 seconds pass between one and the other.
  • Now perform 5 to 10 short, fast, firm contractions. Then relax.
  • Perform the series of exercises, in full, at least 4-5 times a day, remembering not to hold your breath during the contraction phase; do not push down, but contract and pull up; do not contract the buttocks, thighs and abdominal muscles.

Perineum pain

It is estimated that 15 in 100 women of childbearing age suffer from pelvic pain. Pain is often associated with endometriosis, a disease that affects more than 3 million women. But it can also be a symptom of painful bladder syndrome, vulvodynia or syndrome from irritable bowel. If pain in the perineum is frequent and occurs regularly, it should not be underestimated but contact your trusted gynecologist to understand the cause.

Perineum massage

Exercising and massaging the perineum facilitates childbirth, prevents injuries, helps after childbirth, in menopause, contains a possible uterine prolapse.

How to perform perineum massages:

The first advice of the midwife is to choose a calm and intimate place and a comfortable position: standing, on a sit, squatting or on a bed. The oil to be used for the massage should preferably be natural (olive, or wheat sprouts). Here is the type of massage to be performed indicated bymidwife Sara Notarantonio: "Wet your fingers with the oil and insert two fingers into the vagina and massage in a U shape for 5-10 minutes. Make circular movements with your thumb on the large and small lips to increase circulation. Continue with the massage until the oil will not have been absorbed. As soon as the oil has been absorbed by the skin, the index and middle fingers of both hands must be introduced into the vagina and with an opening movement, pressure, to the right and left. A mother who has had a previous episiotomy can also do this massage ". The massage should never be performed below, where the erogenous zones are located.

It is advisable to start the massage no earlier than the 8th month and should be practiced every day for 2/3 minutes. As the days go by, it will become easier and easier to do so. If at first you might find it unpleasant, perhaps even painful, after two weeks, it will be more natural, the midwife reassures. The perineum massage it is however not recommended and not to be practiced in case of hemorrhoids, vulvar varices, and other ailments.
 

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