If we talk a lot about postpartum perineum rehabilitation, it is important to ensure the good health of the perineum even during pregnancy. Estelle Bertrand, physiotherapist, explains the role of the perineum and how to take care of it.
Many women discover the existence of their perineum during pregnancy. And if perineal rehabilitation after childbirth is now widely recommended and practiced, few women have their perineum evaluated when they are pregnant. “Having a check-up with a physiotherapist during pregnancy to check the tone of the perineum but also the muscles of the abdomen is however very useful.“, observes Estelle Bertrand, physiotherapist.
The perineum: what is it for?
“The perineum is a set of different muscles and tissues that close the lower pelvis and extend from the pubis to the coccyx”, describes the physiotherapist. Its role is multiple: it supports the viscera, allows urinary and anal continence, plays an opening role during childbirth and also has a significant impact on the course of sexual intercourse.
The perineum, strained during pregnancy
During pregnancy, the body of the future mother is the scene of a large number of upheavals. The perineum is no exception and is strained. “The hormones of pregnancy relax the muscles, tissues and ligaments to allow passage of the baby’s head. The perineum, less toned, is also subject to significant overweight due to the presence in the baby’s uterus and placenta “, explains Estelle Bertrand. For example, a woman with pain in the pubis, coccyx, lower back or sacrum should consult, the pelvis being made less fixed by the relaxation of the ligaments. The specialist therefore insists on the need to carry out an assessment in order to be offered personalized care.
The perineum during pregnancy: how to tone it?
“The work is both postural, the pelvis is in anteversion during pregnancy, and respiratory, explains the physiotherapist. However, there are no typical exercises that can be recommended for all women. They are adapted to the morphology of each ”, she adds. To cite a concrete example, a pregnant woman whose transverse abdominal muscle will be relaxed will work to tone it. The abdominal muscles will then be better able to “carry” the baby and thus unload the perineum.
In general, a follow-up with a physiotherapist during pregnancy helps to maintain mobility, muscle tone but also to avoid pain. “I teach them exercises that they must then redo at home and then we meet again for regular check-ups”, she specifies. But the physiotherapist also explains that to take care of her perineum during pregnancy you must also fight against constipation. “Pushing too hard, hemorrhoids, all this also weakens the perineum“, recalls Estelle Bertrand.
Perineum massage: preparing the body for childbirth
It is possible to help the perineum to soften and to accustom the tissues to relax before childbirth by performing massages. “We can start in the two months preceding childbirth but this practice must always be supervised by a professional and carried out with the agreement of the obstetrician”, reminds the physiotherapist.
To perform the massage, the mother-to-be must sit comfortably with her bust leaning back on a bed or chair. She may begin to make small circles on the central nucleus of the perineum, the outer area between the vagina and the anus. She will then introduce her thumb into her vagina in order to massage the perineum towards the sides and towards the anus. “The massage must be carried out with a vegetable oil as neutral as possible, organic, first cold pressing or a specific oil for the massage of the perineum“, recommends Estelle Bertrand.
Finally, the physiotherapist is keen to challenge some received ideas. “First, having sex during pregnancy has no negative impact on the perineum. Second, urine leakage during pregnancy is not normal. You must consult a gynecologist, a midwife or a physiotherapist to see where the problem comes from.“, she advises.
Here is a video made by Estelle to adopt the right gestures to massage the perineum
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