How to re-educate the perineum?

Perineum: an important muscle to protect

The perineum is a set of muscles that forms a hammock, between the pubis and the base of the spine. This muscle band supports the small pelvis and organs like the bladder, uterus, and rectum. The perineum helps maintain urinary and anal continence. The Anglo-Saxons call it the “pelvic floor” for “pelvic floor”, And it really has this role of floor, hence its importance! Inside, the perineum is made up of different layers of muscles, called planes. Among them is the levator ani muscle, which participates in digestive continence and plays an important role in pelvic statics. The pubo-coccygeal muscle is a potent agent of support for pelvic viscera, rectum, vagina, uterus. From a sexual point of view, it allows a heightened excitement.

Rehabilitation of the perineum: recommendations

Perineum and perineal rehabilitation: where are we?

In December 2015, the new recommendations of the gynecologists (CNGOF) had the effect of a (mini) bomb! “ Perineal rehabilitation in women without symptoms (incontinence) at 3 months is not recommended. […] No study has evaluated the rehabilitation of the perineum with the aim of preventing urinary or anal incontinence in the medium or long term ”, note these professionals. For Anne Battut, midwife: “When the CNGOF says:” It is not recommended to do … “, it means that studies have not shown that doing this action reduces the risks. But it is not forbidden to do so! Quite the contrary. For the National College of Midwives of France, there are two elements to distinguish: perineal education and perineal rehabilitation. Who are the women who are aware of situations that can be harmful or beneficial to the perineum? Or those who know how to preserve it on a daily basis? Women should have a better knowledge of this part of the anatomy ”. For the moment and since 1985, perineal rehabilitation (approximately 10 sessions) is fully covered by Social Security, for all women, after childbirth.

Perineum: a muscle to tone

Now postnatal visit with the gynecologist or midwife, within six to eight weeks after childbirth, the professional will assess our perineum. It is possible that it does not notice any anomalies. It will still have to be resonated with contraction exercises to do at home, before resuming any sporting activity. One can, from the day after childbirth, practice “false chest inspiration”As advised by Dr. Bernadette de Gasquet, doctor and yoga teacher, author of“ Périnée: let’s stop the massacre ”, published by Marabout. It is about exhaling fully: when the lungs are empty, you have to pinch your nose and pretend you are taking a breath, but without doing so. The belly is hollow. This exercise should be done two or three times in a row to feel the abdominals and perineum go up. You should not wait to practice these reinforcements. Newborn babies may feel a feeling of heaviness in the stomach when standing, as if the organs are no longer supported.

Perineum: we put it at rest

In an ideal world, in the month following childbirth, more time should be spent lying down than standing over a 24-hour period. This prevents further distension of the pelvic floor muscles. It is exactly the opposite that society imposes on mothers! We continue to give birth in a gynecological position (bad for the perineum) and we are forced to stand up as quickly as possible to take care of the newborn (and go shopping!). While it would take stay in bed and get help. Another problem is postpartum constipation, which is frequent and very harmful to the pelvic floor. It is important not to let constipation set in, and never “push”. When we are in the bathroom, to lighten the weight on the perineum, we place a dictionary or a step under our feet. We avoid staying too long in the seat and we go there as soon as we feel the need.

When perineal rehabilitation is essential

After childbirth, There are three groups of women: 30% have no problem, and the remaining 70% fall into two groups. “In about 40% of cases, at the postnatal visit, we notice that the muscles of the perineum are slightly distended. There may be vaginal air noises (during sex) and incontinence (urinary, anal or gas). In this case, in addition to the personal exercises that you have done at home, start a rehabilitation, at the rate of 10 to 15 sessions, with a professional ”, advises Alain Bourcier, perineologist. Electrostimulation, or biofeedback, is training with episodes of relaxation and relaxation, using electrodes or a probe inserted into the vagina. This training is however a little limited and does not allow you to know in depth the different stages of the perineum. Dominique Trinh Dinh, midwife, has developed a rehabilitation called CMP (Knowledge and Control of the Perineum). It’s about visualizing and contracting this set of muscles. Exercises should be continued at home every day.

Practitioners specializing in perineum rehabilitation

Last but not least, in 30% of women, the damage to the perineum is very important. The incontinence is present and there may be a prolapse (descent of organs). In this case, the patient is sent for a perineal assessment in a specialized center, where an X-ray examination, urodynamic exploration and ultrasound will be performed. If you are concerned, contact a physiotherapist or a midwife specializing in perineal pathology. The number of sessions will be assessed in the light of needs. This perineal rehabilitation is essential to regain tone and prevent the disorders from worsening during menopause. If symptoms persist despite careful rehabilitation with qualified healthcare professionals, surgery should be considered. It is possible to benefit from the implantation of a suburethral sling, of the TVT or TOT type. Qualified as “minimally invasive surgery”, it involves placing, under local anesthesia, a self-adhesive strip at the level of the urethral sphincter. It helps stop urinary leakage on exertion, and does not prevent having other children afterwards. Once the perineum is well toned, we can get back to sport.

Three ways to build muscle at home

Geisha balls

Considered as sex toys, geisha balls can help with rehabilitation. These are spheres, usually two in number, connected by a thread, to be inserted into the vagina. They can be of different sizes, shapes and materials (silicone, plastic, etc.). They are inserted with a little lubricating gel and can be worn during the day. It will stir up the perineum of those who do not need rehabilitation strictly speaking.

Vaginal cones

This accessory weighs approximately 30 g and fits into the vagina. It is equipped with a cord similar to that of a tampon. The different shapes and weights make it possible to adapt the exercises according to the capacity of the pelvic floor. Thanks to a natural mechanism, the vaginal cones perfect perineal rehabilitation exercises. One should try to hold these weights while standing.

Perineum fitness

There are neuromuscular electrostimulation devices that help strengthen the perineum at home. The 8 electrodes placed at the top of the thighs contract and consolidate all the muscles of the pelvic floor. Example: Innovo, 3 sizes (S, M, L), € 399, in pharmacies; partially reimbursed by Health Insurance in the event of a medical prescription.