Our advice for effective pelvic rehabilitation

During childbirth, the perineal muscles are heavily stressed, and a tear or episiotomy may have weakened this area. It is therefore recommended to, a few weeks after the birth of the baby, a rehabilitate of the perineum, allowing your muscle to regain all its tonicity. Laure Mourichon, a physiotherapist, a sexologist and the author of Sexualité, maternité, parole de femmes, gives us her advice to better understand this step.


When should we begin pelvic rehabilitation?
During your visit to the gynecologist a few weeks after delivery, a prescription is systematically given to you for a rehabilitation about six weeks after the birth. Typically, a dozen sessions are registered, but the physiotherapist or midwife that you consult will tell you if you need less or more sessions to get the job done properly. Laure Mourichon recalls, however, “Rehabilitation in the office is six weeks after childbirth, but in fact you should begin to try to feel your perineum with little contractions in the first days after birth.” Postnatal rehabilitation should be covered by your medical insurance.

Why should you rehabilitate your perineum?
Even if you have avoided episiotomy and tearing during labor, perineal rehabilitation is still important. This muscle has already been harmed at the end of your pregnancy while the weight of the baby pressed on it, and the crowning period was inevitably intense for those tissues. For those who have had stitches, rehabilitation will help soften the scar. In general, “to ignore the rehabilitation of the perineum exposes you to risks of urinary issues and a lack of sensations during sexual intercourse,” explains L. Mourichon. These are convincing arguments to go to rehabilitation appointments without hesitation…

What is it?
“It’s a manual method of awareness of this muscle, with associated respiratory work,” Laure Mourichon reveals. A method that consists of a physical vaginal touch by the physiotherapist or the midwife to indicate to the patient what muscles she must contract. “Then,” Mourichon adds, “you may work with a probe that will allow you to visualize on a computer screen the holding of the contraction.”

How many sessions do you need?
It depends on the condition of your perineum. At the first appointment, the physiotherapist or midwife will provide a score of 5 to evaluate the necessary work. Laure Mourichon explains, “We talk about the patient’s childbirth to find out if it occurred vaginally, if there were forceps, an episiotomy or a tear. We must also understand the symptoms of the patient, whether she is in pain in that area, and if the perineum has retained its condition well. If she is breastfeeding, no hormonal recovery can be offered, so the perineum can not regain its full function until the end of breastfeeding.”

What benefits do we get?
For Laure Mourichon, perineal rehabilitation is necessary in many ways. Not only are we curing any feelings of heaviness or incontinence, but “we are exercising a muscle that we often did not notice before, which also allows us to play with its sexual benefits,” Mourichon says. “It is also important in the sense that the rehabilitation of the perineum makes it possible to return to a feminine course, to leave maternity ward.”

What exercises can we practice at home?
Rehabilitation of the perineum alone is not enough. Rehabilitation of the abdominals is also very important, as Laure Mourichon recalls. “It must be hypopressive, meaning a work of the deep transverse and abdominal muscles.” In the office, you will learn exercises that you can practice at home, such as lying on your back with your knees up and taking a deep breath. At the time of exhalation, deflate the belly until you have the sensation of sticking your belly button against the spine while contracting the perineum and keeping the vertebrae on the floor. Stay a few seconds in apnea when the lungs are emptied, and repeat the exercise.

Laure Mourichon, a physiotherapist and sexologist in Paris, author of Sexualité, maternité, parole de femmes, published by Robert Jauze.

Tiphaine Lévy-Frébault
Translation: Ashley Griffin

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