The perineum after childbirth: the complete guide

You first hear of it during pregnancy, often in passing at an appointment. Then, within a few hours, it becomes the part of your body you think about most. The perineum. Discreet for years, it makes itself known from the day after the birth.

It has worked hard. It carried the weight of the uterus for nine months, stretched, and was sometimes stitched. What happens next is rarely explained with any precision. Here is what is useful to know to take care of it, without needless worry.

The perineum after childbirth: what are we talking about?

The perineum is a set of muscles and tissues that close the base of the pelvis, between the pubic bone and the coccyx. It is often described as a hammock. It supports the bladder, the uterus and the rectum. It plays a part in continence, in the stability of the pelvis and in sexuality.

During pregnancy, it carries a growing weight and softens under the effect of hormones. This is why the perineum after childbirth needs attention, whatever the mode of birth. It is not damaged. It is tired.

After a vaginal birth or a caesarean

After a vaginal birth

As the baby passes through, the perineum stretches a great deal. It may stay intact, tear slightly or more deeply, or be cut: this is an episiotomy. Stitches usually dissolve on their own within a few weeks. To follow this healing closely, read our article on episiotomy and tears.

In the first few days, the area is swollen, tender and sometimes painful when sitting. An instrumental birth, a heavier baby or a long pushing stage can make recovery slower.

After a caesarean

The perineum was not stretched by the baby passing through, but it carried the pregnancy. Leaks or a feeling of heaviness are possible too. Rehabilitation also concerns women who have given birth by caesarean.

Normal sensations in the first few weeks

Sensation	What is common	What calls for advice
Pain	Discomfort when sitting, easing day by day	Pain that increases, an area that is red, hot or weeping
Heaviness	A feeling of weight at the end of the day, in the first few weeks	A persistent feeling of a “ball” in the vagina
Urinary leaks	Small leaks when coughing or sneezing at first	Leaks that persist after rehabilitation
Wind and bowels	Difficulty holding in wind at first	Loss of stool or inability to hold it in
Sex	Dryness, apprehension about resuming	Pain during sex that persists

These sensations are most marked in the first few days. To soothe them, cold helps a great deal: our guide to the perineal ice pack explains how to use it. Other steps are detailed in our article on relieving perineal pain.

Caring for the perineum day to day

• Rinse with lukewarm water after each visit to the toilet, without rubbing, then pat dry.
• Use a gentle, fragrance-free intimate wash, once a day.
• Change your pad often, roughly every three to four hours.
• Avoid straining on the toilet: drink plenty, eat fibre, raise your feet on a small stool.
• Lie down as soon as you can, on your side, to relieve the pressure.
• Gently tighten the pelvic floor before coughing or sneezing, if it does not hurt.

Rest is not a luxury. It is part of the care.

Pelvic floor rehabilitation

When and how

In France, pelvic floor rehabilitation is usually prescribed at the postnatal check-up, which takes place six to eight weeks after the birth. It is carried out by a midwife or a physiotherapist. It is covered by the Assurance maladie, most often for around ten sessions; the exact number depends on the prescription and on your needs.

It starts with an assessment. Depending on what the examination shows, the sessions combine manual work, contraction exercises and sometimes a probe. The aim: learning to feel your pelvic floor, to tighten it and to release it at the right moment.

Who it is for

Working on the perineum after childbirth is useful even without leaks. Rehabilitation prepares the return to sport, protects you for the future and helps to restore sensation. If you have not been given a prescription, ask for one.

What is best avoided before rehabilitation

Until the pelvic floor has regained its tone, some efforts increase the pressure on the lower abdomen and ask too much of it.

• Traditional abdominal exercises. Crunches and sit-ups push the organs downwards. They are also inadvisable while the abdominal muscles are still separated: read our article on post-partum diastasis.
• Lifting heavy loads. Pushchair, loaded car seat, packs of water: delegate as much as you can.
• High-impact sport. Running, jumping and trampolining wait until rehabilitation is complete and the professional following you gives the go-ahead.

Walking, on the other hand, is welcome as soon as you feel ready. At your own pace.

The signs that call for advice

Most discomfort eases within a few weeks. Some signs, however, deserve a word with your midwife or doctor, without waiting for the postnatal check-up:

• urinary leaks that persist or increase;
• a feeling of heaviness or of a “ball” in the vagina;
• difficulty holding in wind or stool;
• pain during sex that does not go away;
• a scar that is red, hot, weeping or opening up, or a fever.

These signs are common and can be treated. Talking about them early always makes what follows simpler. In the event of a high fever with intense pain or feeling faint, contact the maternity unit or call 15 (the French emergency number).

Frequently asked questions

How long does the pelvic floor take to recover after childbirth?

The pain of the first few days usually eases within a few weeks. The tone of the pelvic floor, however, takes longer, often several months. Rehabilitation helps to restore it.

Is pelvic floor rehabilitation compulsory?

It is not compulsory, but it is recommended when the assessment calls for it and widely prescribed in France. It is useful even without leaks, particularly before returning to sport. Raise it at your postnatal check-up.

Do you need pelvic floor rehabilitation after a caesarean?

Yes, it can be useful. The pelvic floor carried the pregnancy for nine months, even if it was not stretched by the baby passing through. The assessment will tell whether sessions are needed.

Is it normal to have urinary leaks after childbirth?

Small leaks when coughing or exerting yourself are common in the first few weeks. They are not inevitable. If they persist, rehabilitation most often reduces them markedly.

When can you return to sport after childbirth?

Walking can resume as soon as you feel ready. For high-impact sport, it is better to wait until rehabilitation is complete and your midwife or physiotherapist gives the go-ahead. Gentle core work and swimming usually come before running.

A muscle waking up

The pelvic floor works in silence. You only notice it when it tires. Giving it time after the birth means taking care of what carries you, today and for a long time to come.

There is no rush to move quickly. There is a path, and professionals to walk it with you.

To place this work within the weeks that follow the birth, read the post-partum week by week.