Perineum and Pelvic Floor Repair - A Complete Guide!

The perineum is the area between the vagina and the anus. This fragile area plays a significant role in the female reproductive system. This is often intentionally or accidentally torn open to allow for the normal delivery of the baby. This needs to be repaired meticulously to ensure that the pelvic floor is safeguarded from further damage.

The pelvic floor contains multiple muscles and supporting tissues which help in keeping the vagina, rectum, uterus and supporting structures in their places. When these muscles become weak due to childbirth, ageing, perineal injury etc, the uterus, bladder and rectum loosen up and prolapse down.The most common problem that is encountered is urine and fecal incontinence, where the woman has difficulty holding urine and feces. Though not often discussed openly given the private nature of the topic, many women suffer from a weak pelvic floor. Read on to know some of the common causes, symptoms, and management measures.

Causes:

1. Chronic cough: The next time you cough for prolonged periods, notice how much pressure it puts on the pelvic area. This goes unnoticed, but chronic cough can weaken the pelvic floor muscles. It is not common for women to lose some urine during these long-drawn coughing spells.
2. Chronic constipation: The pressure exerted during constipation weakens the pelvic floor, often leading to incontinence.
3. Pregnancy and delivery: Most common cause of perineal injury, where the perineum is torn (accidentally or intentionally) to allow for easy passage of the baby. If it is not repaired meticulously, the pelvic floor is weakened.

Symptoms:

Urinary incontinence is the most common symptom that women present to doctors with. However, there are minor symptoms which a woman would experience prior to reaching this stage. Most often, these are ignored, and only brought to doctor’s notice when symptoms become quite severe. If left unattended, there could be more severe repercussions too.

1. A heavy feeling in the pelvic area, commonly referring to as a bearing down sensation, a feeling that the internal organs are going to pop out through the vagina
2. A small lump that can be felt and/or seen at the vaginal opening
3. Feeling of incomplete emptying of the bladder and/or bowel
4. Constipation
5. Pain or bleeding from the vagina or the rectum
6. Recurrent pelvic and/or urinary tract infections

Management:

1. Kegel exercises are often used to strengthen the pelvic floor. This is very effective if the problem is identified quite early.
2. In more progressive cases, surgical repair is the most effective option. This not only corrects the prolapses but also helps boost confidence of the person, by correcting the incontinence problems and improving sexual experiences. If you wish to discuss about any specific problem, you can consult a gynaecologist.