How are the perineal rehabilitation sessions conducted?

what is the dam

A complex group of muscles in the lower pelvis that perineum remains today an anatomical zone often unknown to women … but also to men! “It’s no coincidence that the nerve that innervates much of the perineal area and genitals was formerly called the pudendal nerve,” notes Dr. Bernadette de Gasquet. This naming reveals the humble veil that the anatomists of bygone ages cast over this part of the human body…”. Also called pelvic floorthe perineum stretches like one hammock from the posterior surface of the pubic bone in front to the coccyx in the back. “It enables the functions of urination, defecation and continence,” the specialist continues. This muscle is also involved in sexual and reproductive function. After all, it plays a supportive role for the organs.”

You have leakage of urine When you sneeze, do you laugh or strain? You feel pains Where from discomfort during sex ? You probably need a perineal rehabilitation.

56% of women have urinary incontinence problems, including more than 49% before age 40, says Dr. de Gasquet. And it’s not just women who have had many children or do hard labour!

Rigorously tested during pregnancy and childbirth, muscles of the perineum lose volume. When visits after childbirth which takes place six weeks after the birth, your doctor or midwife will assess its tone and determine whether or not you need rehabilitation. Know that a Caesarean sectiona episiotomy or even one Crack are not contraindications for perineal rehabilitation.

When to start rehabilitation of the perineum after childbirth?

As a rule, the perineal rehabilitation sessions begin six to eight weeks after birth. “Traditionally, it is estimated that you have to wait six weeks because with hormonal impregnation the muscle response is not the same, confides the specialist. But this period of after childbirth is a high risk for the dam! As a matter of fact, the uterus is heavy, the ligaments stretched, the abdominal muscles too “big”, the perineum relaxed by hormones. However, the mother often stands with her baby in a very bad position: belly forward, shoulders back. Under the pretext that pregnancy is not a disease, we defy the laws of gravity! But let me remind you that they exist incident (descending of organs) that arise after birth because the mother is doing too much…”.

It all depends on the type of perineal rehabilitation. As a rule, at the first appointment, the midwife at which the physiotherapist will perform one « Test Manual » to assess the tone of your perineum. The techniques used then differ according to the therapist: manual rehabilitation, electrostimulation, biofeedback, etc. A rehabilitation session lasts on average one thirty minutes Twice a week.

What different rehabilitation options are there?

Manual rehabilitation

Thanks to the vaginal examination, the practitioner indicates to the patient which muscle to contract by guiding it with light pressure. “The awareness of the muscle contraction and its localization is easier thanks to the manual technique, confirms the High Health Authority. The therapist can vary the strength of the resistance and choose which part of the muscle to work.” How easy it is to find a well-toned perineum!

Rehabilitation through visualization

the manual perineal rehabilitation can also be doubled visualization exercises. “The CMP method – knowledge and control of the perineum – often taught by midwives – combines visualization exercises with strengthening work,” confirms Dr. Bernadette de Gasquet. The woman is half-seated on an examination table, knees bent, feet on the table, thighs apart, and the therapist inserts her fingers into her vagina. She asks the patient to imagine her vagina as a cave, i.e. to pull up the “drawbridge”. muscle pubo-rectalon the surface the “good woman’s curtains” contracting, visualizing the rise of the urethra and bladder, contracting right and left of the vagina with a variety of images”. Once the woman manages to visualize her vagina that her perineum responds and mobilized, the perception is spectacular and the work very delicate.”However, this method has its limitations, admits Dr. de Gasquet: the embarrassment of some women during the vaginal examination, a perineal non-response (in the case of neurological damage, coccyx problems, etc.), Visualization difficulties, etc. Therefore, in some patients electrostimulation better suited, at least initially…”.


Less commonly used after childbirth, through perineal rehabilitation electrostimulation starts six weeks after delivery at the earliest. Electrostimulation is based on the use of electrodes that are inserted into the vagina and send electrical impulses to contract the puborectalis muscle. ” That is totally pain free, assures Dr. de Gasquet. The woman thus becomes aware of the location of the muscles, perceives the sensations of contraction and relaxation that she may not be able to feel without this help when her perineum is very responsive. She can then reproduce these contractions more easily. When the responses are sufficient, electrostimulation is no longer required. Only the biofeedback be practiced before perhaps moving on to manual rehabilitation”.

The biofeedback

the biofeedbackmeanwhile allows the patient to check this the effectiveness of its contractions thanks a Probe inserted into her vagina. This connected probe records muscle activity and effort in real time. “This technique of feedback helps patients become aware of how it works pelvic floorwhether right or wrong,” states the High Authority for Health.

A perineal re-education, but it has its limitations. “The problem is that we’re only interested in the muscles and strengthening the muscles,” warns Dr. de Gasquet. The totality of the morphological and psychological peculiarities of the individual risk factors is not taken into account. Also, mostly they are Rehabilitation is carried out in the worst position : half-sitting, bent in two, grabbed, legs apart. the Diaphragm cannot move and this is the position where the dam is the least mobile! »

Perineal Rehabilitation: Midwife or Physiotherapist?

the rehabilitation of the perineum can be performed by one midwife or one physiotherapist. It is up to you to choose the practitioner with whom you feel most comfortable and safe. During the first appointment, a vaginal examination makes it possible to check the condition of the perineum and determine the number of sessions needed for its rehabilitation.

How long does the dam construction take?

It all depends on the condition of your perineum after childbirth! In general, it must be counted between 5 and 10 sessions regain some sound. The automatic medical prescription is ten sessions. Some patients need more time, others less. Perineal rehabilitation is fully covered by social security.

He is recommended that women slow down the first few weeks after birth keep their dam. “It shouldn’t be reinforced, it should be protected, so don’t press on it,” specifies the specialist.

And add: “In parallel with any perineal rehabilitation, it is important that every mother who has just given birth is aware of:

  • do not fall into the vicious circle of Constipation,
  • adopt the correct positions every day, especially when carrying your baby,
  • avoid gravity and Limit abdominal pressure ».

This means not standing for too long, avoiding heavy loads such as the pram tub or shopping and, if necessary, maternity divorce of the Hobby type, inspired by Japan.

Strengthening the perineum: what exercises can you do at home?

After the birth, certain exercises allow you to do this stimulate the uterus – who withdraw faster and thus become lighter – and deviate less from important rights. dr For example, Bernadette de Gasquet recommends performing a false chest inspiration (FIT©). ” It’s about exhale deeply – then the diaphragm goes up – then closing the mouth and nose by pinching the nostrils with the fingers and pretending to inspire by inflating the chest without air entering. this simple and very powerful exercise has particularly interesting implications for the perineum as it makes you aware that it’s opening inward and not by pushing on it.”

Rehabilitation of the perineum and cesarean section

Perineal rehabilitation after childbirth is not necessary because your child was born by cesarean section and not vaginally. On the other hand ! Between the weight of the baby in the womb and the relaxation of the tissues, the perineum is subjected to a lot of stress during pregnancy. It is therefore also necessary to make an assessment to check its tone and, if necessary, to start rehabilitation once healing is complete.

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