In this brochure you will find information about pain treatment, hygiene and advice on how to take care of yourself and protect your pelvic floor while the rupture is healing.

Anal sphincter rupture

During labour some women develop injuries to the anal sphincter. During the birth of your child, you developed such a rupture, which was treated after the birth. Some may experience problems with holding back gas, urine and in rare cases stool.

You will be visited by a physiotherapist who will talk to you about your injury and how you can take care of yourself while the rupture is healing.

Painkillers

In the first weeks after birth the wound might be swollen, sore and itchy in the area of your rupture . You will be offered painkillers containing paracetamol while you are hospitalized.

Even though you breastfeed, the painkillers will not affect your milk and you can continue taking them when you get home. E.g. two tablets of paracetamol, 3-4 times a day. If needed you can complement with ibuprofen 200 - 400 mg 3 times a day.

Painrelieving ice pads

You can use an ice pad to relieve pain and reduce the swelling. Wrap the ice pad in a cloth and put it on the perineum for about 15 minutes every second hour. You can continue the ice treatment as long as you need. Reusable packs can be bought in pharmacies or in drugstores.

Hygiene

In the first 3-4 weeks after birth it is recommended that you rinse with water and pat dry with a soft towel instead of wiping yourself after passing stool. After 3-4 weeks you can use toiletpaper.

It can ease the process of a bowel movement to add a firm but gentle pressure against the perineum with a folded sanitary pad.

After urinating it is okay to dab gently. If it stings while you urinate it may help to rinse with water while urinating.

How to avoid constipation

It is important to ease the pressure on the pelvic floor while the wound is healing:

• Eat food with high fibres.
• Eat regularly.
• Drink two litres of fluid every day.
• Avoid constipation.
• Avoid pressing when passing stool.

We recommend that you take a regular laxative, e.g. magnesia, which helps the stool remain soft and easy to pass. You can take 1-2 magnesia in the evening. While hospitalized you will be offered magnesia and you can continue taking them when you return home. It is more gentle for your pelvic floor to continue with magnesia than having constipation. Stop taking the laxative if you get diarrhea from it.

Protect the pelvic floor

The first 3-4 weeks after the birth you will need to take it easy so the wound can heal. It will be impossible to completely avoid pressure on your pelvic floor because when ever you laugh, rise up from a chair, cough, sneeze, etc. you will add an extra downward pressure on it. But you can minimize the pressure and protect your pelvic floor if you follow these guidelines:

In the first month:

• Avoid sitting or standing for a long period of time.
• When you sit you can use a soft pillow.
• Avoid sitting on a ring filled with air, as it will strain your pelvic floor.
• Only walk short distances.
• Lie down and relax when you feel pain or need a break.
• Lie down when you breastfeed.
• Avoid lifting more than your baby’s weight.
• Avoid heavy housework like vacuuming , washing floors and shopping.
• Train your pelvic floor muscles and do blood circulation exercises every day.

After the first month:

You can now gradually be more physically active. If you get sore from an activity it means that you overloaded your pelvic floor and you should ease the strain, e.g. sitting or standing for a shorter period of time.

Physical Therapy Evaluation

You will be offered a physiotherapy consultation one month after birth. The physiotherapist will examine your pelvic floor muscles in the vagina as well as the anal sphincter muscle. You will be asked if you have any problems concerning holding back urine, gas and stool or pain in the pelvic floor. You will be guided in how to continue training your pelvic floor muscles.

About six months after birth you will receive a questionnaire concerning pain, e.g. in relation to intercourse, and problems with holding back urine, gas and stool. If you wish to talk with an obstetrician you can check the box in the questionnaire. For example, you may want to discuss options for giving birth with future pregnancies.

When should you contact the hospital?

When the anal sphincter and the pelvic floor muscles are injured, it is common to have problems with holding back gas and urine in the first 3 months after the birth. If you have any problems with holding back stool right after you have been discharged, you should contact the maternity department at Hvidovre Hospital immediately: 3862 2410.

When can you resume sexual activity?

You can resume sexual activity when the pelvic floor muscles and the anal sphincter are healed. It takes about 4-6 weeks. If you experience soreness in the vaginal opening or canal, it can be helpful to use lubrication and anesthetic gel (Xylocain gel 2%). You can buy these items at the pharmacy without a prescription.

Most women feel ready to resume their sex life about 3 - 6 months after the birth. Talk to the physiotherapist or the doctor if you have problems with pain during intercourse.