Il perineum it is the area that lies between the vaginal opening and the rectum. The perineum is the outermost part of the pelvic floor: the set of muscles, bands and ligaments that delimit and close down the bowels, the urinary and reproductive systems. This area extends during childbirth and sometimes the perineum is torn during the birth of the baby or an episiotomy can be performed during delivery, which is a cut in this area to facilitate the baby's exit.
In this article
- Perineum: what is it
- Perineum: how it is made
- Pathologies of the perineum
- Pelvic floor exercises
- Prolapse of the pelvic organs
- Perineal massage
Perineum: what is it
The perineum is located in two triangles, the upper one surrounding the vagina and urethra and the lower one surrounding the anus (anal region). Between the urogenital and anal regions is the tendon center of the perineum. When the perineum does not perform its functions at its best, it can undergo alterations and disorders, including important ones, including urinary incontinence. This disorder affects both men and women, but the latter are more affected especially in the period of menopause.
Other dysfunctions caused by changes in the perineum can be:
- Pelvic pain for more than six months
- Urinary retention
- Urinary urgency
- Slow and painful urination
- Anal pain
- Sexual problems
- vulvar pain
- Pain during sexual intercourse
- Prolapse, that is, the loss of organs.
Perineum: how it is made
The female perineum is a diamond-shaped structure lower than the pelvic diaphragm, between the pubic symphysis and the coccyx, and between the inner faces of the thighs. The perineum has a roof formed by the pelvic diaphragm and a fascia and skin floor. It also contains the muscles and neurovascular system associated with the urogenital structures and the anus.
The urogenital triangle forms the anterior portion of the perineum. The female urogenital triangle houses the opening of the vagina, urethra and clitoris.
The perineal fascia of the urogenital triangle includes superficial and deep layers. The superficial perineal fascia has a fatty layer and a deeper membranous layer (Colles fascia). The fatty layer forms the thickened areas of the labia majora and mons pubis. In males, the fatty layer is much thinner and is absent in the penis and scrotum.
The anal triangle contains the anus and the ischioanal fossa, which are two wedge-shaped spaces between the skin around the anal canal and the pelvic diaphragm. They contain fat and loose connective tissue, which helps support the anal canal but is flexible enough to allow for expansion during bowel movements.
Pathologies of the perineum
Pelvic floor dysfunction pathologies are essentially due to hypotonia and / or dysfunction of the involuntary and striated muscle structures that participate in the constitution of the rectum, anal sphincters, levator ani and pubococcygeus muscle. The pelvic floor is in equilibrium when the three muscular, ligament and fascial components coexist in equilibrium. A good pelvic floor keeps the endopelvic structures in suspension, that is, it maintains pelvic static.
Causes that predispose the pelvic floor to strong stresses, often interfering with the normal balance of this area:
- the pregnancy
- chronic cough
Most women experience trauma to the perineum when they give birth to their first child. Some will experience a more severe tear that extends beyond the vagina, deep into the adjacent muscle or anus. Trauma can make it difficult to walk, use the bathroom, or perform other daily functions. This pain can last for several weeks.
Pain can affect the muscles below the perineum. More severe tears can cause ongoing muscle problems, which can be very painful and can affect the function of the urinary bladder or even that of the anal sphincter. Some women also experience pain during sex. Cold compresses and ice sprays can help treat the pain.
Pelvic floor exercises
Pelvic floor exercises strengthen the muscles around the bladder, butt, and vagina. Strengthening the pelvic floor muscles can help urinary incontinence, treat pelvic organ prolapse, and even improve sex. Everyone can benefit from pelvic floor exercises.
Find your pelvic floor muscles. You can feel the pelvic floor muscles if you try to stop the flow of urine when you go to the bathroom.
It is not advisable to regularly stop the flow of urine in the middle of the flow as it can be harmful to the bladder.
Pelvic floor exercises
To strengthen the pelvic floor muscles, sit comfortably and squeeze the muscles 10 to 15 times. Do not hold your breath or contract the muscles of your stomach, buttocks or thighs at the same time. As you get used to doing pelvic floor exercises, you can try holding each contraction for a few seconds. Each week, you can add more compressions, but be careful not to overdo it and always rest between sets of compressions. After a few months, you should start noticing results. You should keep doing the exercises, even when you notice they are starting to work.
Pregnancy and pelvic floor exercises
If you are pregnant or planning to get pregnant, you can start doing pelvic floor exercises right away. Exercises will reduce the chance of suffering from incontinence after giving birth.
How Pelvic Floor Exercises Can Help With Sex
Strong pelvic floor muscles can also mean increased sensitivity during sex and stronger orgasms.
Prolapse of the pelvic organs
Pelvic organ prolapse occurs when one or more organs in the pelvis slide out of their normal position and swell in the vagina. It can be the uterus, intestines, bladder or the upper part of the vagina. A prolapse is not life threatening, but it can cause pain and discomfort. Symptoms can usually be improved with pelvic floor exercises and lifestyle changes, but medical treatment is sometimes needed.
Symptoms of pelvic organ prolapse
- a feeling of heaviness around the lower belly and genitals
- a dragging discomfort inside your vagina
- feeling that there is something going down your vagina - it could feel like sitting on a ball
- feeling or seeing a lump or lump in or out of your vagina
- discomfort or numbness during sex
- problems peeing - such as feeling like your bladder is not emptying completely, needing to go to the bathroom more often, or leaking a small amount of pee when coughing, sneezing, or exercising (stress incontinence)
Sometimes pelvic organ prolapse has no symptoms and is found during an internal examination done for another reason, such as cervical screening.
Treatment for pelvic organ prolapse
If you don't have any symptoms, or the prolapse is mild and doesn't bother you, you may not need medical attention. But making a few lifestyle changes will likely still help.
- lose weight if you are overweight
- avoiding heavy lifting
- prevent or treat constipation
If the prolapse is more severe or the symptoms are affecting your daily life, there are several additional treatment options to consider.
- pelvic floor exercises
- hormone treatment
- vaginal pessaries
Recommended treatment will depend on the type and severity of the prolapse, symptoms, and general health.
Causes of pelvic organ prolapse
Pelvic organ prolapse occurs when the group of muscles and tissues that normally support the pelvic organs, called the pelvic floor, weakens and fails to hold the organs firmly in place.
A number of things can weaken the pelvic floor and increase the chances of developing pelvic organ prolapse.
- pregnancy and childbirth - especially if you have had a long and difficult birth or if you have given birth to a large baby or several babies
- getting old and going through menopause
- being overweight
- have long-term constipation or a long-term health condition that makes you cough and fatigue
- have a hysterectomy
- a job that requires a lot of heavy work
Certain health conditions can also make a prolapse more likely, including:
- joint hypermobility syndrome
- Marfan syndrome
- Ehlers-Danlos syndromes
The 4 main types of prolapse are:
- the bladder protruding into the anterior wall of the vagina (anterior prolapse)
- the uterus swells or hangs in the vagina (uterine prolapse)
- the upper part of the vagina goes down - this happens to some women after they have had surgery to remove their womb
- the intestine protruding forward into the posterior wall of the vagina (posterior wall prolapse)
It is possible to have more than 1 at the same time.
Pelvic organ prolapse will usually be graded on a scale of 1 to 4 to show how severe it is, where 4 is severe prolapse.
The perineal massage aims to stretch the perineal tissues in preparation for childbirth. Research shows that perineal massage in the third trimester could reduce the chances of perineal trauma in the case of a first birth. According to experts, the ideal would be to start around six weeks before the expected date of delivery, and in any case starting from the 34th week of pregnancy.Article Sources: NHS, nct.org.uk, dummies, Perineal Massage During Pregnancy
- perineum pregnancy
- perineum exercises
- perineum childbirth