Severe Tearing During Childbirth: Consider Pelvic Floor Physical Therapy
Having a baby is considered to be one of life’s largest natural miracles. Taking care of a child is a task that comes with great responsibility, however many mothers should be cutting out time for themselves to reestablish optimal health. Your body goes through a lot of changes during pregnancy and postpartum that are overwhelming enough, and the pressure to re-establish your old body in today’s society can be daunting. One of these changes can be from a difficult childbirth that may result in an obstetric anal sphincter injury (OASIS).
An obstetric anal sphincter injury (OASIS) is a third or fourth degree vaginal perineal tear where the internal and external anal sphincter are injured. In a fourth degree tear, the anorectal mucosa is also involved. This type of injury can have effects on the pelvic floor muscles by affecting their ability to contract both rectally and vaginally. Scarring near a third or fourth degree perineal tear can also cause bothersome intercourse with penetration. Having an OASIS during your first delivery may increase your risk of a recurrent OASIS during your second delivery.
Current research is trending towards showing an increased risk of anal incontinence long term with history of an OASIS or recurrent OASIS injury. Anal incontinence is defined as the involuntary loss of feces.
New research emerging shows:
- OASIS is associated with an increased risk of anal incontinence 15-23 years later. One study showed women with OASIS have more than a doubled risk of longer term symptoms of anal incontinence versus controls.
- Forceps delivery can be associated with an increased risk of a fourth degree vaginal tear versus normal vaginal deliveries.
- Recurrent OASIS in second delivery may increase your risk of anal incontinence more. Having an OASIS with your first delivery increases your risk of having a recurrent OASIS with your second delivery.
Luckily, pelvic floor physical therapy can help address some of the issues that may arise post an obstetric anal sphincter injury (OASIS) during childbirth. Physical therapist specialized in the pelvic floor can:
- Help retrain your pelvic floor muscles so you can continue to maintain both urinary and fecal continence.
- Perform scar massage and manual therapy to the pelvic floor muscles in areas that may be restricted or painful.
- Make general dietary suggestions in avoiding bowel or bladder irritants while you may be experiencing any incontinence.
- Help retrain your core and hip strength that may have decreased during pregnancy.
I have often heard a wise saying that “an ounce of prevention is worth a pound of cure.” If you have had an OASIS injury during childbirth, it is a great idea to get your pelvic floor muscle strength screened by a physical therapist who can recommend an appropriate course of treatment. Anal incontinence does not have to be part of your future.
Andrea Wood, PT, DPT, PRPC
References:
Cornelisse S, Arendsen L, Martijn Job van Kutijk S, et al. Obstetric anal sphincter injury: a follow-up questionnaire study on longer=term outcomes. Int Urogynecol J. 2016; 27: 1591-1596.
Halle T, Salvesen K, Volloyhaug I. Obstetric anal sphincter injury and incontinence 15-23 years after vaginal delivery. Acta Obstetricia et Gynecolgica Scandinavica. 2016; 95: 941-947.
Jango H, Langhoff-Roos J, Rosthoj S, et al. Recurrent obstetric anal sphincter injury an the risk of long term anal incontinence. Am J of Obstet and Gynecol. 2016; doi: 10.1016/j.ajog