3rd & 4th degree perineal tears are also known as Obstetric Anal Sphincter InjurieS (OASIS). There are 2 grades of OASIS, and these tears occurs in the perineum, which is the area between the vaginal opening and the back passage, and extend to the anus.
- First degree tears — small skin deep tears which heal naturally.
- Second degree tears — deeper tears affecting the muscles of the perineum. These are usually repaired with stitches.
- Third degree tears — deeper tears that involve the anal sphincter muscles.
- Fourth degree tears — tears extending further up the anus into the rectum.
Some long terms effects of perineal tears and OASIS can include:
- bowel urgency
- difficulty controlling wind
- difficulty controlling bowel matter
- painful sex
After 6 weeks, and once the perineal area has healed you can begin to do some exercises to strengthen the area and reduce or prevent anal incontinence.
1. Pelvic Floor Exercises with an Anal Cue
These anal sphincter muscles need to be retrained as part of your pelvic floor, because the perineal injury can cause them to become lazy or switch off.
Lying on your back in an aligned neutral position.
Breathe in to relax your pelvic floor down.
Breathe out as you squeeze and lift your pelvic floor muscles focussing on the anus being pulled up towards your lower back.
Breathe in to relax the pelvic floor muscles back down.
Repeat 10 times.
Repeat another set in aligned sitting.
Repeat another set in aligned standing.
2. Pelvic Floor Elevator with an Anal Cue
You need to be able to control these muscles at different points so that you are able to control your wind and bowel movements and prevent accidental leaks or accidents.
Visualise your anal canal (from your anus to your rectum to the centre of the dimples in your lower back) as 3-storey building with an elevator in it.
Tighten your anus and pull it up a third of the way — bring the elevator from Ground Floor to Level 1
Tighten your anus further and pull it up two thirds of the way — bring the elevator to Level 2
Tighten your anus as much as you can and pull it up all the way — bring the elevator to the Roof.
Slowly release the elevator down to Level 2, then Level 1 and back down to Ground Floor
Repeat 3 times.
3. Anus Quick Flicks
You need your anal sphincter muscles to get stronger in their fast-twitch fibres and especially down at the exit, to help you overcome or manage bowel urgency.
Visualise the anus at the exit of your bottom as a circular muscle. Imagine trying to pull up a pea through the anus just 3 mm and back out again.
Do 10 quick flicks as fast as you can in a pulsing manner as you tighten the circular anus closed and release again.
4. Squats with Anal Sphincter Cue
Once you have mastered Exercise 1, you need to begin to integrate these anal sphincter muscle activations with movement. Since mothers bend down a lot or can sometimes lose control when moving from sitting to standing and vice versa, coordinating the anal squeezes with squats is important.
Begin in aligned standing.
Breathe in to sit your hips back into a squat, reaching your bottom back behind you and keeping your back straight and your knees behind your toes. You can float the arms up to counterbalance.
Breathe out as you squeeze and lift your pelvic floor muscles focussing on the anus being pulled up towards your lower back, and simultaneously rise out from the squat, as you squeeze your gluteal muscles.
Repeat 2 sets of 8 squats twice per day.
5. Bicep Curls with Anal Sphincter Cue
Once you have mastered Exercise 1, you need to begin to integrate these anal sphincter muscle activations with upper body work. Since mothers carry their children and objects a lot, sometimes they can lose control as they pick things up, so coordinating the anal squeezes with bicep curls is important.
Begin in aligned sitting. Have hand weights starting at 1–1.5kg and gradually progress.
Breathe in to prepare.
Breathe out as you squeeze and lift your pelvic floor muscles focussing on the anus being pulled up towards your lower back, and simultaneously bend your elbows and curl your biceps.
Breathe in as you relax your pelvic floor and straighten the arms down.
Repeat 2 sets of 8 bicep curls twice per day.