The pelvic floor/perineal clinic in the urogynaecology department sees women who have sustained significant perineal (vaginal/anal) injury following childbirth. Symptoms can include pain, difficulty with sexual intercourse, scarring and/or urinary and faecal incontinence. These injuries can also cause significant psychological trauma.
The perineal area in women includes the vulva, vagina and anus. Whilst it is common to experience a tear in this area during childbirth, the majority of women make a full recovery, a small group of women tear more seriously and may tear the muscle complex around the anus, the anal sphincter, and these women sometimes need follow-up treatment.
Most patients have a good prognosis. Most women are seen in clinic once, where they undergo examination and testing. If these tests are normal and there are no significant symptoms, women are discharged from the clinic with physiotherapy follow up and advice about maintaining their recovery.
In the unlikely event that a full recovery has not been made, then women will be followed up more closely. Women are also offered counselling with a specialist midwife to assess the psychological trauma that they may still be suffering from.
Surgical procedures can be offered to women with severe perineal scarring or distortion which cause physical and psychological trauma and these are usually carried out as day cases.
Patients whom have had previous 3rd and 4th degree tears are seen at 20-24 weeks gestation in their next pregnancy for assessment and planning to minimise the chances of another tear. This consultation would also include deciding the recommended method of delivery e.g. caesarean section or natural birth.
