Perineal cut

introduction

The perineum is the group of muscles that stretch below the pelvis and around the anus and genital organs in humans. The perineum consists of numerous muscles whose tasks are to maintain the stability of the trunk and, on the other hand, to carry out holding processes. The perineum muscles are particularly important during continence and childbirth. The perineum muscles cannot always be moved consciously (usually only after pelvic floor training).

The perineum muscles also enclose and limit the external female sexual organs. They also play a crucial role in childbirth.

The perineum muscles can only be stretched to a limited extent. During the birth process, the child slides out of the uterus and wanders through the vagina, which, limited by the perineal muscles, is stretched to the maximum. Since the entrance to the vagina has to expand many times its normal size during birth, there is a risk that both the vagina and perineum muscles will tear during the birth process. To prevent this, a piece of the perineum muscles are cut as a precaution in women who are expected to tear. This increases the ability of the muscles to stretch in this area and the child can be born without any problems. After the birth, the severed ends of the muscles are sewn back together. While no anesthesia is used in the perineal incision (the woman does not feel the incision during childbirth), a local anesthetic is used in the suturing.

You might also be interested in the following article: The process of a birth.

The obstetricians usually decide spontaneously during the birth who needs to have a perineal incision. Several factors are decisive for this. On the one hand, it must be taken into account how narrow the vaginal opening of the patient is and how strong the perineal muscles are developed (a weakly developed musculature tends to give in during the birth process and in most cases does not have to be severed), and on the other hand, whether the child is larger than average Has. A perineal incision is usually not necessary for smaller children, while an incision is often required for older children.

Please also read: Pain in childbirth and complications during childbirth

Risks

Compared to other surgical interventions, the risks of a perineal incision are relatively low. The musculature in the area of ​​the perineum that is severed is only incised 1-2 cm. This area is sutured immediately after the birth and usually heals well.
Risks exist in one Wound healing disorder, that means that the sewn muscle ends do not grow together properly and cannot withstand the pressure. In this case, the muscles can tear open again and the wound can become infected. Infections in this area are relatively rare. It is also important that the outer edge of the vaginal entrance is stabilized by the obstetrician despite a perineal incision. Because despite a perineal incision, the vagina and the surrounding perineum muscles can tear in an uncontrolled manner.

Perineal tears represent a complex complication. They have to be sewn or reconstructed in a laborious manner. After a perineal incision, the muscles in the area cannot be fully used again due to the lack of stability. It can therefore happen that the urine cannot be held as usual immediately after giving birth. This temporary Incontinence but should disappear as soon as the muscles have completely grown together again. Despite all the precautionary measures, prolonged to permanent incontinence can still occur after a perineal incision.

Prevention / Avoidance

The question of whether or not to perform a perineal incision is not that easy to answer. The opponents postulate that perineal cuts are the number of Dam cracks The advocates of the perineal incision argue that perineal incisions avoid perineal ruptures.

When asking whether you can prevent or avoid a perineal incision, it should be noted that the most important thing is to avoid a perineal tear. If a perineal tear is likely, a perineal incision should be advised, as the risks and benefits are clearly on the side of the benefit. The smaller a child and the larger the woman's perineum area, the less the need for a perineal incision.
There are also numerous reports that forced pressing exercises during childbirth increase the risk of perineal rupture. From a conventional medical point of view, however, a speedy delivery process is very important for the safety of the child.
It is also said that lying on the back at birth increases the risk of perineal rupture / incision risk. Midwifery associations recommend different body positions for delivery.
The most important measure to avoid perineal cuts is a safe one Dam protectionperformed by the midwife. A dam is one through the Obstetrician performed holding technique that limits and supports the edges of the perineal muscles accordingly. This holding technique ensures that the dam tears less frequently. Particularly well trained pelvic floors tend to be stable due to the muscular tone and tend not to make room for the born child, which greatly increases the risk of a perineal cut.

Leaving a pelvic floor untrained, however, does not make sense with regard to the consequences of childbirth (risk of incontinence). If the perineum incision is waited too long or deliberately avoided and the perineum tears, then this process cannot be revised by a subsequent perineal incision. Damage ruptures should be prevented in any case.
A further preventive measure is the Perineum massage Recommended shortly before birth to reduce strong muscle tone. Skin oils should be used for perineal massage.

Inflammation of the perineal incision

In a perineal incision, muscles of the perineal area are separated from one another by a scalpel in order to give the child more space during the birth process. These muscle ends are sutured again after the birth and closed with a bandage. As with any wound that needs to heal, there can always be inflammation that develops after such a surgical procedure. The risk of inflammation of the wound in the area of ​​the perineal muscles is rare but cannot be ruled out. Infections in the area of ​​the perineal incision usually set in after a few days.

Most of the time, self-dissolving sutures are used for perineal incision sutures. The first signs of a wound infection are a weeping wound, reddening of the wound, and pain. A gynecologist should have a Wound control be performed. It is essential to check whether the muscle ends have already grown together or whether there is a gap in the wound. In this case the seam should be corrected again.
In the event of infection, treatment should be carried out quickly. Chamomile baths that can be used regularly are available without medication. If that is not enough, antibiotics must be given. A preparation should be selected that is suitable for use during breastfeeding (see also Problems in breastfeeding) can be used safely. Mention would be e.g. Cefuroxime 500 mg 2 times a day.

Promote healing

How long it takes for a perineal incision to heal depends on several factors. First of all, the length and depth are crucial. The longer and or deeper a perineal incision, the longer the healing time as a rule. It is also important how good the general healing of the patient is. If healing disorders occur in the entire body, which is rather rare in young healthy people, healing disorders also occur in the area of ​​the perineal incision.
For faster healing, sufficient rest should first be observed. Lifting heavy loads should be avoided, as should any sporting activity. The perineum area can also be cooled. Another measure is the use of chamomile baths. Since chamomile has a disinfectant effect, chamomile baths promote faster healing and reduce the risk of infection in the area of ​​the perineal incision.

The area around the perineal incision should also be kept as dry as possible in order to prevent pathogens from breeding. After every use of the toilet, the perineum area should be cleaned with gentle lotions and then dried. Any abnormalities around the wound area should be presented to a doctor in order to avoid infection.

Also read the article: How does the vagina change after giving birth?

scar

As with any incision, when the perineal cut wound heals, one occurs Scarring. As a rule, this becomes less and less visible over time, but does not disappear completely. The finer the seam, the less you can see the scar. If appropriate rest periods are observed after the procedure, there are usually no complications of the Perineal scar.
Problems arise more often after perineal ruptures or very deep and long perineal incisions, in the case of corresponding infections or in the case of tears in the suture due to excessive stress. This is where the body has to build excessive connective tissue to cover the relevant skin defect. In the area of ​​this connective tissue, the muscle function cannot be maintained as in the rest of the muscle. Incontinence and difficulties in subsequent births can occur if large, plate-shaped connective tissue strips have developed.
There are numerous ointments, lotions, and gels designed for better scar healing.