Feeling of heaviness in the perineum after childbirth. Care and possible negative consequences after a perineal incision

Even after childbirth, uncomplicated by a rupture or incision of the perineum, it would be good to do the Kegel exercise or any of its modifications from the second day after childbirth. It is important to understand that you cannot “pump the press” without tightening the muscles of the pelvic floor.

If there was damage to the perineum, then it is important to understand that you cannot sit for the first two weeks. It is very important to properly get out of bed and lie down on it. Here's how to make it easier: Lying on your side, slide over to the edge of the bed and stand up on your top leg and help yourself with your hands. We must try to keep the knees together, because when the legs are spread, the muscles of the perineum are stretched, on which the stitches were applied. Keeping her knees together, the woman lies down on the bed. Within 2 weeks after birth, the baby will be fed only in the supine position.

Being in the ward with the baby, of course, is also possible if there are stitches on the perineum. When caring for a baby, a mother spends a lot of time in vertical position. In this case, the organs of the abdominal cavity and small pelvis "press" on the pelvic floor. In the perineal area, a woman may experience discomfort, heaviness, discomfort. That is why it is so important to lie down on the bed with a pillow under your buttocks. In this position, the load on the muscles of the perineum is reduced, they "rest", the healing of the sutures improves. You need to rest in this position even after discharge from the hospital.

In the maternity hospital, the stitches on the perineum will be processed by a midwife according to special rules.

When you are at home

Mom will need to go home from the maternity hospital reclining in the back seat of the car. It will be possible to sit in 10 days, and you need to start sitting on hard chairs. There is no need to sit in a low easy chair, because the scar on the perineum has not yet grown stronger, and there is a possibility of its divergence. Knees, as before, try not to breed widely. For the first 10 days, continue to feed the baby lying down, then choose the most comfortable position.

It is necessary to monitor the work of the intestines, the chair should be every day and not cool. To do this, include vegetables, fruits, dairy products. Of course, we are talking about products that are allowed for a nursing mother.

At home, it is also very important to properly care for the scar on the perineum. We continue to wash ourselves several times a day, especially after the act of defecation. good to use special means for intimate hygiene. The perineum should not be rubbed, it is better to get wet with soft movements. At this time, it is better to use not a towel, which is familiar to us, but disposable napkins. You should not use one pad all day, it should be changed often, especially after feeding or pumping. There will be more secretions at this point because the hormone oxytocin contracts both the uterus and the milk ducts. Remember to rest with a pillow under your buttocks. Use this time to air baths: at the time of rest, take off your clothes and underwear.

The scar on the perineum can not be lubricated with anything, but essential oils can be used for speedy healing. Strong antiseptic property has tea tree oil, manuka, kayaput; contribute to the healing of palmarosa oil, Roman chamomile. Dilute 1 drop of oil in 5 ml boiled water and a cotton swab after each visit to the toilet, treat the perineum with this solution or do baths with it. You can make applications: in solution essential oils moisten a washcloth, squeeze out excess water and apply to the sore spot.

Propolis has a good analgesic, anti-inflammatory and regenerating effect in the form of alcohol solutions and ointments. You can already find it on sale finished preparations. So in the Israeli company BABY TEVA there is a "Complex of oils for processing postoperative sutures". The composition of this tool includes almonds, calendula, geranium, lavender, patchouli, thyme, gum resin.

When all the discharge from the genital tract is over, you can begin to live a sexual life. In the event of a perineal injury during childbirth, women may have some fear of resuming sexual intercourse. Explain your fears to your partner, ask him to take his time and wait fully prepared to contact. Use special lubricants, select a position in advance in which the pressure on the perineal scar will be minimal. In the same company BABY TEVA there is an "Exciting oil for erotic massage". By the way, it can be used during pregnancy.
We continue to do special exercises for the crotch. The first 7-10 days of classes will go in a prone position, then we add exercises on all fours. Only by the end of the first month can you do standing exercises. Do not run, jump, dance. It's better to postpone it.

Tears are among the most common injuries that occur during childbirth. They occur at the stage of expulsion of the fetus from the uterus. Perineal rupture is one of the most common injuries of this type. It is mainly associated with insufficient elasticity of the tissues of the organ.

Causes of perineal tissue trauma during childbirth

The perineum is a collection of pelvic floor muscles between the anus and the posterior wall of the vagina. It consists of the anterior (genitourinary) and anal regions. During childbirth when the fetus passes through the birth canal soft tissues the crotches are stretched. If the elasticity is insufficient, a gap is inevitable. The frequency of pathology is approximately 1/3 of the total number of births.

Predisposing factors include:

the first childbirth after the age of 35, when there is a natural decrease in muscle elasticity;
incorrect behavior of the woman in labor - especially characteristic of inexperienced primiparous women who tend to panic and not follow the commands of the doctor and obstetrician;
untimely or incorrectly provided medical care;
application obstetric forceps or vacuum extraction;
rapid delivery - pressure on soft tissues increases significantly;
inflammatory processes in the genitals, leading to thinning and decrease in muscle elasticity;
scars left after previous injuries or surgical procedures;
weakness of labor activity, prolonged attempts, causing swelling.

The threat of perineal rupture increases with or the birth of a large fetus (more than 4 kg), during childbirth after 42 weeks of gestation (post-term baby).

The classification of birth injuries of the perineum allows us to distinguish the following degrees of severity of ruptures:

Grade 1 - there is damage to the outer layer of the vagina or a violation of the integrity skin;
2 degrees - mark injuries to the muscle layer of the organ;
Grade 3 - traumatized external sphincter up to a complete break;
Grade 4 - occurs in rare cases, injuries of the walls of the rectum are characteristic.

If the posterior wall of the vagina, the muscular layer of the pelvic floor and the skin of the surface are affected, while maintaining the integrity of the anus, a central rupture of the perineum is diagnosed. In this case, the birth of a child occurs through an artificially created channel. This severe injury is extremely rare.

Treatment of injuries should be immediate, as they are fraught with serious consequences. The most dangerous among them is severe bleeding. Through open wound pathogens can easily enter the body, causing an inflammatory process in the genitals.

To more distant negative consequences birth injury perineum can be attributed to violations of the microflora of the vagina,. Grade 3 and 4 tears can lead to urinary and fecal incontinence, other disturbances in work urethra and rectum.

Diagnosis of damage is not difficult. Immediately after the end of childbirth (placenta exit), the doctor examines the condition birth canal, which allows you to determine the presence of gaps and their severity.

Treatment

After identifying injuries with the help of special vaginal mirrors, they are sutured. It is very important to determine the severity of the damage. A first and second degree perineal tear requires suturing, which is performed under local anesthesia. The integrity of the perineum is restored with catgut sutures, which dissolve on their own over time, or with silk sutures, which must be removed. At the first degree, the seams are applied in one layer, at the second - in two.

Treatment of grade 3 tears involves the use of general anesthesia. The woman in labor is examined not only the muscle layer, but also the anus and rectum. In this case, suturing begins with the restoration of the integrity of the walls of the rectum and sphincter. Then suturing is performed to eliminate damage to the skin. Suturing is carried out immediately or within half an hour after childbirth.

If there are risks of rupture during childbirth, at birth big baby and in the case of rapid labor, an episiotomy (perineal incision) is indicated. Thanks to this intervention, the exit from the vagina becomes wider, which prevents damage to the rectum and blood vessels.

Conduction helps not only to avoid injury to the woman in labor, but also stops bleeding and minimizes Negative consequences for a child.

Before making an incision, the genitals are treated iodine solution. The dissection is performed with the help of special scissors at the moment when the attempt becomes the most intense. This moment is more favorable for manipulation, since when strong tension the woman feels less pain. The length of the cut is 20 mm.

Seam care after suturing tears

How long does a perineal tear heal after childbirth and how to properly care for the stitches?

Self-absorbable sutures take two weeks to heal. Usually the process goes well. Seams from other materials will be tightened within a month. Recovery time depends on individual features organism and severity of ruptures. The patient must know the rules of care and follow medical recommendations that will help her recover as soon as possible.

Rules of conduct after childbirth:

Regularly treat the seams with brilliant green or a solution of potassium permanganate (at least 2 times a day). Immediately after childbirth, this is done by the midwife, in the future, the processing is done independently.
Observe the rules of personal hygiene: wash the genitals as often as possible warm water, change pads every 2-3 hours;
Wear only cotton Underwear. It should be free and not exert excessive pressure on the perineum.
When taking a shower, direct the water jet from top to bottom. Do not rub the genitals with a washcloth or hard towel. Dry the skin with gentle blotting movements.
While at home, it is recommended to dry the affected area with air baths, ointments (Solcoseryl, Bepanten), and do special gymnastic exercises.
Do not lift weights above 3 kg, avoid physical activity and doing sports.
Introduce foods into the diet that provide normal bowel movements and eliminate constipation.
The sexual life of the spouses can be resumed no earlier than 1.5-2 months after the complete healing of the injuries.

Separately, it is necessary to highlight the need for regular visits to the toilet. The process of urination and defecation delivers strong pain. Fear of pain and discomfort makes a woman postpone the process to the last. Cluster stool puts even more stress on the muscles of the perineum, which only exacerbates the severity of the situation.

Pain medications may be prescribed to relieve pain and glycerin suppositories to soften stools. With severe swelling, an ice pack is applied. For third-degree tears, antibiotics are prescribed to prevent infection of the rectum.

During the first 10-14 days after suturing the gaps, it is forbidden to sit. Mom should rest more, not make sudden movements. Eating should be done standing up or lying down using the bedside table. The baby should be fed lying down.

How long can you sit?

You can sit on hard surfaces after two weeks, on soft surfaces after three weeks. When returning from the maternity hospital in a car, the patient is recommended to take a reclining position to eliminate pressure on the perineum.

Complications

Among frequent complications allocate:

painful sensations;
divergence of seams;
severe itching and swelling;
suppuration;
bloody issues.

To relieve pain and itching, heating with a quartz or infrared lamp is prescribed, lubricating the seams with Contractubex ointment. Itching often indicates a healing process, but if it is too bothersome, washing the genitals with cool water is recommended.

Discharge of pus usually indicates the penetration of an infection. In this case, antibiotics, ointments Levomekol, Vishnevsky, Solcoseryl are prescribed. Chlorhexidine and hydrogen peroxide are used to disinfect the wound cavity. The presence of bleeding requires additional suturing of the damaged area.

Most dangerous complication occurs when the seams are torn. In this situation, it is strictly forbidden to self-medicate. The woman should immediately call ambulance. Re-suturing is usually required in a medical facility.

Rupture Prevention

There is a popular belief that it is inevitable. This is not true. You can prevent damage to the perineum through careful preventive preparation during pregnancy. Preventive measures include performing special intimate gymnastics, perineum massage.

Massage

The best prevention is regular massage. It can be done at any time, but still the best period is the third trimester. The benefits of massage are as follows:

activates blood circulation, improves metabolism in tissues;
trains the muscle tissue of the perineum;
gives the muscles the necessary softness, suppleness and elasticity;
promotes relaxation, which significantly reduces the risk of injury.

For maximum effectiveness, perineal massage for the prevention of ruptures is performed using natural oil. You can use linen, pumpkin, burdock, olive oils. There is also a special oil for perineal massage, which can be purchased at a pharmacy.

Before the massage you need to take a warm shower. intestines and bladder should be emptied, hands should be washed thoroughly. The perineum, genitals and fingers are lubricated with oil. A woman needs to take a comfortable position and relax as much as possible. With fingers inserted into the vagina, soft movements are made towards the anus, pressing on the back wall of the vagina. Pressing should be alternated with the usual massage movements.

The duration of the massage is 5-7 minutes. Usually it is difficult for a woman to carry out the procedure on her own, because her stomach interferes, so the help of people close to her is very desirable. A number of contraindications should be taken into account in which massage cannot be performed. In particular, these are inflammatory and infectious diseases of the genital organs. Massage in this case can be carried out only after a complete cure, otherwise it will contribute to the further spread of infection in the body.

Massage is categorically not recommended if there is a threat of miscarriage or if the fetus is incorrectly presented and if the pregnant woman has skin diseases. It is very important that the procedure does not cause any negative emotions or physical discomfort. Before performing it, you need to obtain the consent of the doctor who is observing the expectant mother.

Gymnastics

To effective prevention includes the performance of special gymnastic exercises that help improve the elasticity of the perineum.

Exercise 1. Become sideways to the back of the chair and rest your hands on it. Take the leg alternately to the side 6-10 times.

Exercise 2. Set your feet wide. Slowly sit down, holding the body in this position for a few seconds, then also slowly rise. Do the exercise 5-6 times.

Exercise 3 Put your feet shoulder width apart. Breathing deeply, alternately draw in the stomach, and then relax its muscles. The back should be straight.

Exercise 4 Alternately strain and relax the muscles of the anus and vagina. The exercise can be done both in the supine position and sitting. This exercise can be performed not only at home, but also at work and even in public transport.

Food

A pregnant woman should also pay attention to her diet. Vitamin E must be included in it. It can be taken both in capsules and drunk vegetable oil which is rich in these vitamins. The menu should include fish that is rich fatty acids or fish fat. From 28-30 weeks it is recommended to take a dessert spoon apple cider vinegar before breakfast.

The elimination of meat in the third trimester also contributes to the prevention of ruptures. If a woman is not ready for such a decision, you should at least not include smoked products in the menu.

To others preventive measures should include:

regular visits to the gynecologist, the implementation of all his recommendations;
timely registration for pregnancy (no later than 12 weeks);
attending antenatal training courses to teach proper behavior during childbirth;
timely detection of inflammatory processes in the genital organs and their complete cure even at the stage of pregnancy;
following all the instructions of the doctor and obstetrician during childbirth.

Intimate plastic surgery without surgery (recovery of the perineum after childbirth), biorevitalization of the intimate zone with hyaluronic acid)

Intimate plastic surgery without surgery (recovery of the perineum after childbirth), biorevitalization of the intimate area with hyaluronic acid

The cost of the procedure for biorevitalization of the intimate zone is 15500 UAH using 2 ml hyaluronic acid

The vagina after childbirth, especially if this is not the first childbirth or childbirth with a large fetus, loses its original properties. For some women, the recovery process after childbirth is fast. But, unfortunately, these women make up only a small percentage. The main problem - the gaping of the entrance to the vagina after childbirth - is not only a problem, or rather, far from being only an aesthetic one.

Consider purely medical aspects Problems:

The function of the barrier to bacteria is lost - normal bacteria cannot linger (discharge from the vagina is observed in women), then, according to the principle “a holy place is never empty”, a “bad” microflora inhabits the depleted “soil”, thrush develops, bacterial vaginosis and d.t. Restoration of the microflora of the vagina helps only for a while. There is no barrier function, normal bacteria “exit”, pathological ones “come in”. Not much in this process important role other factors play - wearing panty liners all the time, intimate hygiene products with allergens, dietary habits, thong underwear, etc.
Flabbiness of the muscles of the perineum contributes to the progression of the prolapse of the internal genital organs (uterus with appendages). At first, there is no omission, often gynecologists do not focus on the problem of gaping the entrance to the vagina. This approach is not rational, because at this stage, it is still possible to stop the process without surgical intervention.
The function of adjacent organs is disturbed, one of the most unpleasant problems is stress urinary incontinence - when urine spontaneously leaks when jumping, sneezing or coughing, constipation is also possible, or vice versa, fecal incontinence.

Now let's touch the problem from the other side. In my opinion, a much more dramatic and unpleasant topic of self-doubt after childbirth.

Women with "relaxation" of tissues after childbirth often do not betray this problem, believing that having fulfilled their childbearing function, they can no longer be "full-fledged" in terms of their personality. This approach creates a bunch of psycho-emotional problems. Self-doubt, fatigue, a cardinal change in the rhythm of life and goals after the birth of a child does not go away on its own, but develops into a lot of interpersonal problems: with a husband, children. A self-confident woman builds relationships in the family more skillfully, raises her children to be more successful and happy, her husband is always passionate about her and does not look at others. Where does insecurity come from? Previously, it was not necessary to live for another person (child) - this is a big responsibility, and it is round-the-clock! Name me a position where an employee works 24 hours a day, seven days a week and with irregular sleep? And does it actually do it for free? YES, YES, it's a mother's job! Naturally, such a regime creates a feeling chronic fatigue. Plus, if the child is not one, but two - you, as a responsible person, need to pay attention to everyone equally, in addition, teach brothers and sisters to interact with each other in a quality manner so as not to raise two enemies. And there is also a husband who will ask a fair question: “But what about me?”. In turn, you ask, where to find a place for yourself? The personality of the beautiful and clever girl gradually begins to fade and fade against the background of the interests of all the above family members. I'm not talking about cleaning up, feeding everyone, etc.

It was a lyrical digression from the topic. We started about problems intimate life after childbirth.

What measures can be taken to increase the elasticity of the renewal of sensations for you and your spouse?

Kegel exercises. Physical tension and relaxation of the pelvic floor muscles. Proper and regular performance leads to an increase in the tone of the muscles of the perineum. Try holding your urination while emptying your bladder. You will see which muscles are working. Then, without urinating, you begin to clamp these muscles in three stages: a little, harder and as hard as possible. At maximum tension, stay for 5-7 counts, then relax the muscles in the same way in stages: relaxed a little, more, relaxed as much as possible. As soon as you relax, you immediately need to do it a second time, without rest. This is the key to proper training. Start with 5-7 times, gradually reach 30. Ideally, perform Kegel exercises 2 times a day, every day at any time. At the same time, you can put the child to sleep, cook, drive or walk.
An effective remedy replenishment of the lost volume in the vagina and closing the entrance serves insertion of an intimate filler which contains hyaluronic acid. For intimate plastic surgery special fillers of the compacted composition are used. The introduction of this substance allows non-surgical and safe restoration of the problem of "gaping" of the vaginal entrance (postpartum or age-related) and flabbiness of the tissue.

Advantages of the method of intimate plastic surgery using hyaluronic acid:

Does not require a hospital stay.
It is carried out under local anesthesia.
reversible procedure.
Childbirth after the procedure through the natural birth canal is not contraindicated.
Hyaluronic acid preparations have proven to be non-toxic
Restoring "intimate attraction" for a partner, increasing own self-esteem
Solving the problem of dysbacteriosis in the vagina (in combination with medications)
Prevention of prolapse of the internal genital organs
Stress urinary incontinence

Disadvantages of the method

It has limitations associated with strong stretching, when suturing is indispensable.
Not applicable during pregnancy and lactation. This is due to a decrease in the body's immune reactivity during pregnancy or breastfeeding. Adaptation of hyaluronic acid takes longer.
The introduction of the filler must be repeated every 6-12 months, since hyaluronic acid breaks down in the tissues over time
After the injection, tissue swelling remains, which disappears on its own in 3-7 days.

Preparation for the procedure:

Lack of inflammation in the vagina (lack of colpitis, vaginitis).
General hygiene perineum 1 hour before the procedure.
Shaving the perineum before the procedure.

Carrying out the procedure:

Applying a local anesthetic gel. Exposure 20-30 minutes. If necessary ( hypersensitivity) intimate areas- additional injection anesthesia.
The introduction of directly intimate filler (hyaluronic acid increased density) to the required zones. The choice of zones, the amount of injected gel is discussed in advance. It depends on the complaints of the patient, the desired aesthetic effect and is determined by medical indications.
Pain during the procedure is minimized.
Swelling, soreness at the injection site disappears in an average of 3-5 days.

After the procedure for the introduction of an intimate filler:

Puffiness and swelling of tissues can persist up to 3-5 days.
It is impossible to overcool and overheat the area where the gel for intimate plastic surgery was injected.
5-7 days it is necessary to refrain from sexual activity, physical activity.

in obstetrics and gynecology, we work in such areas as:

Vaginal discharge in women, discharge during pregnancy

Ultrasound diagnostics of Down syndrome and other chromosomal abnormalities

We treat such problems.

The hardest part is over: the birth is over, and the happy mother and baby have returned home. But here new difficulties can await her - from severe lack of sleep and sore nipples when feeding crumbs to exacerbation of various diseases. Of course, you should not panic, but it is important to remain calm and do everything possible to normalize the condition.

1. Abdominal pain after childbirth

Abdominal pain after childbirth normal phenomenon you don't have to be afraid of them. They can be pulling or cramping. This suggests that the enlarged uterus is shrinking and gradually returning to its previous size. Pain becomes especially intense during, since at this moment the hormone oxytocin is produced, which contributes to uterine contraction. Therefore, in breastfeeding women, contraction and recovery the uterus is coming faster. Abdominal pain can be felt from several days to 1 week from the moment of delivery.

In the maternity hospital, doctors sometimes recommend applying cold to the lower abdomen for 10–15 minutes after each emptying of the bladder for the first 1–2 days, more lying on the stomach. To improve well-being with strong painful sensations you can take antispasmodics.

Pain in the abdomen after childbirth also occurs after. In the maternity hospital, painkillers are used for no more than 3-4 days and strictly according to indications. Usually, by the 4-5th day, acute discomfort practically disappears, and the postpartum period as a whole continues in the same way as in women who have given birth naturally, although the recovery of the uterus after caesarean section more time is required - 2-3 weeks.

2. Pain in the perineum after childbirth

Pain in the perineum after childbirth is also normal, even if the birth took place without tissue dissection. Indeed, at the birth of a child, as a rule, there is tension, compression, microcracks may appear.

If a woman did, then the pain in the perineum after childbirth persists a little longer, up to several weeks or months, aggravated by exertion (coughing, sneezing, laughing, straining, bending forward, squatting).

After that, it is not recommended to sit for a month, but on the 5-7th day it is allowed to sit on the toilet, a hard chair on the buttock, opposite to the direction of the incision: the mother needs to check with the doctor on which side the incision was. When getting out of bed, you must first turn on your side to avoid a sitting position, take your time and do not make sudden movements. It is better to feed the baby after suturing while lying on your side. It is also undesirable to lift weights during the first two months after childbirth. In the presence of secretions, it is necessary to change sanitary pads in time - at least once every 3 hours, preventing the occurrence of a "greenhouse effect".

If the discharge is accompanied bad smell, pain in the perineum significantly increased both at rest and during movement, body temperature increased, nausea or vomiting appeared - you should immediately consult a doctor.

3. Hemorrhoids

Pregnancy and childbirth are one of the main factors in the development of hemorrhoids in women, which is associated with an increase in pressure on the walls of the intestine from the pregnant uterus, an increase in intra-abdominal pressure, violation of blood filling of the veins due to slowing down venous outflow. In this case, the dilated vein forms a "bag of blood" - the actual hemorrhoid. During childbirth, the head of the fetus compresses the vessels, including the veins of the rectum. The longer the birth, the more pronounced the stagnation of blood. After childbirth anus and hemorrhoids gradually decrease and may disappear completely, but sometimes they persist.

Hemorrhoids after childbirth can be external and internal. External hemorrhoids after childbirth are easier, complications occur less often. External hemorrhoids are less of a concern for a woman, but can cause discomfort in the anus, itching, and less often bleeding. Internal hemorrhoids often cause pain, may fall out during bowel movements, cough, irritate the skin around the anus. The fallen bumps can be infringed, and then the pain becomes unbearable, necrosis of the mucous membrane occurs, the body temperature rises to 38 ° C, and thrombosis of varicose veins may occur. In such a situation, you should immediately consult a doctor.

Plays an important role proper nutrition. It is necessary to adjust the work of the intestines so that there is no constipation and defecation occurs without straining. It is useful to eat more fruits, vegetables (broccoli, corn, carrots, ripe apples, beets, cauliflower, potatoes, raisins, prunes, dried apricots) and cereals (especially pearl barley, oatmeal). Spicy, salty, spicy foods, marinades should be excluded, as these products increase the blood supply to the hemorrhoidal veins. It is recommended to limit fatty foods: it slows down the digestion of food, creating conditions for the development of constipation.

Improving the functioning of the large intestine and reducing congestion in the veins of the small pelvis contributes light gymnastics aimed at strengthening the abdominal muscles and improving blood flow. A set of permitted exercises may be recommended by the attending physician.

It is also advisable to lie on your back for 15 minutes 2-3 times a day with an elevated pelvis - putting your buttocks, for example, on a small pillow. It is very important to avoid hypothermia (especially the lower part of the body), do not sit on a cold surface, give up long (more than 1 hour) hiking and long work in a standing and sitting position, as this can lead to a slowdown in blood flow, an increase in stagnation in the hemorrhoidal veins and, consequently, an exacerbation of hemorrhoids.

There are conservative methods of treating hemorrhoids after childbirth: warm baths, ointment applications and suppositories containing novocaine, anestezin, belladonna. These drugs have anti-inflammatory, astringent, drying and local anesthetic effects. AT acute period apply lead lotions, lotions with drilling liquid, furacilin, which have an astringent, antiseptic and anti-inflammatory effect. Ointments with venotonic, angioprotective properties (swelling, pain, bleeding are reduced) and other means are often prescribed.

Surgical treatment is indicated for prolonged periodic moderate bleeding or arising from time to time. heavy bleeding, the development of anemia, infection, thrombosis, the formation of cracks and fistulas of the rectum.

Particular attention should be paid to hygiene. In the acute period of the disease, you need to take cool shower 2-3 times a day, and also rinse the perineum after each stool or use wet wipes.

4. Constipation after childbirth

Constipation after childbirth is the most common problem, which is associated with physiological changes in the digestive system during pregnancy, especially in the second half. The intestines are gradually squeezed by the enlarged pregnant uterus, blood circulation is disturbed (occurs venous congestion in the vessels of the small pelvis), the innervation changes, which leads to a weakening of peristalsis. The processes of fermentation and flatulence are intensified, constipation occurs, along the way, hemorrhoids become aggravated. In addition, the hormone progesterone, which is released during pregnancy, helps to relax smooth muscles, including the intestines, which reduces its peristalsis.

The regulation of intestinal activity is provided by the central and vegetative nervous system, which also undergo changes during pregnancy and childbirth. After childbirth, fears often arise that the seams will open during a bowel movement. In addition, the abdominal muscles become more flabby, stretched, and it takes time for them to tone up.

To normalize the stool, it is important to follow basic dietary recommendations. Sufficient content in the diet is necessary dietary fiber, daily should be consumed at least 400 g of vegetables and fruits (raw or in any cooked form), soaked dried fruits (especially prunes), bran, sour-milk products.

It is advisable to exclude products that lead to increased gas formation(legumes, cabbage, unripe fruits).

If constipation after childbirth continues to bother, the doctor may prescribe medications. Lactulose preparations are the safest for solving this problem.

5. Violation of urination and urinary incontinence

The bladder of a woman who had recently given birth, as well as her intestines, felt the influence of the pregnant uterus, which led to a temporary decrease in its sensitivity. This will pass in 3-5 days after childbirth: some women may not have the urge to urinate, others have them, but new mothers cannot empty the bladder. This phenomenon is associated with atony of the bladder or, conversely, with a spasm of its sphincter. However, it is necessary to empty the bladder within 6-8 hours after childbirth - and if this cannot be done on her own, a catheter is placed in the woman, since a filled bladder can prevent the uterus from contracting normally.

At home, it is necessary to empty the bladder at least once every 4 hours. If there are cramps, pain during urination, this is a sign of the inflammatory process of the bladder, so you should immediately consult a doctor.

Urinary incontinence after childbirth may also be detected. It occurs with tension (coughing, sneezing, laughing), possibly involuntary leakage of urine before, between or after urination, reflex urinary incontinence, for example, with the sounds of running water. The reason for what is happening is the weakening of the pelvic floor muscles, stretching of the ligamentous apparatus of the muscles of the small pelvis, dysfunction of the urethral sphincter.

More often this phenomenon is observed in multiparous women, women who have undergone severe traumatic childbirth. However, urinary incontinence also occurs in women whose childbirth proceeded without any complications. This is due to the fact that the pelvic floor muscles experience high blood pressure, excessive compression of soft tissues during pregnancy and childbirth, as a result of which there may be violations of innervation, blood circulation and, as a result, dysfunction of the urinary organs.

Urinary incontinence after childbirth is not something to be ashamed of. It is important to consult a doctor in time, who will prescribe the appropriate treatment. It can be both conservative and operational (in severe cases). conservative therapy usually they start with special exercises aimed at strengthening the muscles of the pelvic floor: for a certain time it is necessary to hold specially designed “weights” with the muscles in the vagina, contract the muscles during urination, etc.

Also prescribed medical preparations, which reduce the contractile activity of the bladder, suppress involuntary excretion of urine, increase the interval between urination, increase the volume of urine excreted, contribute to the disappearance or weakening of imperative (false) urges. Conservative treatment can last up to 1 year. In the absence of efficiency conservative treatment surgical methods are used

6. Sore nipples

This problem often accompanies the start of breastfeeding. Soft skin the nipples are still very sensitive, and the mother may experience severe pain when breastfeeding. Cracks and damage to the nipples often occur when the baby is not properly attached to the breast. It is necessary that the baby captures not only the nipple, but also the areola.

For relax disease state you can use special nipple covers during feeding, treat them with an ointment containing dexpanthenol - you can not wash it off before each feeding. In addition, it is recommended to leave the chest open more often.

There is no need to wash the mammary glands with soap before each feeding, it is enough to take a shower 2 times a day, you can simply wash your breasts with warm water - preferably boiled until the cracks have healed, in order to avoid infection.

When lactation is established (this will happen within about 1 month), the skin of the nipples will become somewhat rough, and breastfeeding will not bring discomfort.

7. Stitches after caesarean section

Currently in modern obstetric practice for suturing after caesarean section, absorbable suture material is used (it completely disappears on the 40–45th day). Depending on the characteristics of the maternity hospital, sometimes non-absorbable sutures are used, which are removed before discharge on the 7-10th day. AT special care a seam is not needed. In most maternity hospitals, postoperative dressings are not applied to the suture area, only local treatment is done 2 times a day with alcohol or brilliant green. At home, you do not need to process the seam and wear bandages. You can take a shower on the second day, the seam area, of course, should not be intensively rubbed with a washcloth. But lying in the bath is better to postpone for 1-1.5 months.

If you notice a discharge from the suture area, redness appears, the temperature rises, or growing intense pain begins to bother you, you should immediately consult a doctor.

In the area of postoperative scar a feeling of numbness, discomfort (up to several months), itching, burning can persist for a long time - and this is normal. To alleviate the condition, you can wear a bandage.

If the temperature rises after childbirth ...

An increase in temperature after childbirth is not a pathology if it does not rise above 37.5–38 ° C and lasts no more than two days. This is due to a significant change hormonal background after childbirth, the appearance of muscle tremors (it looks like chills) throughout the body, "the arrival of milk", a reaction to the introduction medicines. However, an increase in body temperature can be due to more serious reasons. Most often it is endometritis (inflammation of the uterine cavity), mastitis (inflammation of the mammary gland) or lactostasis (milk stasis), pyelonephritis (inflammation of the kidneys), chorioamnionitis (inflammation of the membranes and uterus during childbirth), peritonitis (inflammation of the peritoneum), sepsis (general infection blood). For this reason, with any increase in temperature, you should immediately consult a doctor.

I so want to sleep!

Few women who have recently given birth do not complain about lack of sleep. It is clear that the main consequence is constant sleepiness, loss of strength, decreased attention and even lactation. Mom may be disturbed by headaches, irritability, increased appetite (the production of appetite hormones is disturbed), and emotional depression.

To sleep, any person needs about 8 hours of sleep. And the young mother is no exception. Set aside everything and try to sleep during the day, at the same time as the baby. Can practice together night sleep with a child or move his crib to yours so as not to get up at night to feed. Ask dad or grandma to take a walk with the crumbs during the day, while you yourself get some sleep or just relax. Over time, the baby will grow up, and you will be able to get enough sleep.

As you know, labor pain is wonderful property She is quickly forgotten. Therefore, many women, recalling the birth of their child, only talk about how doctors "cut" them, as a result of which their life became more complicated in the first month after childbirth. As a rule, in this case we are talking about perineo- or episiotomy. We will tell you what these operations are, why they are needed, and most importantly, what a woman can do to avoid them or make these injuries less painful.

What is a perineum?

The pelvic floor, or perineum, is internal support our body, all our internal organs. It is made up of three layers of muscles. The muscles of the lower (outer) layer are arranged in the form of a figure eight, the rings of which wrap around the vagina and anus. middle layer represented by a triangular muscle. And finally, the upper (inner) layer forms the diaphragm of the pelvis. This is the steam room and the most powerful pelvic muscle, whose fibers create a real dome.

Such a complex structure and close connection of the perineum with urinary organs imply that this area is subject to heavy loads and plays an important role in the work of organs located in the small pelvis.

Indeed, the pelvic floor is a support for the internal genital organs, bladder and rectum. Damage or weakness of this musculature leads to omission or even prolapse of organs and disruption of their functions.

In addition, along with muscles abdominal wall and the diaphragm (the muscular septum separating the chest and abdominal cavity), the pelvic floor is involved in the regulation of intra-abdominal pressure, and therefore affects the organs located in the abdominal cavity.

During childbirth, these muscles stretch in a unique way, forming a wide tube through which the baby passes. After childbirth, they are reduced, again taking the same position.

Causes of breaks

Unfortunately, no matter how perfectly “designed” the muscles of the perineum are, there are many factors that reduce their elasticity and contribute to the rupture of the perineum. Among them:

a woman's age is over 35, especially if this is her first birth;
high crotch (when the distance between anus and the entrance to the vagina is more than 7-8 cm);
developed muscles of the perineum (for example, in women professionally involved in sports);
scars on the perineum after injuries received during previous births or as a result of plastic surgery;
swelling of the perineum (with weak labor activity, prolonged attempts);
quick and rapid childbirth;
insufficient protection of the perineum (reception provided by the midwife) when removing the head and shoulders of the child;
inappropriate behavior women in labor - during childbirth, especially during the second period, when the fetus is expelled, it is necessary to strictly follow the recommendations of the doctor and midwife, who control the condition of the perineum.

Premature attempts, strong attempts at the moment when it is necessary to breathe through the contraction (at the time of the removal of the head and shoulders of the fetus), contribute to the appearance of tears.

Do not forget that the inflammatory process in the vagina (colpitis, vulvovaginitis) contributes to a significantly greater traumatization of the soft tissues of the birth canal. Therefore, all women are advised to take smears for the vaginal flora at 36 weeks of pregnancy and, if necessary, undergo appropriate treatment.

Tears are internal (on the cervix and inside the vagina) and external (at the exit from the vagina). Cervical ruptures most often occur at the end of the first stage of labor, when the cervix has not yet fully opened, and the fetal head has already pressed against the entrance to the small pelvis, pressing on the bladder and rectum; at the same time there is a desire to push and thereby get rid of the pain. However, in no case should this be done, since pressure on the cervix that has not yet opened leads to its ruptures.

In turn, according to the principle “the force of action is equal to the force of reaction”, the cervix presses on the head of the fetus and leads to additional injuries in the unborn child. The fetal head should descend slowly, gradually expanding the tissues of the vagina and perineum. Any forcing can lead to vaginal injuries - abrasions and tears.

To prevent this from happening, you need to listen to the recommendations of the doctor and midwife and do not push until the head completely fills the entire vagina and reaches the exit from the small pelvis. During the birth of the head and shoulders of the fetus, the mucous membrane of the labia may be injured. This occurs with rapid extension during her birth.

Degrees of perineal rupture:

I degree: the posterior commissure (a small area of the skin of the perineum between the entrance to the vagina and the rectum) and the walls of the vagina are disturbed. The muscles of the perineum remain intact.

II degree: violated the skin of the perineum, the walls of the vagina and muscles to the sphincter of the rectum.

III degree: the rupture of the II degree deepens, capturing the sphincter of the rectum, and sometimes its wall.

When is a perineal incision needed?

There are the following indications for dissection of the perineum:

Threatening rupture of the perineum(occurs at large fruit, high perineum, rigidity - poor extensibility of perineal tissues, etc.). Most often, the gap begins with posterior commissure, and then goes to the perineum and the walls of the vagina. The gap does not begin suddenly - it is preceded by changes appearance perineum.

Signs that indicate an impending rupture include a characteristic protrusion of the perineum, cyanosis, swelling, and then pallor of the skin. If obstetricians notice signs threatening rupture, then cut it. This is done because the smooth edges of the incised wound heal better after suturing than jagged edges lacerated wound.

preterm birth- to avoid pressure of the perineal tissues on the fragile bones of the skull of a premature baby.

The need to shorten the period of exile due to the condition of the woman in labor (increased arterial pressure, congenital and acquired heart defects, myopia, etc.).

Indications for episiotomy are the threat of rupture of the "low" perineum (when the distance between the rectum and the entrance to the vagina is small), acute subpubic angle (the angle at which the bones of the pubic joint converge), pelvic presentation of the fetus, cicatricial changes in the perineum, obstetric operations(imposition of obstetric forceps, vacuum extractor).

Lateral episiotomy - an incision strictly to the side - is carried out only when pathological changes perineum, which does not allow the use of another method of its dissection (for example, with tumors) - such incisions heal worse.

Perineotomy and episiotomy are performed in the second stage of labor, when the presenting part of the fetus has sunk to the pelvic floor and there is tension in the perineum, before it ruptures. The operation is performed by a physician emergency cases in his absence, a midwife.

The operation of perineotomy does not require anesthesia, since ischemia (lack of blood supply) to the tissues of the perineum leads to a loss of pain sensitivity. Before dissection, the skin of the perineum is treated with tincture of iodine. The incision is usually made with scissors at the time of eruption of the fetal head. Its length is on average 2-3 cm. Blood loss, as a rule, is small. Restoration of the dissected perineum is performed after the birth of the placenta.

Seam care

To identify injuries, after childbirth, the doctor must examine the soft tissues of the birth canal. Regardless of whether it was a tear or an incision, the integrity of the tissues is necessarily restored. Whether anesthesia will be used, and which one, depends on the degree of damage to the birth canal.

If a woman has only cervical ruptures, then anesthesia is not required, since there are no pain receptors in the cervix. Cervical tears are sutured with absorbable sutures (catgut or vicryl). You don't need to take them off.

If ruptures of the vagina and small labia are revealed, they are sewn up, as a rule, under local anesthesia. As with rupture of the cervix, as suture material absorbable sutures are used.

If the perineum was damaged, depending on the depth of the wound, either local anesthesia, or intravenous anesthesia (in this case, the woman falls asleep for a short time). If epidural anesthesia was used during childbirth, then the woman is simply injected with an additional dose of anesthetic.

The integrity of the perineum is restored in layers. First, muscles are carefully compared - deep and superficial, then sutures are placed on the skin. If the sutures are applied with catgut, they do not need to be removed, and if with a silk thread, then the sutures are removed 5-7 days after birth.

AT postpartum period seams on the perineum and labia are treated with hydrogen peroxide and a solution of "potassium permanganate" or "brilliant green" 1 time per day. This is done by the midwife postpartum ward. If the ruptures of the soft tissues of the birth canal were deep, then it is possible to prescribe antibacterial drugs- due to the proximity of the rectum and the possibility of infection.

For pain in the area of the seams, painkillers are prescribed in the first three days after childbirth, with edema, the use of an ice pack is recommended.

How to behave?

If you have stitches in the perineum, follow a number of rules:

In the absence of contraindications, a woman is allowed to walk by the end of the first day after childbirth, to sit - 2-3 days after the removal of sutures (that is, on the 7-10th day after childbirth). In maternity hospitals where women eat not in the ward, but in the dining room, high tables are provided for such women in childbirth (something resembling a bar counter).
The baby will need to be fed lying down.
At break III degree the first days will need to be adhered to special diet(broth, tea, fruit juices, kefir), so that there is no stool for 6-7 days. On the 7th day you will be given a laxative (no pushing): it is desirable that the act of defecation is as easy as possible.
Then you will be allowed to sit sideways, on one of the buttocks - it is recommended to sit down on the side where there is no incision (this can be done on the 5th day after childbirth), on a hard surface.
During your stay in the hospital and for a week at home, after each trip to the toilet, you need to treat the perineum (rinse it with running water, dry it well). It should be remembered that washing movements should be made from front to back, from the pubis to the rectum, to reduce the likelihood of germs entering the wound. After that, it is advisable to lie down without underwear for a few minutes so that the skin dries on its own, and then you can get dressed, but do not forget to change the pads more often (every 2 hours), since the wound should be dry.

Possible Complications

Pain, swelling, wound infection, hematomas, abscesses can occur in the area of sutures. When severe pain, feelings of pulsation and twitching, bursting in the area of \u200b\u200bthe seams, immediately complain to your doctor in order to exclude this formidable complication.

If complications occur, the doctor will prescribe therapy - depending on the type of complication: frequent application of ice, treatment with ointments or surgical intervention. In the presence of ruptures of the cervix, especially deep ones, with a concomitant inflammatory process in the vagina, after suturing, a cicatricial deformity- a state in which connective tissue scarring deforms the cervix.

In the future, this defect can be corrected with a laser, and with a deeper lesion, surgical correction- plastic surgery of the cervix.

Ruptures of the vagina and labia minora heal with virtually no consequences and no visible scarring. However, with breaks in the clitoris, sensitivity in this area may be impaired, which is then restored within a few months.

Healing of the perineum can take place without complications - only a skin scar will remain. In the presence of colpitis (inflammation of the vagina), divergence of the seams on the perineum is possible. The formation of insolvency of the pelvic floor muscles, followed by the prolapse of the walls of the vagina and uterus.

In such a situation, a few months after childbirth, it will take enough complicated operation- Vaginoplasty.

Prevention

Can rips and cuts be avoided? It is impossible to answer this question unambiguously. But, as already mentioned, a lot depends on the woman herself - on her calmness and readiness to follow all the doctor's instructions.

What can you do on your end to try and avoid cuts?

First, you should consciously treat the preparation for childbirth. You just have to be aware of the flow normal delivery and ways to breathe and relax in them. This will allow you to get as close as possible to the physiological course of childbirth and avoid artificial interference with the natural process.

We also note that the likelihood of ruptures increases with fast and stimulated labor, therefore, by skillfully and in time relaxing, moving correctly and, most importantly, without fear of the unknown, you will help both yourself and your baby.

Secondly, it will help you perineum massage, which should be done regularly. Starting from any period (optimally - from the middle of pregnancy, but if there are complications during pregnancy, in particular increased tone uterus, the threat of abortion - then after 36 weeks of pregnancy) every day or 2-3 times a week, massage the perineum with vegetable oil. Massage is best done after a shower or bath in a state of relaxation and comfort.

Take a comfortable position - someone likes to lie down, someone likes to put one foot on a raised platform (for example, in the bathroom on the side). Pour 1 or 2 fingers with oil (it is better to pour it on rather than dip it in oil for hygiene reasons) and insert them into the vagina. With pressing movements, massage it from the inside, especially towards the anus (this is where the maximum stretch during childbirth will be).

You can try to stretch the vagina to the side. This exercise is best done not immediately, but when you are already used to massage: at first, stretching can be unpleasant due to inelastic tissues. The duration of the massage is at least 3 minutes.

At the same time, try to relax the muscles of the vagina as much as possible - then the discomfort will not be so strong (during massage), and having learned such relaxation, you will be able to apply your skill at the moment the baby is born - then the risk of ruptures will decrease even more, because there will be no " excess "tension in the perineum.

By the way, perineal massage will help you even if after childbirth the vagina becomes “too narrow” (it happens!). To prepare a special oil for perineal massage, take a pack of St. John's wort and vegetable oil. Put the grass in a jar with a lid, fill with oil "with a top" and heat in a water bath for 15-20 minutes. Then put the jar in the closet for a week, after which it can be used.

If you have not made a special massage oil, you can use any vegetable oil.

Third, do it regularly special exercises aimed at gradually increasing the elasticity of perineal tissues(Consult your gynecologist about whether you can perform such exercises and which exercises will be most effective for you).

In conclusion, I would like to say: tune in to the best, optimism and preparedness for childbirth will help you avoid surgery.

Kegel exercises

Slow contractions. Tighten the muscles of the perineum, slowly count to three. Relax. It will be a little more difficult if, holding the muscles, hold them in this state for 5-20 seconds, then gently relax.

"Elevator". We start a smooth ascent on the “elevator” - we squeeze the muscles a little bit (1st floor), hold for 3-5 seconds, continue to rise - we squeeze a little harder (2nd floor), hold - etc. to its limit - 4-7 "floors". We go down in the same way in stages, lingering for a couple of seconds on each floor.

Abbreviations. Tighten and relax your muscles as quickly as possible.

Pushing. Push down moderately, as if having a bowel movement. This exercise, in addition to the perineal muscles, causes tension in some of the abdominal muscles. You will also feel the tension and relaxation of the anus.

Start training at ten slow contractions, ten contractions and ten push-ups five times a day. You should repeat the exercises at least 25 times during the day. You can do the exercises almost anywhere - while walking, watching TV, sitting at a table, lying in bed.

Early in your workout, you may find that your muscles don't want to stay tense during slow contractions. You may not be able to do contractions quickly or rhythmically enough. This is because the muscles are still weak - control improves with practice. If the muscles get tired in the middle of the exercise, rest for a few seconds and continue.