Perineal Tears: What They Are and How Massage Can Help Prevent Them

Childbirth is a miraculous experience, but it can come with physical challenges. One common concern is perineal tears which are tears or injury to the area between the vagina and anus during delivery. Understanding perineal tears and taking proactive steps to avoid a tear as best you can (ie: perineal massage) may help reduce the risk and make recovery smoother.

What Are Perineal Tears?

Understanding the Perineum

The perineum is a complex network of muscles, connective tissue, and nerves that supports the bladder, bowel, and sexual function. During childbirth, these tissues stretch to allow the baby to pass through the birth canal.

Types of Perineal Tears

Perineal tears are classified by severity:

• First-degree: Small tear affecting only the skin.

• Second-degree: Extends into the muscles of the perineum.

• Third-degree: Involves the muscles around the anus.

• Fourth-degree: Extends through the anal sphincter and rectal mucosa.

How Common Are Perineal Tears?

Perineal tears are common, particularly for first-time mothers. Estimates suggest:

• 60–70% of first-time births may involve some degree of tear.

• Severe tears (third- or fourth-degree) are less common, affecting around 2–4% of deliveries.

What Causes Perineal Tears?

Several factors increase the risk:

• First-time birth: Perineal tissues haven’t stretched before.

• Baby’s size: Larger babies can increase tearing risk.

• Use of instruments: Forceps or vacuum-assisted delivery may contribute.

• Labour and delivery positions: Certain positions may increase perineal stress.

The Impact of Perineal Tears

Physical Effects

• Pain, swelling, and bruising

• Stitches and longer recovery time

• Difficulty with sitting, walking, or bowel movements

Emotional Effects

• Fear of future births

• Reduced confidence in body function

• Anxiety about intimacy or recovery

Long-Term Complications

• Pelvic floor weakness

• Urinary or faecal incontinence

• Scar tissue tightness or discomfort during intercourse

What Is Perineal Massage?

Perineal massage is a gentle technique designed to stretch and prepare the perineum before childbirth. It can be performed by the mother or guided by a physiotherapist or midwife.

When to Start and How Often?

• Typically starts around 35–36 weeks of pregnancy.

• Recommended 2–3 times per week, for a few minutes each session

How Perineal Massage Helps Prevent Tears?

• Improves flexibility and elasticity of the perineal tissues.

• Increases blood flow and reduces tension, making tissues more resilient.

• Boosts confidence and control, helping mothers feel more prepared for delivery.

Step-by-Step Guide to Perineal Massage

When and How to Perform It Safely

1. Wash hands thoroughly and trim nails.

2. Use a comfortable, relaxed position, sitting, lying, or semi-reclined.

Techniques and Positioning

• Gently insert a lubricated thumb or finger into the vagina, stretching towards the rectum.

• Massage the sides and lower part of the vaginal opening in a U-shaped motion.

• Hold stretches for a few minutes, gradually increasing pressure over weeks.

Oils or Lubricants

• Natural oils such as vitamin E, almond, or olive oil are commonly used.

• You can consider water based lubricants as well.

• Avoid fragranced or irritating products.

Other Ways to Reduce the Risk of Perineal Tears

• Breathing and relaxation techniques during labour

• Upright or side-lying positions to reduce perineal strain

• Guided support from midwives or women’s health physiotherapists

When to Seek Professional Help

• If massage causes pain, discomfort, or bleeding

• Persistent soreness or tension

• Postnatal assessment for recovery guidance

• Women’s health physiotherapists can provide personalised exercises, scar tissue management, and education

Conclusion

Perineal massage is a proactive, simple step to prepare the body for childbirth. Combined with awareness, guided support, and proper technique, it can reduce the risk of tearing and improve confidence during delivery. Taking ownership of perineal health empowers women to recover faster, minimise complications, and feel in control of their bodies.

Our team of trained women physiotherapists are here to educate you and your partner (if you choose) on how to do perineal massage and the use of other techniques or modalities to reduce the risk of a tear and an overall healthier birthing experience!

Contact Information

Email: hello@physiomatters.com.sg

Phone: +65 9352 9067

Address: 360 Orchard Road #10-07 International Building, 23886