Perineal massage in pregnancy: how to do it and when to start

If you are pregnant, surely by now you have heard about perineal massage during pregnancy. How do I do it? When I start?

Let's start with the most important thing: perineal massage is just one part of preparing the pelvic floor and should always be done with the support of a qualified professional.

We recommend that you go to a physio who specializes in pelvic floor to evaluate you during pregnancy and help you with adequate follow-up during the postpartum period to avoid complications.

In this post, we tell you everything you need to know about the pelvic floor, perineal massage and what you can do to avoid both episiotomy and other dysfunctions of the perineal area. Let's start!

The pelvic floor or perineum is the set of muscles and ligaments that support and support the pelvic organs (the bladder, urethra, uterus, vagina, rectum and anus). But why is it so important? Because although we are not very aware of it, I play a crucial role in very important physiological functions.

Despite being so important, it is a great unknown to which we do not pay much attention until it starts to give us problems. Do you know what basic functions it participates in?

• Support : keeps the pelvic organs in the correct position

• Reproductive : the pelvic floor is “the last door” that the baby crosses during childbirth, and is responsible for helping the baby rotate its head and for the expulsive reflex that generates the desire to expel.

• Continence : responsible for urinary and fecal continence

• Sexual : since a toned pelvic floor is key to better quality sexual relations

It is not surprising, then, that pregnancy and childbirth are a great challenge for the pelvic floor.

The increase in weight during pregnancy puts extra pressure on the pelvic area, which, together with greater elasticity of the tissues due to hormonal issues, weakens the muscles in the area.

Childbirth pushes the entire structure to the limit.

So both pregnancy and childbirth are the origin of many of the most common discomforts such as prolapses, incontinence or sexual dysfunctions, especially if we do not take care of our pelvic floor both before and after childbirth.

Perineal massage is a manual technique of gentle stretching of the pelvic floor to prepare the muscles and skin between the vagina and rectum for childbirth. The objective is to reduce the incidence of pelvic floor injuries such as tears, episiotomies or other dysfunctions such as postpartum pelvic pain.

In addition, perineal massage helps to become familiar with the sensation of stretching of the perineal area that will be felt during childbirth (improves proprioception), which can be very useful during the delivery phase.

The main benefit of perineal massage is that the skin surrounding the perineum is more flexible during childbirth and protects it against tears and episiotomies.

Perineal massage, along with other pelvic floor preparation techniques, not only help at the time of childbirth, but also promote a much gentler postpartum recovery.

We outline the main benefits of perineal massage for you:

• Increases the elasticity of the perineum .

• It promotes blood circulation in the area, facilitating the relaxation of these muscles during childbirth.

• Enhance self-knowledge

• Reduces the incidence of perineal injuries such as episiotomy.

• Reduces pain in that area after childbirth.

• They have no harmful effects.

• You can do it alone or do it with your partner.

It is recommended to start between weeks 32 and 34 of pregnancy, and do it at least twice a week (although it can be done daily).

Consistency, as in all muscle training, is key!

Perineal massage focuses on the area between the vagina and the anal sphincter, in the space of the central fibrous nucleus of the perineum.

It must be done using a lubricant or a natural oil and includes the following steps:

1. Insert your thumbs into the vagina approximately 2-3 cm. Make light pressure towards the anus.

2. Make a gentle rocking movement with your thumbs, like clockwise (from 9 o'clock to 3 o'clock, round trip).

3. Apply gentle pressure towards the anus and outwards at the same time, for approximately 2-3 minutes.

The entire massage should last between 5-10 minutes and should be done twice a week until delivery.

As we mentioned at the beginning, we recommend consulting with a pelvic floor professional to make an assessment (this is best done in the second trimester) since they can also accompany you in the overall care of the pelvic floor, including perineal massage.

We share a video of On Firm Ground, with tips and tricks on where, when and how to do it. No one better than a specialist to explain it to us:

We leave you a few things to keep in mind:

• Wash your hands before starting the massage.

• Try not to have excessively long nails.

• Empty your bladder before the massage.

• Choose to have a mirror on hand to check that you are doing the massage correctly.

• Find a comfortable place: on the edge of the bed, the bidet, in the bathtub or squatting are the best options to perform the massage.

• You can use hot and cold pads to warm and relax the area.

• If you do self-massage, you have to use your thumbs. If another person does it, the index or middle fingers are used.

• Lubricate your fingers before inserting them into the vagina with oil or lubricant.

• Perform massages of at least 5 to 10 minutes, at least 2 days a week.

• Alone or as a couple?

If you both feel like it, your partner can participate in the massage, thus improving intimacy; a subject generally pending in the last weeks of pregnancy and the first months of postpartum.

Although performing perineal massage is not a complex practice, there are products that can help you not only in the process, but also in the result.

Using heat pads to relax the perineal area, specific lubricant to avoid friction or a natural oil to hydrate the skin are the best allies you can have.

Whether you do the perineal massage yourself or your partner does it.