It's rarely discussed, or only half-heartedly between pregnancy secrets. And yet, pelvic floor rehabilitation concerns a vast majority of women after childbirth. Much more than a medical formality or a series of exercises to perform, this key postpartum stage lies at the intersection of physical care and reconnecting with oneself. Manual or assisted by a probe, the right choice is the one that respects your body, your sensations, and your rhythm. Because a well-supported pelvic floor also means a more confident woman.
SUMMARY:
- The perineum after childbirth: what you need to know
- The two main methods of perineal rehabilitation
- How do you know which method is right for you?
- Frequently asked (and uninhibited) questions about perineal rehabilitation
The perineum after childbirth: what you need to know
Invisible and often overlooked, the perineum nevertheless plays a central role. Its muscles support the pelvic organs and ensure continence, while also facilitating sexual pleasure... It goes without saying that women have every interest in learning more about it.
What is the perineum for? A quick anatomical reminder
The perineum, also called the pelvic floor, is a group of muscles and tissues located between the pubis and the coccyx. It supports the organs of the lower abdomen (bladder, uterus, rectum) and plays a key role in urinary control, pelvic stability and the quality of sexual intercourse. Indeed, when it is toned, the perineum intensifies sensations during intercourse by naturally tightening the contact between the two partners. Suffice to say, it is essential in everyday life... even if we often discover it during maternity.
What can weaken it
During pregnancy, the perineum is put under severe strain: it carries the weight of the baby, the amniotic fluid, the placenta, etc., until delivery, particularly vaginally, which can cause significant stretching, even micro-tears or slackening. However, during life, other, more subtle factors can contribute to weakening it:
- chronic constipation,
- certain high-impact sports (running, trampolining, etc.),
- the regular carrying of heavy loads,
- or even prolonged and repeated coughs.
When should you consider perineal rehabilitation?
In France, perineal rehabilitation is systematically offered to new mothers, generally 6 to 8 weeks after giving birth, whether it took place vaginally or by caesarean section. It is covered 100% by health insurance, upon prescription. However, certain signs or sensations should prompt you to consult:
- urinary leaks during exercise, when coughing or laughing,
- a feeling of heaviness in the lower abdomen,
- a decrease in sexual sensations,
- or a feeling of muscle relaxation.
💡 Good to know: even without apparent symptoms, you can ask your midwife or a specialized physiotherapist for a check-up.
The two main methods of perineal rehabilitation
Do you recognize yourself in the symptoms mentioned above, or are you expecting a baby and want to know what to expect next? Pelvic floor rehabilitation is a progressive exercise that focuses on both tone and body awareness. Depending on your needs, it is offered in two main forms, which can also complement each other: manual or catheter-assisted.
Manual rehabilitation
This is the method often proposed as a first line of treatment. Several sessions delivered by a midwife or physiotherapist teach you which muscles to contract and release voluntarily.
-
The goal? To better feel your muscles, regain control, and restore tone through training sessions performed in a lying or sitting position and guided by voice, or through vaginal examination.
-
Who's it for? This approach is ideal if you want to progress gently and listen to your body. It also promotes breathing, posture work, and overall pelvic floor coordination.
-
The plus points: no equipment required, sensory learning and independent awareness of the body and its sensitivity.
-
Limits: requires more personal involvement for sometimes slower progress.
Rehabilitation by probe
Here, a perineal probe is inserted into the vagina, connected to a biofeedback device (which captures and displays contractions on a screen) or electrostimulation. At Perifit, they have even combined rehabilitation and an interactive video game, for the fun side and to stay more easily motivated!
-
The goal? To see or receive a physical signal to strengthen your pelvic floor, especially if voluntary contractions are difficult. With biofeedback, you visualize your efforts for greater motivation. With electrostimulation, contractions are triggered automatically to "wake up" the muscles.
-
Who is it for? This method is often recommended for women who have difficulty feeling or initiating a contraction, or in cases of very loose perineum, for example after several pregnancies.
-
The advantages: useful in cases of significant muscle weakness and sometimes faster in gaining tone.
-
Limitations: Less focused on feeling and requires equipment that some women may be reluctant to use.
🩷 In addition to the rehabilitation practiced with your doctor, at home you can perform series of perineal contractions while you are seated at a table or at your desk, stretches, hypopressive abdominals (work accentuated by the vacuum of air), enjoy the benefits of certain yoga postures (Supta Baddha Konasana, Balasana or Setu Bandhasana) or discover Pilates. Do not hesitate to ask your doctor who will be able to best present these alternatives to you.
Choosing a midwife or physiotherapist: the importance of good support
Midwives and physiotherapists can support your perineal recovery, provided they are trained. Do you feel the need for comprehensive or more emotional support, or are you postpartum? A midwife offers a more maternity-focused framework. Are you looking for technical support or support related to other musculoskeletal disorders (lower back pain, instability, etc.)? A specialized physiotherapist can be an excellent option.
In any case, trust your feelings. Good rehabilitation always begins with a relationship of trust.
Learn to know your body to take care of it
Beyond the chosen method, perineal education plays a fundamental role upstream. Understanding how the body works, knowing when and how to contract the right muscles, learning to breathe consciously and adopt good postures... All these elements reinforce the effectiveness of rehabilitation and prevent recurrences.
How do you know which method is right for you?
When choosing, the advice of a healthcare professional is your best guide, as they will be able to assess the health of your perineum as well as your needs based on your personal history.
But, beyond the protocol and the best medical approach for your body, your feelings have their place. Whether you are involved in your rehabilitation or fully supported, the right method is one that does not cause you any stress and respects your pace. Also, alternating or combining is entirely possible.
Finally, as with any treatment approach, the bond of trust with your practitioner is central; because it is an intimate area and because you have already been solicited throughout your pregnancy. You must feel free to ask questions, express your doubts, and object to the exercises if they make you uncomfortable.
Frequently asked (and uninhibited) questions about perineal rehabilitation
🩺 Does the probe hurt?
No, the catheter is generally well tolerated. It is thin, flexible, and its use is gently guided. If discomfort occurs, it can be adjusted or replaced with another method.
🙈 Is rehabilitation awkward?
It's a private area, but professionals are trained to handle you with respect. Also, discomfort often fades after the first few minutes, especially if you feel confident.
🍼 What if I don't breastfeed, does it change anything?
No. Rehabilitation is recommended for all women after childbirth, whether breastfeeding or not. It works on the muscles, regardless of what the baby is eating.
👶 Does this only apply to vaginal deliveries?
No. Even after a cesarean section, the perineum may have been overstressed during pregnancy, so it deserves to be assessed.
💧 Is it really useful if I don't have any leaks?
Yes! The absence of leaks doesn't mean everything is perfect. Rehabilitation can prevent potential problems and restore good overall tone.
🧘 How does a perineal rehabilitation session take place?
It lasts approximately 30 minutes. Depending on the method chosen, it may include manual exercises, guided contractions, or the use of a probe. Everything is explained and tailored to your comfort.
🚫 Are there any contraindications?
Pelvic floor rehabilitation is generally gentle and well-tolerated. However, in cases of infection, unexplained pelvic pain, or a specific neurological condition, it is essential to seek medical advice before beginning. The goal always remains personalized care, tailored to your overall health.
What if we changed our perspective on perineal rehabilitation?
Too often experienced as a medical formality or a chore, the care given to the pelvic floor can also be seen as a moment of reconnection with oneself. The opportunity to reinhabit one's body after pregnancy, with deep care, far from any injunction.
Your body deserves time, attention, and respect. So, whatever the method, the most important thing is to be supported with kindness.
And after? Perineal rehabilitation during menopause
Although it is often mentioned after childbirth, perineal rehabilitation can also be offered later, particularly at the time of menopause. With the hormonal drop, the perineum can become loose. Targeted sessions then allow you to regain tone and comfort, at any age.
