The sphincter is a circular muscle encasing the anus. The function of the sphincter is to hold back intestinal gas and faeces. If the sphincter has been ruptured and hasn’t healed properly, the closing mechanism can be weakened which will make you leak intestinal gas and/or faeces. The Latin term of the muscle is “the anal sphincter”.

When you are giving birth to your child through the vagina the muscles and connective tissue of the pelvic floor will become dilated, and rupture can occur. Many women having their first baby will have minor ruptures, but in rare cases the rupture of the perineum can reach all the way down to the rectum, tearing the sphincter completely or partially. The risk of rupturing the sphincter will especially become higher if the woman is having a quick birth, if the child is big, or if it is born by suction.

The sphincter is stitched together by soluble stitches in order to assemble the muscle ends. If the healing is not complete you may have problems holding back intestinal gas (farts) and faeces.

Often when rupturing the sphincter there will also be a severe rupture of the perineum, which will also have been stitched together after the birth. Thus, you may experience some swelling and tenderness after the birth, and typically this will all come from the stitching of the perineum.

It is normal to feel a stinging burn when urinating during the first couple of days after the birth. Within the first couple of weeks you may experience that the wound is itching. Healing of the rupture will normally take 3-4 weeks. You may therefore expect that it can take up to a month before you are completely pain free and have regained a normal sense of touch around the vagina.

You may expect to need pain medication 1-2 weeks after the birth. We recommend that you relieve the pain with non-prescription drugs, e.g. 1g. of paracetamol (Pamol/Pinex etc.) up to 4 times a day. If this is not sufficient you can add 400 mg. of Ibuprofen/Ipren up to 3 times a day. If you feel strong pain or you get a fever, you should contact a doctor or a hospital. Increasing pain could be a sign of inflammation or hematomas in the tissue. The suggested pain medication will not affect your child through the breast milk.

The stitches you have been stitched with will dissolve themselves within 1-2 months after the birth. Thus, you don’t need to have them removed unless they are very uncomfortable.

In order to obtain the best possible healing it is very important that the area is relieved. After the first week you will have to feel your way on how much your pelvic floor and sphincter can take.

Here is some advice on how to protect the pelvic floor while the wound is healing:

• Avoid sitting up for too long since it puts a strain on the wound and hurts unnecessarily.
• Get in and out of bed by rolling to the side.
• Lie preferably on the side when breast feeding.
• Carry no more weight than maximum the equivalent weight of the child including a child car seat/carry cot.
• Use ice cold dressings against swelling and pain during the first couple of days.
• Take pain medication as needed.
• Avoid constipation.

During the first couple of days after the birth you can use ice cold dressings to ease pain and swelling. The ice cold dressing is placed on the perineum for 15 minutes in 2 hours intervals.

You keep the wound clean by rinsing yourself with lukewarm water every time you have been to the toilet. During the first couple of days it may be lenient to dab yourself with a piece of clothing instead of toilet paper. You should not scrub or clean too much around the stitches when showering. Usually it is sufficient to hand shower the area clean.

You should avoid sitting up for too long during the first week after the birth. Thus, it is a good idea to breast feed by lying down on the side. The personnel at the hospital can show you some good breast feeding positions and help you and your baby to get a good start.

It is normal that the digestion stalls when giving birth, and thus that the bowels don’t start to move until a couple of days after. You will be offered a laxative while you are hospitalized. It is a good idea to continue with this after returning home in order to keep the faeces thin. Take good time when going to the toilet during the first couple of days after the birth. Breathe deeply and calmly and relax in your abdomen so that you try to make the bowels move without applying too much pressure. You may want to hold a washcloth against the perineum in order to feel that you dare to squeeze a little.

You can prevent constipation by:

• Drinking about 1 ½ litre of water every day.
• Keep a fiber-rich diet such as whole grain bread, fruit, raisins, or prunes.
• Continue with the laxatives that you were given at the hospital.

If your faeces becomes too thin you should cut down on the laxatives or stop taking them completely. When having your bowels moving on a daily basis without applying pressure, you may normally stop to use laxatives.

You should seek professional help in the following situations:

• If you get a fever.
• If the wound swells up too much.
• If the pain from the wound intensifies.
• If you think that the wound has burst open.
• If you cannot keep your faeces inside.
• If you after one month still cannot keep the intestinal gas inside

Feel free to contact the nurses in the Maternity Ward by telephone during the first 3 weeks after the birth.

Far the most women that have had a birth rupture will heal well after the birth. Many women with severe ruptures in the perineum after giving birth worry whether their abdomen will become normal again.

Thus, we recommend you to:

• Look at the wound together with a nurse/midwife at the hospital before leaving. The personnel can also check if you are healing normally.
• Ask your general practitioner, gynaecologist, physical therapist, or nurse/midwife about advice in case of doubts.

Your body has been strained by not only the rupture that will have to heal, but also the pregnancy and the birth itself. It is therefore important that you train your pelvic floor muscles after the birth. You are welcome to go ahead with the training of your pelvic floor muscles immediately after the birth.

If you find it difficult to get started with the pinching, you may want to follow this little programme:

• Lie on your back or on the side with bent legs. Pinch together in the pelvic floor.
• Feel that you are tightening the anus briefly and then let go slowly.
• Relax in your stomach, your buttocks, and your thighs while pinching.
• Take a break of 5-10 seconds between each pinch so the muscles have time to relax.
• Repeat the pinches 5-10 times.
• Eventually keep the tension for 5-10 seconds. When you can keep a pinch without feeling pain you may increase the number and the duration of the pinches.
• Repeat this several times a day.

Try gently how much you can pinch, but avoid pinching so hard that it causes pain. You may pinch as much as you want, and of course every time when you need to close up your pelvic floor. This means for example that you should pinch every time you lift up your child and when standing up or sitting down.

Most women will want to have sex with their partner a couple of months after giving birth. A severe rupture will expectedly take about a month to heal. In case of rupture in the rectal sphincter muscle we advice against having anal sex during the first 2 months after the birth.

Your sex drive may naturally be diminished as long as you are breast feeding. This is due to a change in your hormonal balance which also causes you to feel dry in the vagina. Thus, you may want to use Lubricants or almond oil to avoid pain during sexual intercourse. If you want to have sex but are feeling sore inside the vagina, you can also buy a numbing gel at the pharmacy (Xylocain 2%). Lubricants, almond oil, and numbing gel can all be purchased at the pharmacy or in Matas. Lack of sleep and a change of roles in the relationship can also affect the sex drive after the birth.

Your general practitioner will offer you a health check after the birth. Here it will among other things be checked if your uterus has contracted and if the bleeding after the birth has stopped.

You can speak with your general practitioner if you are feeling a lasting pain from the area around the stitches. Your doctor can refer you on to a gynaecologist if you are having problems with pain or holding urine, intestinal gas, or faeces inside.

We will offer you counselling by a physical therapist before you return home from the hospital. The physical therapist will guide you on how to protect the pelvic floor during the first couple of weeks after the birth. Before you are discharged there will be made an appointment for you with a physical therapist 4-6 weeks after the birth, and here you will have your abdominal pinch function checked out. This will be done by the physical therapist feeling on the inside of your vagina and rectum.

Training of the pelvic floor will halve the risk of having problems holding intestinal gas and faeces inside – so training of the pelvic floor is important. You may start to pinch harder and longer after a month.

However, avoid pinching so hard that it causes pain. Remember to take breaks between the pinches.

A nurse from the Maternity Ward will call you five months after the birth.

The nurse will interview you based on a schema where you among other things will be asked whether you can hold intestinal gas and faeces inside.