The muscles surrounding the rectum (the perineal muscles
) become weak with age and can separate.
Anatomically, in women, the perineal body separates the anal canal from the urogenital diaphragm in the median plane where the deep bulbospongiosus and superficial transverse perineal muscles
meet the external anal sphincter (EAS).
(3) Perineal access provided us surgical exposition in extrasphincteric plane fossa without comprimising of the perineal muscles
and pudendal nerves in the ischioanal fossa.
Sometimes, the stretching is too much and the perineal muscles
will tear, resulting in perineal tears.
Postsurgical prognosis is better in adult patients in whom the gluteal cleft is fully developed beside the sacrum and the normal gluteal muscle mass, the nerves are intact to maintain the anal reflex, and the voluntary perineal muscles
are visibly contractile (3).
A vaginal probe is advanced over about 3.5 cm and the patient is asked to contract her perineal muscles
. The normal pressure range for a perineometer is 30-60 cm H2O.
Kegel or pelvic muscle exercises are discrete exercises that strengthen the perineal muscles
. In the past, they have been largely promoted by physicians to their female patients in an effort to aid with stress incontinence following childbirth.
(3,4) Traditionally, the vagina is stitched using a continuous locking suture and the perineal muscles
and skin are repaired using intermittent sutures.
Perineal pain arises from perineal tears, inflammatory reaction, swelling of the adjacent tissues and the contractions of levator ani and other perineal muscles
.1 It is a common problem following episiotomy,2 and vaginal delivery, and is very severe in early postnatal period.3 The severity of pain also depends on mode of delivery,4 degree of trauma,5 type of suture material used for repair and technique of perineal repair.6 There is a negative impact of pain on physical and psychological functions, including successful breast feeding.7 Physical effects associated with perineal pain include reduced motility, sitting, urinary and faecal incontinence and sexual dysfunction.
A first-degree tear is an injury to the perineal skin only; a second-degree tear means injury to the perineal muscles
but not the anal sphincter; a third-degree tear also involves the anal sphincter complex; and a fourth-degree injury involves the anal sphincter complex and the anal epithelium.
The pelvic floor is made up of a group of muscles and connective tissue that extends as a sling across the base of the pelvis; it comprises two layers, the superficial perineal muscles
and the deep pelvic diaphragm, and provides support for the pelvic organs, the bladder and elements of the spine.