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.
Such perineal reeducation helps to strengthen the perineal muscles and is provided by midwives in many countries.
Anatomical and physiological characteristics of perineal muscles
in the male rabbit.
Progressive resistence exercise in the functional restoration of the perineal muscles
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.
Arnold Kegel in 1948 for the restoration of the perineal muscles
, Kegel exercises, or progressive resistance exercises, are recommended for women with stress, urge and mixed incontinence.
Tears are grouped according to severity and number of tissue layers involved: First degree - injury to skin only, second degree - injury to the perineal muscles
but not the anal sphincter, third degree - injury to the perineum involving the anal sphincter (further divided into 3a: less than 50% of external sphincter thickness torn; 3b: more than 50% of external sphincter thickness torn; 3c: internal anal sphincter torn) and fourth degree - injury to the perineum involving the anal sphincter complex and anal epithelium.
The repair will bring the transverse perineal muscles
Optimally, the bladder should be full, and the patient should relax the perineal muscles
and assume a position as close to upright as possible; the patient should cough or strain vigorously once while the examiner observes for urine loss from the urethra.
Fused anteriorly to the posterior vaginal wall and attached laterally to the perineal membrane and bulbocavernosus and superficial transverse perineal muscles
, a significant portion of what is clinically called the perineal body is actually the muscle of the external anal sphincter.
Moreover, the single incision allows access to anal sphincter muscles and the perineal muscles
for a perineoplasty, which improves support and thickness of the perineal body.
Vaginismus results from involuntary spasm of the levator ani and perineal muscles
of the outer third of the vagina.