Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial

Int Urogynecol J. 2020 Mar;31(3):613-619. doi: 10.1007/s00192-019-03937-6. Epub 2019 Apr 2.


Introduction and hypothesis: The aim of this study was to evaluate the effectiveness of perineal massage, pelvic floor muscle training (PFMT) and a pelvic floor dysfunction (PFD) prevention educational program in pregnant women above the age of 35 years to prevent perineal tear and episiotomy.

Methods: A randomized parallel assignment study involved two groups of pregnant women at the obstetrics outpatient clinic 4 weeks prior to their due date. The first group (n = 200) was educated to do digital perineal massage and pelvic floor muscle training and received an educational PFD prevention program. The second group (n = 200) received only the prevention education program. Occurrence of perineal laceration was reported at time of delivery as a primary outcome. Statistical analysis was done using the IBM SPSS computer program (Statistical Package for the Social Sciences; IBM Corp, Armonk, NY, USA), release 22 for Microsoft Windows.

Results: Delivery was significantly less complicated by perineal tear, episiotomy and postnatal pain in the first than in the second group (p < 0.05). Grades of perineal tear were mostly of first and second degree in the first group compared with the second group. We found a significantly lower need for analgesia and fewer ampoules required during the hospital stay in the first group (p < 0.001, 0.002, respectively).

Conclusions: Performing antenatal digital perineal massage and PFMT in addition to health education is recommended to reduce perineal complications.

Keywords: Episiotomy; Health education; Pelvic floor muscle training; Perineal massage; Perineal tear; Pregnancy above 35.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Episiotomy / adverse effects
  • Female
  • Humans
  • Massage
  • Pelvic Floor*
  • Perineum
  • Pregnancy
  • Pregnant Women*