Perineal rehabilitation after childbirth: the best ways to regain sensation
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During the webinar “How to Optimize Our Postpartum Care” with Julie Cantournet, one question comes up frequently among practitioners:
👉 “What should we do during the assessment when a patient has no awareness of her perineum and cannot contract it?”
This situation, although common, can be unsettling for therapists, especially when they want to offer personalized and effective care from the very first sessions. Understanding the origin of the blockage is the first step in adapting follow-up and proposing relevant exercises.
Understanding the situation: shutdown or deficit of voluntary control
Before any intervention, it is essential to determine the cause of the lack of perineal control. Two main scenarios may arise:
1. Perineal shutdown
Some patients present what Julie calls a perineal shutdown.
Definition: perineal shutdown is a form of transient contractile dysfunction of the perineal muscle
This situation can occur after childbirth, particularly in the event of obstetric trauma, an episiotomy, a cesarean delivery, or postpartum stress. The muscle is not “paralyzed,” but the brain and body are no longer communicating properly to allow voluntary contraction.
Possible interventions:
Gentle perineal massage to restore sensitivity
Tissue mobilization and relaxation
Body awareness exercises (breathing, visualization)
These approaches help resolve the sensory disconnect, a necessary step before proposing active contraction exercises.
2. The reflex mechanism is intact, but voluntary control is absent
In other cases, the patient has no structural or reflex problem: the perineum functions properly, but she is unable to contract it voluntarily.
Recommended strategies:
Integrate the perineum into functional exercises: breathing, postural control, and management of abdominal pressure
Work on coordination between the pelvic floor and the trunk muscles to restore effective motor control
Offer simple, progressive, and monitored daily exercises so the patient can build confidence
💡 Practical example: Julie notes that even 2–3 minutes per session with a biofeedback exercise, followed by an Andrew® program, can produce visible results very quickly.
Why this distinction matters
Understanding whether the difficulty is due to shutdown or a voluntary deficit is crucial:
To avoid proposing isolated contractions that would be ineffective
To target appropriate exercises and avoid patient frustration
To ensure rapid and safe progress
The importance of personalized postpartum follow-up is emphasized by the recommendations of the French National Authority for Health (HAS), which advocate individualized assessments of the pelvic floor after childbirth.
The role of Andrew® in care
The Andrew® platform becomes a valuable complementary tool to support patients at home and strengthen perineal awareness.
Relevant features:
Guided breathing and posture videos to integrate the perineum into global movement
Progressive sessions based on recovery level and observed progress
Remote monitoring: notifications, reminders, and feedback on completed exercises
💡 Impact example Andrew®:
More than 21,700 perineal exercises have been prescribed via Andrew®, enabling continuous follow-up between sessions and better patient engagement.
Integrating pelvic floor rehabilitation into daily practice
1. Observation and precise assessment
Assess the presence of urinary leakage, discomfort, or pain
Identify the postpartum stage and obstetric history
Determine the level of perception and muscle control
2. Progressive planning
Short but regular sessions to avoid fatigue
Integrate exercises into the patient’s daily life: breathing, lifting objects, sitting/standing posture
Use Andrew® to supplement home exercises and maintain traceability of progress
3. Communication and education
Explain the role of the perineum in posture and continence
Reassure the patient about progress, as some patients may feel an initial blockage
Highlight small successes to strengthen motivation
The importance of follow-up and personalization
Postpartum follow-up is not just a series of exercises: it is evolving and adaptive support. The patient must understand that:
Progress is gradual, sometimes slow
Every woman has a unique path and requires personalized adjustments
Success depends as much on consistency as on the quality of the exercises
Andrew® makes it possible to extend this follow-up outside the clinic, offering continuous support, even remotely, and encouraging patient adherence to the programs.
💡 More than 8,100 patients regularly open their Andrew® program
Summary of key points
Identify the source of the perineal deficit: shutdown vs voluntary deficit
Resolve sensory blockages before initiating contraction
Integrate the perineum into functional breathing and posture exercises
Offer home follow-up with Andrew®, including guided videos and progressive advancement
Maintain clear, reassuring education for the patient
Regularly assess progress and adapt the program
More questions? Check out our other articles or contact an Andrew® therapist directly.
After addressing the challenges of perineal rehabilitation and the strategies to adopt when a patient presents with no perineal awareness, it is just as essential to look at the practical tools available to support this rehabilitation work on a daily basis.
Successful postpartum follow-up depends as much on the relevance of the exercises offered as on the diversity and quality of the content available to each patient. This is exactly what Andrew® provides, thanks to a rich and evolving exercise library designed with pelvic-perineal experts such as Aude Gastauer and Julie Cantournet.
How many exercises are available for the pelvic-perineal specialty?
During the webinar “How to Optimize Our Postpartum Care” with Julie Cantournet, a frequent question was asked:
👉 “What is the approximate number of exercises available on Andrew® for the pelvic-perineal specialty?”
Julie shares her experience: the selection is already very broad, and the platform continues to evolve.
1. A rich and comprehensive exercise library
Perineal rehabilitation (including postpartum): approximately 60 to 70 exercises, including all the content filmed with Julie Cantournet.
Prenatal: approximately 100 exercises, to prepare for and support pregnancy with Aude Gastauer.
Total perineum: nearly 200 available videos.
This diversity makes it possible to offer follow-up tailored to each patient, according to her level and specific needs.
💡 Perineology refers to the medical and paramedical specialty devoted to the prevention, assessment, and rehabilitation of the pelvic floor muscles
2. Add your own exercises
Andrew® also allows practitioners to create and add their own exercises, usable only by them:
Personalized follow-up for each patient
Integration of practitioner-specific methods or approaches
Total flexibility to adapt programs to evolving needs
💡 Andrew® example: More than 5,800 personalized exercise videos added by therapists on Andrew®.
3. Structured and evolving follow-up
Exercises can be organized into progressive programs based on the level of postpartum recovery.
It is possible to monitor the patient’s progress remotely thanks to the Andrew®.
It enables comprehensive support, even in addition to conventionally billed sessions with follow-up outside the standard nomenclature.
In summary
The platform already offers a wide range of post- and prenatal exercises.
Practitioners can add their own content to personalize follow-up.
Andrew® makes it possible to build progressive programs tailored to each patient.
Ideal for comprehensive, structured, and autonomous postpartum follow-up.
Would you like to know more about Andrew®? Contact one of our therapists.
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