Assessment of Effects of Kegel Exercises on Reduction of Perineal Pain after Episiotomy in Primiparous Women

Document Type : Original Article


1 M.Sc. of Midwifery, School of Nursing and Midwifery of Abadan, Ahvaz Jundishapur University of Medical Sciences, International Branch of Arvand Abadan, Ahvaz, Iran.

2 M.Sc. of Nursing, School of Paramedicine, Yasouj University of Medical Sciences, Yasouj, Iran.


Introduction: Episiotomy is the most common surgery among women and pain resulted from episiotomy have been reported over 60%. The lack of effective control on pelvic and perineal body causes undesirable psychological and physiological effects. This study carried out with the aim of assessment of the effects of Kegel exercises on reduction of post episiotomy pain in primiparous women.
Methods: This single blind randomized clinical trial was conducted on 64 primiparous women referred to Imam Sajjad hospital of Yasouj, Iran in 2011 for delivery and episiotomy was performed for them. Women were randomly divided into two groups of case and control. Routine care and Kegel exercises were done for case group and routine care for control group. Data were gathered using a questionnaire and pain visual analogue scale. Pain severity, oral analgesic dose and frequency of analgesic use (mefenamic acid) were evaluated during the first 48 hours in both groups. Data were analyzed with SPSS software version 16, independent t-test and Pearson tests. P value less than 0.05 was considered significant.
Results: The mean of pain severity after episiotomy based on visual analogue scale were 5.9±0.8 and 7.9±0.5 in the case and control groups, respectively. Mean of analgesic dose in case and control groups were respectively 0.29±0.80 and 1.16±1.39 mg per each time and frequency of analgesic use were respectively 0.94±0.92 and 4.09±1.03 times in case and control groups. Pain severity, oral analgesic dose and frequency of analgesic use were significantly less in case group (p<0.05).
Conclusion: The use of Kegel exercises after episiotomy is associated with less pain, analgesic consumption and frequency of analgesic use.


  1. Abushaikhn L.Oweis A. Labour pain experience and intensity :a Jordanian prespective. Int J Nurs Pract 2005 Feb;11(1):33-8.
  2. Chung YC, Hou YC, Pan AC. Endoglin (CD105) expression in the development of heamorrhoids. Eur J Clin Invest 2004 Feb;34(2):107-12.
  3. Steen M, Cooper K, Marchant P, Griffiths-Jones M,Walker J. A randomised Controlled trial to compare the effectivenss of ice-packs and Epifoam with cooling maternity gel pads at all eviating postnatal perineal trauma. Midwifery 2000 Mar;16(1):48-55.
  4. May KA, Mahlmeister LR. Maternal and neonatal nursing: family-centered care. 3rd ed. Philadelphia:Lippincott;1994.
  5. Albers LL, Sedler KD, Bedrick EJ, Teaf D, Peralta P. Midwifery care measures in the second stage of labor and reduction of genital tract trauma ta birth: a randomized trial. J Midwifery Womens Health 2005 SepOct;50(5):365-72.
  6. Low LK, Seng JS, Murtland TL, Oakley D. Clinican-specific episiotomy rates: impact on perineal outcomes. J Midwifery Womens Health 2000 Mar-Apr;45(2):87-93.
  7. Cunningham FG, Leveno KJ, Bloom SL, Haut JC, Rouse DJ, Spong CY. Williams obstetrics. 23rd ed. New York: McGrow-Hill;2010.
  8. Lund KJ, McManaman J. Normal labor, delivery, newborn care, and puerperium. In: Gibbs RS, Karlan BY, Haney AF, Nygaard IE. Danforth's obstetrics and gynecology. 10th ed. Philadelphia:Lippincott Williams & Wilkins;2008:22-42.
  9. Williams FL, du V Florey C, Milres GJ, Ogston SA. Episiotomy and perineal tears in low-risk UK primigravidae. J Public Health Med 1998 Dec;20(4):422-7.
  10. Abraham S, Child A, Ferry J, Vizzard J, Mira M. Recovery after childbirth: a preliminary prospective study. Med Aust 1990 Jan;152(1):9-12.
  11. Kajoye Shirazie C, Davaty A, Zayere F. [Episiotomy rate and its complication] [Article in Persian]. J Ghom Univ Med Sci 2009:3(2):1-4.
  12. Woolley RJ. Benefits and risks of episiotomy: a review of the English-language literature since 1980. Part I. Obstet Gynecol Surv 1995 Nov;50(11):806-35. Review.
  13. Wilasrusmee S, Chittachareon A, Jirasiritum S, Srisangchai P. Naproxen supposity for perineal pain after vaginal delivery. Int J Gynecol Obstet 2008 Jul;10(1):19-22.
  14. Seckin B, Avsar F, Parlakyigit E, Aksakal O. Effects of indomethacin supposity and lidocaine pomade for relief of post-episiotomy pain. Int J Gynecol Obstet 2002 Aug;78(2):159-61.
  15. Renzi C, Peticca L, Pescatori M. The use of relaxation techniques in the perioperative management of proctological patients: preliminary results. Int J Colorectal Dis 200 Nov;15(5-6):313-6.
  16. Mobaraki A. Effective exercise on maternal &fetal “International conference Impact of Global Issues on Women & Children. Dhaka ,Bangladesh 2006:February 12-16:121.
  17. Namvar F, Golmakani N. [Assessment and pelvic floor muscle strengthening exercises using vaginal cones Kejel] [Article in Persian]. J Sabzevar Univ Med Sci 2002;8(4)16-23.
  18. Burroughs A. Maternity nursing: an introductory text. 7th ed. Philadelphia:W.B. Saunders;1997:232.
  19. Baba-Muhammad H, Khalili H. [The effect of pelvic floor exercise to treat urinary incontinence in the elderly in hospitals of Imam Reza Ghrzy Sirjan, 2000] [Article Persian]. J Sirjan Univ Med Sci 2004;11(3):63.
  20. Sar D, Khorshid L. The effect of pelvic floor muscle training on stress and mixed urinary incontinence and guality of life. J Wound Ostomy Continence Nurs 2009 Jul-Aug;36(4):422-35.
  21. Dolan LM, Casson K, McDoland P, Ashe RG. Urinary incontinence in Northern Ireland: a prevalence study. BJU Int 1999 May;83(7):760-6.
  22. Lorenzi EA. Relaxation: episiotomy incisional pain & overall discomfort. J Adv Nurs 1991 Jul;16(6):701-9.
  23. Motavaselian M, Farnia F. [Muscle relaxation techniques to investigate the effect of episiotomy pain where women primy parr spicial nursing] [Article Persian]. J Shahid Sadoghi Yazd Univ Med Sci 2003;10:25-32.
  24. Kashanian M, Shah A Nazemi.M [Effects of exercise machines and kegel master of urinary incontinence in women of reproductive age and their compression] [Article in Persian]. J Iran Univ Med Sci 2010 Nov;17(77): 55-66
  25. Raz S. Female urology. 2nd ed . Philadelphia:W.B. Saunders;1996.
  26. Willson JF. Behavioral preparation for surgery: benefit or harm? J Behav Med 1981 Mar;4(1):79-102.
  27. Davies J, Duffy D, Boyt N, Aghahoseini A, Alexander D, Leveson S. Botulinum toxin (botox) reduces pain after hemorrhoidectomy: results of a double-blind, randomized study. Dis Colon Rectum 2003 Aug;46(8):1097-102.
  28. Navarro Nunez C, Pacheco Carrasco M. [Transcutaneous electric nerve stimulation (TENS) to reduce pain after cesarean section] [Article in Spanish]. Gynecol Obstet Mex 2000 Feb;68:60-3.
  29. Wang B, Tang J, White PF, Naruse R, Sloninsky A, Kariger R, et al. Effect of the intensity of transcuetaneous acupoint electrical stimulation on the postoperative analgesic requirement. Anesth Analg 1997 Aug;85(2):406- 13.
  30. Chiu JH, Chen WS, Chen CH, Jiang JK, Tang GJ, Lui WY, et al. Effect of transcutaneous electrical nerve stimulation for pain relief on patients undergoing hemorrhoidectomy: prospective, randomized, controlled trial. Dis Colon Rectum 1999 Feb;42(2):180-5.
  31. Lantsev EA, Smirnov AA. [The use of transcutaneous electric neurostimulation for postoperative analgesia in parturients undergoing cesarean section] [Article in Russian]. Anesteziol Reanimatol 1990 Nov-Dec;(6):66-9.
  32. Paterson C, Symons L, Britten N , Bargh J. Developing the medication change questionnaire. J Clin Pharm Ther 2004 Aug;29(4):39-49.