Assistência fisioterapêutica na reabilitação do assoalho pélvico pós laceração e/ou episiotomia
##plugins.themes.bootstrap3.article.sidebar##
Publicado
Apr 29, 2025
##plugins.themes.bootstrap3.article.main##
Resumo
Objetivo: Analisar a eficácia da assistência fisioterapêutica na reabilitação do assoalho pélvico após laceração e episiotomia. Métodos: Trata-se de uma revisão integrativa de literatura, realizada entre março e maio de 2024, com o uso de bases de dados eletrônicos Scientific Eletronic Library Online (Scielo), Pubmed, Physiotherapy Evidence Database (Pedro), Literatura Latino Americana e do Caribe em Ciências da Saúde (Lilacs) e Cochrane Library. Foram considerados critérios de inclusão: estudos observacionais, publicados em periódicos científicos, revisados por pares nos idiomas inglês e português, que abrangeram mulheres que tiveram ou laceração ou passaram por episiotomia. Resultados: Após o término da seleção de artigos, foram inicialmente selecionados 2420 artigos, nos quais 1758 foram excluídos por não terem sido publicados nos últimos 5 anos. Foram removidas43 duplicatas e 611 foram excluídos por não respeitar critérios metodológicos. Há significância estatística em favor das intervenções fisioterapêuticas no manejo das disfunções do assoalho pélvico associadas ao trauma perineal pós-parto e à episiotomia, principalmente voltadas para o alívio da dor pélvica, recuperação da função sexual e da melhora da fraqueza muscular. Conclusão: A assistência fisioterapêutica mostra-se eficaz na literatura estudada na reabilitação do assoalho pélvico pós laceração perineal e pós episiotomia.
##plugins.themes.bootstrap3.article.details##
Como Citar
SilvaE. C. M., SouzaL. B. R. de, SilvaL. C. A. P. da, BrandãoA. K. L., CardosoA. S., PinheiroP. P. da F., SilveiraT. S., & BritoM. V. H. (2025). Assistência fisioterapêutica na reabilitação do assoalho pélvico pós laceração e/ou episiotomia. Revista Eletrônica Acervo Saúde, 25, e18733. https://doi.org/10.25248/reas.e18733.2025
Seção
Revisão Bibliográfica
Copyright © | Todos os direitos reservados.
A revista detém os direitos autorais exclusivos de publicação deste artigo nos termos da lei 9610/98.
Reprodução parcial
É livre o uso de partes do texto, figuras e questionário do artigo, sendo obrigatória a citação dos autores e revista.
Reprodução total
É expressamente proibida, devendo ser autorizada pela revista.
Referências
1. AGUIAR BM, et al. Factors associated with the performance of episiotomy. RevistaBrasileira de Enfermagem. 2020; 73(4).
2. ALHAFEZ L e BERGHELLA V. Evidence-based labor management: first stage of labor (part 3). American Journal of Obstetrics & Gynecology MFM. 2020; 2(4): 100185.
3. ÁLVAREZ-GONZÁLEZ M, et al. Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial. Journal of Clinical Medicine, 2021; 10(21): 4934.
4. ALVES PGJM, et al. Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial. Brazilian Journal of Physical Therapy. 2011; 15(5): 393–8.
5. BELEZA ACS. A dor perineal no pós-parto normal com episiotomia: mensuração, caracterização e efeitos da crioterapia (Doutorado em Enfermagem em Saúde Pública) – Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, São Paulo, 2008.
6. BERGMAN I, et al. Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear. Obstetrics & Gynecology. 2020; 135(2): 341–51.
7. BONIATTI C, et al. Comparison of photobiomodulation with cryotherapy in the immediate postpartum period of parturients with grade I, grade II lacerations and/or episiotomy in reducing perineal and vulvar and edema: A randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2024.
8. BORTOLETTO J, et al. Fatores associados à incontinência urinária em mulheres pós-parto Factorsassociatedwithurinaryincontinence in postpartumwomen. 2021 49(5): 300-308.
9. CAO X, et al. PFMT relevant strategies to prevent perineal trauma: a systematic review and network meta-analysis. Archives of Gynecology and Obstetrics. 2022.
10. CHOULHARI RG, et al. A review of episiotomy and modalities for relief of episiotomy pain. Cureus. 2022; 14(11).
11. DESTA M. Mortality Rate and Predictors Among Women With Obstructed Labor in a Tertiary Academic Medical Center of Ethiopia: A Retrospective Cohort Study. 2023; 9: 237796082311656.
12. FILIPPINI M, et al. The Utility of CO2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery. Journal of Personalized Medicine, 2023; 14(1): 60.
13. GHULMIYYAH L, et al. Episiotomy: history, present and future – a review. The Journal of Maternal-Fetal & Neonatal Medicine. 2020; 1–6.
14. HERSH AR, et al. Third stage of labor: evidence-based practice for prevention of adverse maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 2023; 3(1).
15. HUANG CC, et al. Comparison of Labor and Delivery Complications and Delivery Methods Between Physicians and White-Collar Workers. International Journal of Environmental Research and Public Health. 2020; 17(14): 5212.
16. HUTCHISON J, et al. Stagesof Labor. 2023. Disponível em:
17. KÄMPF C e DIAS RB. A episiotomia na visão da obstetrícia humanizada: reflexões a partir dos estudos sociais da ciência e tecnologia. História, Ciências, Saúde-Manguinhos. 2018; 25(4): 1155–60.
18. KHAN N, et al. Episiotomy and its complications-a cross sectional study in secondary care hospital. Journal of the Pakistan Medical Association [Internet]. 2020; 1.
19. LAVAND’HOMME P. Postpartum chronic pain. Minerva Anestesiologica. 2019; 85(3).
20. LEAL MC, et al. Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos. Cadernos de Saúde Pública. 2019; 35(7).
21. LUCENA DA SILVA, M, et al. The effectiveness of interventions in the prevention of perineal trauma in parturients: A systematic review with meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2023; 283; 100–111.
22. MACEDO MD, et al. Detailed classification of second‐degree perineal tears in the delivery ward: an inter‐rater agreement study. ActaObstetricia et GynecologicaScandinavica, 2022.
23. MANZOTTI A, et al. What is known about changes in pelvic floor muscle strength and tone in women during the childbirth pathway? A scoping review. European Journal of Midwifery, 2024; 8(8): 1–23.
24. MELO I, et al. Selective episiotomy vs. implementation of a non episiotomy protocol: a randomized clinical trial. Reproductive Health. 2014; 11(1).
25. MOTA P, et al. Pelvic floor muscle function after grade II tears—Surface electromyography test–retest and differences between nulliparous and primiparous. Neurourology and Urodynamics, 2023; 42(5): 1162–1168.
26. OUZZANI M, et al. Rayyan—a Web and Mobile App for Systematic Reviews. Systematic Reviews, 2016; 5(1).
27. RODRIGUES S, et al. Effect of Perineal Massage and Warm Compresses Technique in Postpartum Pelvic Floor Dysfunction. A Secondary Analysis from a Randomised Controlled Trial. Reproductive Sciences, 2024.
28. RODRIGUES S, et al. Perineal massage and warm compresses – Randomised controlled trial for reduce perineal trauma during labor. Midwifery [Internet]. 2023; 124: 103763.
29. ROMA NZH, et al. Effect of Dry Heat Application on Perineal Pain and Episiotomy Wound Healing among Primipara Women. 2023; 9572354.
30. SANTOS PFD, et al. Eletroestimulação funcional do assoalho pélvico versus terapia com os cones vaginais para o tratamento de incontinência urinária de esforço. Revista Brasileira de Ginecologia e Obstetrícia. 2009; 31(9): 447–52.
31. SILVA EV, et al. Relação do tipo de parto com o perfil epidemiológico da assistência pré-natal e perinatal em um município de Minas Gerais. RevistaBrasileira de SaúdeMaternoInfantil [Internet]. 2020; 20: 241–7.
32. STEER, P e FLINT, C. Physiology and management of normal labour. BMJ: British Medical Journal, 1999; 318(7186): 793–796.
33. UGWU EO, et al. Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research. 2018; 44(7): 1252–8.
34. UZDENOVA Z, et al. Physical therapeutic factors in stage medical rehabilitation of puerperas with perineal wounds after fetal vacuum extraction. Georgian Medical News 2021; 319: 31–6.
35. VESTING, S, et al. The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis after Pregnancy: A Longitudinal Prospective Cohort Study. Physical therapy, 2023; 104(4).
36. ZHANG, D, et al. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third‐ or fourth‐degree perineal tear: Systematic review and meta‐analysis of randomized clinical trials. Actaobstetricia et gynecologicaScandinavica, 2023.
2. ALHAFEZ L e BERGHELLA V. Evidence-based labor management: first stage of labor (part 3). American Journal of Obstetrics & Gynecology MFM. 2020; 2(4): 100185.
3. ÁLVAREZ-GONZÁLEZ M, et al. Prevalence of Perineal Tear Peripartum after Two Antepartum Perineal Massage Techniques: A Non-Randomised Controlled Trial. Journal of Clinical Medicine, 2021; 10(21): 4934.
4. ALVES PGJM, et al. Comparison between two different neuromuscular electrical stimulation protocols for the treatment of female stress urinary incontinence: a randomized controlled trial. Brazilian Journal of Physical Therapy. 2011; 15(5): 393–8.
5. BELEZA ACS. A dor perineal no pós-parto normal com episiotomia: mensuração, caracterização e efeitos da crioterapia (Doutorado em Enfermagem em Saúde Pública) – Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, São Paulo, 2008.
6. BERGMAN I, et al. Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear. Obstetrics & Gynecology. 2020; 135(2): 341–51.
7. BONIATTI C, et al. Comparison of photobiomodulation with cryotherapy in the immediate postpartum period of parturients with grade I, grade II lacerations and/or episiotomy in reducing perineal and vulvar and edema: A randomized clinical trial. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2024.
8. BORTOLETTO J, et al. Fatores associados à incontinência urinária em mulheres pós-parto Factorsassociatedwithurinaryincontinence in postpartumwomen. 2021 49(5): 300-308.
9. CAO X, et al. PFMT relevant strategies to prevent perineal trauma: a systematic review and network meta-analysis. Archives of Gynecology and Obstetrics. 2022.
10. CHOULHARI RG, et al. A review of episiotomy and modalities for relief of episiotomy pain. Cureus. 2022; 14(11).
11. DESTA M. Mortality Rate and Predictors Among Women With Obstructed Labor in a Tertiary Academic Medical Center of Ethiopia: A Retrospective Cohort Study. 2023; 9: 237796082311656.
12. FILIPPINI M, et al. The Utility of CO2 Laser Treatment of Pelvic Symptoms in Women with Previous Perineal Trauma during Delivery. Journal of Personalized Medicine, 2023; 14(1): 60.
13. GHULMIYYAH L, et al. Episiotomy: history, present and future – a review. The Journal of Maternal-Fetal & Neonatal Medicine. 2020; 1–6.
14. HERSH AR, et al. Third stage of labor: evidence-based practice for prevention of adverse maternal and neonatal outcomes. American Journal of Obstetrics and Gynecology, 2023; 3(1).
15. HUANG CC, et al. Comparison of Labor and Delivery Complications and Delivery Methods Between Physicians and White-Collar Workers. International Journal of Environmental Research and Public Health. 2020; 17(14): 5212.
16. HUTCHISON J, et al. Stagesof Labor. 2023. Disponível em:
17. KÄMPF C e DIAS RB. A episiotomia na visão da obstetrícia humanizada: reflexões a partir dos estudos sociais da ciência e tecnologia. História, Ciências, Saúde-Manguinhos. 2018; 25(4): 1155–60.
18. KHAN N, et al. Episiotomy and its complications-a cross sectional study in secondary care hospital. Journal of the Pakistan Medical Association [Internet]. 2020; 1.
19. LAVAND’HOMME P. Postpartum chronic pain. Minerva Anestesiologica. 2019; 85(3).
20. LEAL MC, et al. Avanços na assistência ao parto no Brasil: resultados preliminares de dois estudos avaliativos. Cadernos de Saúde Pública. 2019; 35(7).
21. LUCENA DA SILVA, M, et al. The effectiveness of interventions in the prevention of perineal trauma in parturients: A systematic review with meta-analysis. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2023; 283; 100–111.
22. MACEDO MD, et al. Detailed classification of second‐degree perineal tears in the delivery ward: an inter‐rater agreement study. ActaObstetricia et GynecologicaScandinavica, 2022.
23. MANZOTTI A, et al. What is known about changes in pelvic floor muscle strength and tone in women during the childbirth pathway? A scoping review. European Journal of Midwifery, 2024; 8(8): 1–23.
24. MELO I, et al. Selective episiotomy vs. implementation of a non episiotomy protocol: a randomized clinical trial. Reproductive Health. 2014; 11(1).
25. MOTA P, et al. Pelvic floor muscle function after grade II tears—Surface electromyography test–retest and differences between nulliparous and primiparous. Neurourology and Urodynamics, 2023; 42(5): 1162–1168.
26. OUZZANI M, et al. Rayyan—a Web and Mobile App for Systematic Reviews. Systematic Reviews, 2016; 5(1).
27. RODRIGUES S, et al. Effect of Perineal Massage and Warm Compresses Technique in Postpartum Pelvic Floor Dysfunction. A Secondary Analysis from a Randomised Controlled Trial. Reproductive Sciences, 2024.
28. RODRIGUES S, et al. Perineal massage and warm compresses – Randomised controlled trial for reduce perineal trauma during labor. Midwifery [Internet]. 2023; 124: 103763.
29. ROMA NZH, et al. Effect of Dry Heat Application on Perineal Pain and Episiotomy Wound Healing among Primipara Women. 2023; 9572354.
30. SANTOS PFD, et al. Eletroestimulação funcional do assoalho pélvico versus terapia com os cones vaginais para o tratamento de incontinência urinária de esforço. Revista Brasileira de Ginecologia e Obstetrícia. 2009; 31(9): 447–52.
31. SILVA EV, et al. Relação do tipo de parto com o perfil epidemiológico da assistência pré-natal e perinatal em um município de Minas Gerais. RevistaBrasileira de SaúdeMaternoInfantil [Internet]. 2020; 20: 241–7.
32. STEER, P e FLINT, C. Physiology and management of normal labour. BMJ: British Medical Journal, 1999; 318(7186): 793–796.
33. UGWU EO, et al. Effectiveness of antenatal perineal massage in reducing perineal trauma and post-partum morbidities: A randomized controlled trial. Journal of Obstetrics and Gynaecology Research. 2018; 44(7): 1252–8.
34. UZDENOVA Z, et al. Physical therapeutic factors in stage medical rehabilitation of puerperas with perineal wounds after fetal vacuum extraction. Georgian Medical News 2021; 319: 31–6.
35. VESTING, S, et al. The Impact of Exercising on Pelvic Symptom Severity, Pelvic Floor Muscle Strength, and Diastasis Recti Abdominis after Pregnancy: A Longitudinal Prospective Cohort Study. Physical therapy, 2023; 104(4).
36. ZHANG, D, et al. Influence of pelvic floor muscle training alone or as part of a general physical activity program during pregnancy on urinary incontinence, episiotomy and third‐ or fourth‐degree perineal tear: Systematic review and meta‐analysis of randomized clinical trials. Actaobstetricia et gynecologicaScandinavica, 2023.