While giving birth, you sustained an anal muscle tear, called a ”sphincter rupture”. The sphincter muscle is part of the pelvic floor. It is a circular muscle, whose function is to close the anal opening. 
It is very common to experience small tears in the pelvic floor during childbirth. However, if you also tear the sphincter muscle, there are certain considerations to be taken postnatally. In general, you should: 

1. Not put pressure on the pelvic floor.
2. Avoid constipation.
3. Train the muscles of the pelvic floor.

Each of these points will be discussed in more details later on, but first, some information about the pelvic floor.

The pelvic floor

The pelvic floor is the layer of muscle that stretches from your pubic bone in the front to your tailbone at the back, forming the floor of the pelvic. It has two important functions: 

1. A closing function: To close off the bladder and bowel outlets to help prevent the leakage of urine, feces and gas.
2. A supporting function: To support the pelvic organs: bladder, uterus and bowel.

The pelvic floor is only one cm. thick. However, the sphincter muscle, situated around the anus, is two cm. thick. It is this muscle which partially or completely ruptured during childbirth, and was subsequently sewn together.
After pregnancy and childbirth, the pelvic floor is weakened. When the sphincter muscle is injured as well, it puts extra stress on the pelvic floor. It is very important to strengthen the pelvic floor muscles. They must be able to close, to prevent leakage and support the pelvic organs, to prevent future problems with a sinking uterus, bladder and intestines. It is recommended that all women exercise their pelvic floor muscles regularly throughout life, to prevent or correct weakness.

Stress 

In order for your muscles and rupture to heal optimally, you must avoid putting stress on the pelvic floor.
For the first 14 days: 

• Do not sit for more than 15 minutes at a time.If you are uncomfortable sitting or have swelling, sit as little as possible. Never sit on a ring-shaped cushion! Use a regular pillow, if you feel it is comfortable. Sit with your weight distributed equally on your buttocks and place both feet on the floor or on a low footrest. For the first month, we recommend that you: - Lie down several times a day, half an hour at a time.
• Avoid lifting more than your child’s weight. If possible, let others carry things for you. - Avoid doing heavy housework, such as vacuumin and washing the floors.

If you are experiencing a lot of pain, it may be due to excessive tension in the muscles of the pelvic floor. Many women automatically tense these muscles to protect the stitches or as a result of pain in the pelvic floor. Unfortunately, this causes more pain. Try to relax the muscles surrounding the anus. Practice relaxation techniques while lying down, sitting and standing. A sign of overexertion is a heavy feeling in the pelvic floor. This is a signal, that the pelvic floor is not strong enough to do its job properly. To alleviate this problem, lie down and rest many times a day, avoid sitting for long periods of time and take many shorts walks instead of one long walk. You alone can feel how your pelvic floor is working. Intercourse / sex can be attempted after 8 weeks. Use a condom if you’re still bleeding.

Constipation

Keep your bowel movements regular. On the ward, you will get a laxative, ”magnesia”, to soften the stool. You can continue taking this for a total of 10 days. If you tend to be constipated:

• Eat foods rich in fiber, such as oatmeal and carrots.
• Drink plenty of fluids, at least 2-3 liters a day.- Periodically, eat prunes, grapes and drink fig juice.

Training

The muscles of the pelvic floor can be trained just like every other muscle in the body. Pelvic floor exercises draw the muscles inward and upward with a ”squeeze and lift” action. Right after childbirth, your muscles are of course weak and it can be difficult to perform this action. And, perhaps, you have never done this before. When you ”squeeze and lift”, the muscles in the pelvic floor including the circular muscles contract. A squeeze always starts at the back of the pelvic floor, near the anus, and spreads towards the front. 
This means, that when you squeeze, you should focus on your anal opening. Concentrate on closing the anus as if you’re trying to stop passing wind. It is very important to practice the correct ”squeeze and lift” technique:

• Contract only the muscles in the pelvic floor. Do not tighten the muscles of the buttocks thighs and stomach.
• Inhale as you squeeze. Do not pull your stomach in and do not hold your breath.

These exercises entail a lot of concentration in the beginning. You can’t see what’s happening, but you can feel it. In time, it will be easier to do these exercises. The first week, do only small, short squeezes: 1-2 seconds, a few times a day. After one week, begin daily training. It doesn’t have to take more than 10 minutes a day.
In the beginning, you won’t be able to do very much. Realistically, you will probably be able to do 5 squeezes every 3 seconds.

In the long run, the goal is to do 20 good squeezes 3 times a day. Hold the squeeze for 6-8 seconds, with a rest of 6-8 seconds between each muscle contraction. Eventually, you should also practice doing 1-2 long squeezes for 30-60 seconds.

For the first 3 months, you should:

1. Lie down when you exercise.
2. Exercise in the morning, or after you’ve been lying down and resting.