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Masnila, Nurlama Siregar. (2022). The Effect of Kegel Exercises on

Perineal Wound Healing in Postpartum Mothers. Journal Eduvest.

Vol 2(3): 530-538

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Eduvest – Journal of Universal Studies

Volume 2 Number 3, March, 2022

p- ISSN 2775-3735- e-ISSN 2775-3727

THE EFFECT OF KEGEL EXERCISES ON PERINEAL

WOUND HEALING IN POSTPARTUM MOTHERS

Masnila, Nurlama Siregar

Health Polytechnic of the Ministry of Health Medan, Indonesia

Email: [email protected], [email protected]

ARTICLE INFO ABSTRACT

Received:

Ferbuary,

2022

Revised:

March, 15

2022

Approved:

March, 16

2022

The purpose of this study was to determine the effect of Kegel

exercises on the healing of perineal wounds in postpartum

mothers at the Niar Pratama Clinic and the Citra Pratama

Clinic, Deli Serdang Regency. The design used in the study was

a quasi-experimental method with a static group comparison,

which is a type of research to determine the effect of an action

on a group of subjects who received treatment, then compared

it with a group that did not receive treatment. This research

was conducted at the Niar Pratama Clinic and the Citra

Pratama Clinic, Deli Serdang Regency which was carried out in

November 2019 - November 2020. The sampling design was

based on purposive sampling, namely postpartum mothers

with perineal injuries of degree I. The number of samples was

60 people who received treatment 30 people, while the control

group was 30 people. Data analysis was carried out after all

data had been collected by re-examining all the questionnaires

one by one and ensuring that all data had been filled in

according to the instructions. Then provide a code for all the

questions that have been asked to make it easier for

researchers when tabulating and analyzing data. Data were

tabulated and analyzed using the Median Test (Mann-Whitney

U-Test) with a significance level of < 0.05. The results of this

study are that there is a difference in wound healing in post

partum mothers who do Kegel exercises when compared to

mothers who do not do Kegel exercises with a difference of

18.76 points and there is an effect of Kegel exercises on

perineal wound healing in postpartum mothers at the Pratama

Masnila, Nurlama Siregar

The Effect of Kegel Exercises on Perineal Wound Healing in Postpartum Mothers 531

Niar Clinic and Pratama Clinic. Image of Deli Serdang Regency.

KEYWORDS

Kegel Exercises, Postpartum Mothers, Perineal Wounds

This work is licensed under a Creative Commons Attribution-

ShareAlike 4.0 International

INTRODUCTION

The process of pregnancy, childbirth and postpartum is still something that is

risky and can be life threatening for women and babies in Indonesia (Zainiyah & Susanti,

2020). The results of the 2015 Inter-Census Population Survey stated that the maternal

mortality rate (MMR) in Indonesia was 305 per 100 thousand live births (Manik, Triyoga,

Siregar, Rochadi, & Poddar, 2022). In 1 hour, Indonesia lost 2 mothers and 8 newborns

due to deaths, most of which could actually be prevented (Orlandi et al., 2018). The

causes of maternal death are formulated as 4 Too 3 Too late, namely: Too young (<20

years) Too old (>35 years) Too often or many children (>3 children) Too close in birth

spacing (<2 years) Too late to make a decision Late until in health facilities it was too late

to get adequate help, because it was too late so that in handling it was too late (Gunawan,

Widyaningtyas, Wibawa, Darusalam, & Pranolo, 2018). Research conducted by the

Faculty of Public Health, University of Indonesia (FKM-UI) revealed that 75% of

maternal deaths were caused by bleeding severe (mostly postpartum), infection, high

blood pressure during pregnancy, obstructed labor, unsafe abortion. It was also stated that

the case of the mother died due to obstetric complications that were not handled properly

and on time.

The puerperium is a period that requires serious treatment to prevent

complications, including infection (Phillips & Walsh, 2020). Infection can occur due to

injury to the perineum (Jones, Webb, Manresa, Hodgetts-Morton, & Morris, 2019). When

going through an exciting and stressful labor, you should be aware of post-delivery

infections. Wounds due to perineal tears are susceptible to infection. Cases of episiotomy

infection are relatively small, and the risk is 1-4%. The severity varies depending on the

area and depth of the infected tissue. Starting from the vagina, vulva (outer and inner

lips), it can even spread to the uterus. Generally, it occurs 1-2 days after delivery

(Richards & Wood, 2018).

One of the actions that can be taken to speed up the healing process of perineal

wounds is to carry out Kegel exercise (Budiyarti, 2019). This exercise is carried out to

increase blood circulation around the genitalia.

Research from Martini, DE (2015) on "Effectiveness of Kegel Exercises on

Accelerated Healing of Perineal Wounds in Postpartum Mothers at the Kali Tengah

Lamongan Health Center" showed that almost all mothers (93.3%) in the treatment group

experienced fast wound healing and a small percentage (6, 7%) experienced slow wound

healing, compared to the control group more than half (66.7%) experienced slow wound

healing and some (33.3%) experienced fast wound healing. The results of the Mann-

Whitney test obtained a Z value of -3.352 with a significance of 0.001 (p <0.05) so it can

be concluded that Kegel exercises are effective for accelerating the healing of perineal

wounds. Research from Antini, A (2016) on "Effectiveness of Kegel Exercises Against

Perineal Wound Healing Time in Normal Post Partum Mothers" shows the average

healing time of perineal wounds in the Kegel exercise group is 6 days with a minimum

limit of 5 days and a maximum of 7 days faster compared to the mobilization group the

average was 7 days, the minimum limit was 4 days and the maximum was 9 days. The

results of the bivariate analysis obtained a P value = 0.000, so it can be concluded that

Eduvest – Journal of Universal Studies

Volume 2 Number 3, March 2022

532 http://eduvest.greenvest.co.id

there is a significant relationship between the length of time for wound healing between

mothers doing Kegel exercises and mothers doing mobilization in postpartum mothers.

Research from Ridhayanti, A (2014) on "The Relationship Between Kegel Exercises and

Healing of Perineal Suture Wounds in Post Partum Mothers at Afiatun Hasanah Hospital,

Bandung City" shows that from 24 samples, in the first evaluation, group I obtained 10

people while Group II only 4 people showing a normal perineal appearance. In the second

evaluation in group I the entire sample (12 people) while in group II only 8 people

showed a normal perineal appearance. The results of the Pearson correlation test showed

a correlation of 0.742 with a p value of 0.006 and a p value of <0.05. This means that

there is a relationship between Kegel exercises and perineal suture wound healing.

Based on the results of a preliminary survey conducted at the Niar Pratama Clinic

on November 8, 2019, it was found that the number of postpartum mothers from January-

June 2019 was 153 people, of which 105 people experienced perineal injuries (68.63%),

second degree as many as 20 people (13.07%) and 28 people without hecting (18.3%), the

average number of postpartum mothers was 38 people. Meanwhile, at the Pratama Citra

Clinic, Deli Serdang Regency, the number of postpartum mothers from July-October

2019 was 184 people, of which 117 people (63.58%), second-degree perineal injuries

(11.4%) had no hecting as many as 46 people (25%) every month an average of 10

people. The average number of postpartum mothers is 30 people.

Based on the above, the researchers wanted to do research on "The Effect of

Kegel Exercises on Healing Perineal Wounds in Postpartum Mothers at Niar Pratama

Clinic and Citra Pratama Clinic, Deli Serdang Regency".

RESEARCH METHOD

The design used in the study was a quasi-experimental method with a static group

comparison, which is a type of research to determine the effect of an action on a group of

subjects who received treatment, then compared it with a group that did not receive

treatment (Sutomo, Wahyudi, Pangestuti, & Muharam, 2020).This research was

conducted at Niar Pratama Clinic and Citra Pratama Clinic, Deli Serdang Regency. The

study was conducted in November 2019 - November 2020. The population of this study

were postpartum mothers with grade I perineal injuries who were treated at the Pratama

Niar Clinic and Pratama Citra Clinic, Deli Serdang Regency.

Sample of this study were all postpartum mothers who experienced first-degree

perineal injuries at the Niar Pratama Clinic and the Citra Pratama Clinic, Deli Serdang

Regency. The sampling design was based on purposive sampling, namely postpartum

mothers with grade I perineal injuries (Afni & Ristica, 2021). The number of samples was

60 people, where 30 people were treated, while the control group was 30 people. Data

collection was carried out in 2 (two) clinics, each with 30 respondents. Prior to the

intervention, the respondents were given information about their participation in the

study. If the mother agrees, then the mother fills out the informed consent (Combs et al.,

2019). The intervention group was given Kegel exercises every day for seven days (until

the perineal wound healed), then evaluation was carried out on the seventh day of the

puerperium. While the control group was not given any treatment, the perineal wound

was observed on the seventh day of the puerperium. Data analysis was carried out after

all data had been collected by re-examining all the questionnaires one by one and

ensuring that all data had been filled in according to the instructions (McManus, Mason,

& Young, 2021). Then provide a code for all the questions that have been asked to make

it easier for researchers when tabulating and analyzing data (Drosos, Barik, Guo, DeLine,

Masnila, Nurlama Siregar

The Effect of Kegel Exercises on Perineal Wound Healing in Postpartum Mothers 533

& Gulwani, 2020). Data were tabulated and analyzed using the Median Test (Mann-

Whitney U-Test) with a significance level of < 0.05.

RESULT AND DISCUSSION

A. Description of Research Locations

This research was conducted in a maternity clinic in the work area of the

Patumbak Public Health Center, Deli Serdang Regency, namely the Pratama Niar Clinic

and the Pratama Citra Clinic.

B. Demographic Data

To see the demographic data for postpartum mothers at the Niar Pratama Clinic

and the Citra Pratama Clinic, Deli Serdang Regency, see Table 1.

Table 1. Demographic Data of Postpartum Mothers at Niar Pratama Clinic

and Citra Pratama Clinic, Deli Serdang Regency

Characteristics

of Respondents

Treatment

Control

Age

< 25 age

36,7

30,0

26-30 age

30,0

46,7

31-35 age

23,3

20,0

> 35 age

10,0

3,3

Total

100,0

Education

Primary School

6,7

Junior High

School

13,3

16,7

Senior High

School

63,4

70,0

Diploma

3,3

0,0

Bachelor

13,3

3,3

Total

100,0

Housewife

90,0

entrepreneur

6,7

Job

Teacher

3,3

Total

100,0

Childbirth Ke

First

13,3

20,0

Second

50,0

33,3

Third

26,8

33,3

Fourth

3,3

Fifth

3,3

Sixth

3,3

6,8

Total

100,0

Eduvest – Journal of Universal Studies

Volume 2 Number 3, March 2022

534 http://eduvest.greenvest.co.id

Based on table 1, it can be seen that the age of postpartum mothers at the Pratama

Niar Clinic and Pratama Citra Clinic, Deli Serdang Regency in the treatment group was

more with age <25 age as many as 11 people (36.7%), while in the control group were

more with age 26- 30 age as many as 14 people (46.7%), education of postpartum

mothers in the treatment group was more with high school as many as 19 people (63.4%)

and in the control group also more with high school as many as 21 people (70.0%), The

work of postpartum mothers in the treatment and control groups was more with IRT each

as many as 27 people (63.4%), postpartum mothers in the treatment group more by giving

birth to a second child as many as 15 people (50.0%), while in the control group more by

giving birth to the second and third children each as many as 10 people (33.3%).

C. Perineal Wound Healing

To see the healing of perineal wounds in postpartum women at the Niar Pratama

Clinic and the Citra Pratama Clinic, Deli Serdang Regency, see Table 2.

Table 2. Healing of Perineal Wounds in Postpartum Mothers at Niar

Pratama Clinic and Citra Pratama Clinic Deli Serdang Regency

Perineal Wound Healing

Treatment

Control

Fast

80,0

26,7

Slow

20,0

73,3

Mean = 4,83

Mean = 6,97

Based on table 2, it can be seen that the healing of perineal wounds in postpartum

mothers at the Pratama Niar Clinic and Pratama Citra Clinic, Deli Serdang Regency in the

treatment group with the fast category as many as 24 people (80.0%), while in the control

group as many as 8 people (26.7 %). Then the healing of postpartum women's perineal

wounds in the treatment group with the slow category as many as 6 people (20.0%), while

in the control group as many as 22 people (73.3%) with an average perineal wound

healing in the treatment group 4.83 days and the average perineal wound healing in the

control was 6.97 days.

D. The Effect of Kegel Exercises on Perineal Wound Healing in Postpartum

Mothers

To see the effect of Kegel exercises on perineal wound healing in postpartum

mothers at the Niar Pratama Clinic and Citra Pratama Clinic, Deli Serdang Regency, it

can be seen in Table 3:

Table 3. The Effect of Kegel Exercises on Perineal Wound Healing in

Postpartum Mothers at Niar Pratama Clinic and Citra Pratama Clinic Deli Serdang

Regency

Variable Group

Mean Rank

Sum of Ranks

p-value

Perineal wound healing

Treatment

21,12

633,50

Control

39,88

1196,50

0,000

Total

Masnila, Nurlama Siregar

The Effect of Kegel Exercises on Perineal Wound Healing in Postpartum Mothers 535

Based on Table 3, it is found that the mean rank or average rating of each group,

namely in the treatment group the average rating is 21.12 lower than the average control

group, which is 39.88, meaning that there is a difference in wound healing in post partum

mothers where mothers who do Kegel exercises are more recovered quickly when

compared to mothers who did not do Kegel exercises with a difference of 18.76 points.

This means that it can be concluded that Kegel exercises can accelerate the healing of

perineal wounds.

Then based on the median test (mann-whitney u-test) obtained a sig value or p-

value of 0.000 <0.05, meaning Ho is rejected, meaning that there is a significant

difference or there is an effect of Kegel exercises on perineal wound healing in

postpartum mothers at the Pratama Clinic. Niar and Pratama Citra Clinic, Deli Serdang

Regency.

Discussion

A. Perineal wound healing

Perineal wound healing in postpartum women at the Pratama Niar Clinic and

Pratama Citra Clinic, Deli Serdang Regency in the treatment group with the fast category

as many as 24 people (80.0%), while in the control group as many as 8 people (26.7%)

with an average Perineal wound healing in the kegel exercise group was 4.83 days faster

than the control group with an average of 6.97 days.

According to Smeltzer (2002), and Ismail (2012) states that the wound healing

phase consists of an inflammatory phase that lasts for 1 to 4 days (when the

microcirculation is damaged, blood elements such as antibodies, plasma proteins,

electrolytes, complement, and water penetrate the vascular space). for 2 to 3 days, causing

edema, feeling warm, redness and pain), the proliferative phase, lasting 5 to 20 days, and

the maturation phase lasting 21 days to a month or even aging (Ridhayanti, 2013; Ismail,

2012).

In fact, the average perineal wound healing varies, some are normal (< 6 days)

and some are slow (≥ 7 days). The speed of perineal wound healing is influenced by

several factors including internal factors, namely age, tissue management, haemorrhage,

hypovolemia, local edema factors, nutritional deficits, personal hygiene, oxygen deficit

and over activity. While the influence of external factors include environment, tradition,

knowledge, socio-economics, handling of officers in providing health education for

perineal wound care and mobilization exercises, maternal condition and nutrition. One of

the supporting factors that can accelerate the healing of perineal wounds is through the

recommendation of mobilization by health workers. This mobilization can be directed

with various exercises.

Another study is similar to Antini's (2016) study on the effectiveness of Kegel

exercises on the healing time of perineal wounds in normal postpartum mothers. The

average length of time for perineal wound healing in the Kegel group was 6 days with a

minimum limit of 5 days and a maximum of 7 days.

The recommended form of exercise according to Nursalam (2006) is that Kegel

exercises will be able to have a good influence on the level of human physical ability if

carried out properly and directed, because Kegel exercises can strengthen the pelvic floor

muscles, especially the pubococcygeal muscles so that women can strengthen the muscles

of the pelvic floor. urinary tract muscles and vaginal muscles so that it has an effect on

accelerating the healing process of perineal wounds. In addition to Kegels, there are many

Eduvest – Journal of Universal Studies

Volume 2 Number 3, March 2022

536 http://eduvest.greenvest.co.id

movements that postpartum mothers can do, including lifting the pelvis gradually and

others.

The results of Ridhayanti's research (2013) found that the average day for

perineal wound healing using Kegel exercises is more than 5-7 days. Meanwhile,

according to Dewi Dina's research (2013) which examined the effectiveness of early

mobilization on the speed of perineal wound healing, it was found that from 16

respondents, most of the respondents (10) accelerated wound healing more slowly (> 7)

and only 6 respondents entered the category of fast wound healing. The results showed

that the average day of wound healing for kaegel exercises was faster than mobilization

(hip lifting exercises).

B. Effect of Kegel Exercises on Perineal Wound Healing in Postpartum Mothers

The results showed that the mean rank or average rating of each group, namely in

the treatment group the average rating was 21.12 lower than the average control group,

which was 39.88, meaning that there was a difference in wound healing in post partum

mothers where mothers who did Kegel exercises were faster. recovered when compared

to mothers who did not do Kegel exercises with a difference of 18.76 points. This means

that it can be concluded that Kegel exercises can accelerate the healing of perineal

wounds. Then based on the median test (mann-whitneyu-test) obtained a sig value or p-

value of 0.000 <0.05, meaning Ho is rejected, meaning that there is a significant

difference or there is an effect of Kegel exercises on perineal wound healing in

postpartum mothers at the Niar Pratama Clinic. and Pratama Citra Clinic, Deli Serdang

Regency.

Referring to the results of the statistical test, the more Kegel exercises are

performed on postpartum women, the more healing the perineal wound will be, and the

less Kegel exercises are performed on the postpartum women, the slower the perineal

wound healing will be. The effect of Kegel exercises on accelerating the healing of

perineal wounds is due to the contraction of the pubococcygeal muscles affecting the

circulation of oxygen and improving blood circulation so as to make new tissue grow to

close the suture wound (accelerate the proliferative phase).

Paul Fine (2007) in his research explained that the exercise of contraction of the

pubococcygeal muscles during pregnancy and postpartum is a good potential in

increasing the elasticity of the perineal muscles during labor and accelerating the healing

of perineal wounds in postpartum mothers.

According to Proverawati (2012) that the Kegel exercise procedure can be

remembered and carried out with activities related to mother's daily activities. Like when

you sit in the bathroom after urinating and this is a relaxed position to contract these

muscles, and when you want to sleep and under any circumstances. Doing Kegel

exercises regularly can help flex the perineal tissue of the mother during childbirth.

The results showed that there was a theoretical suitability and was supported by

the results of Ridhayanti's research in 2013 which said that there was a significant

relationship between Kegel exercises and the healing of perineal sutures in normal

postpartum mothers (p value = 0.006). So it can be concluded that Kegel exercises

performed with a frequency of 3 times / day on days 1 and 2 and 5 times / day on days 3,

4, 5, 6 and so on until the perineal wound heals can accelerate wound healing.

Masnila, Nurlama Siregar

The Effect of Kegel Exercises on Perineal Wound Healing in Postpartum Mothers 537

Antini's research (2016) on the effectiveness of Kegel exercises on the healing

time of perineal wounds in normal postpartum mothers. The average length of time for

perineal wound healing in the mobilization group with an average number of days was 7

days, with a minimum limit of 4 days and a maximum of 9 days. According to the

opinion of the respondent researchers who did not do Kegel exercises, only a small

proportion had fast healing, namely from 30 people as many as 8 (26.7%) people, based

on the results obtained from the study, it was assumed that Kegel exercises could

accelerate wound healing.

A similar study by Ridhayanti (2011) researched the relationship between Kegel

exercises and healing of perineal sutures in normal postpartum mothers at Alfiatun

Hasanah Hospital, Bandung City. There is a difference in the healing of perineal wounds

before and after Kegel exercises obtained a p-value of 0.001 where 0.001, Kegel

exercises are exercises to strengthen the pelvic floor muscles before delivery, the aim is to

strengthen the pelvic floor muscles, help prevent urinary incontinence problems, and can

flex the tissue. perineum as the baby's birth canal. So that all mothers should be motivated

to move the pelvic floor muscles as little and as often as possible, slowly and quickly as

labor approaches.

According to the researcher's opinion, many factors affect wound healing, each

respondent has its own factors so that the wound healing process is different for each

respondent. In the Kegel group, based on the results of the study, it is known that Kegel

exercises will be able to have a good influence on perineal wound healing. pelvic floor

especially the pubococcygeal muscles so that women can strengthen the urinary tract

muscles and vaginal muscles so that it has an effect on accelerating the healing process of

perineal wounds. In addition to Kegels, there are many movements that postpartum

mothers can do, including lifting the pelvis gradually and others.

CONCLUSION

Based on the analysis and discussion, it can be concluded that there is a difference

in wound healing in post partum mothers who do Kegel exercises when compared to

mothers who do not do Kegel exercises with a difference of 18.76 points. There is an

effect of Kegel exercises on perineal wound healing in postpartum women at the Pratama

Niar Clinic and Pratama Citra Clinic, Deli Serdang Regency.

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