Midline episiotomy and anal incontinence: retrospective cohort study
- PMID:10625261
- PMCID: PMC27253
- DOI: 10.1136/bmj.320.7227.86
Midline episiotomy and anal incontinence: retrospective cohort study
Abstract
Objective: To evaluate the relation between midline episiotomy and postpartum anal incontinence.
Design: Retrospective cohort study with three study arms and six months of follow up.
Setting: University teaching hospital.
Participants: Primiparous women who vaginally delivered a live full term, singleton baby between 1 August 1996 and 8 February 1997: 209 who received an episiotomy; 206 who did not receive an episiotomy but experienced a second, third, or fourth degree spontaneous perineal laceration; and 211 who experienced either no laceration or a first degree perineal laceration.
Main outcome measures: Self reported faecal and flatus incontinence at three and six months postpartum.
Results: Women who had episiotomies had a higher risk of faecal incontinence at three (odds ratio 5.5, 95% confidence interval 1.8 to 16.2) and six (3.7, 0.9 to 15.6) months postpartum compared with women with an intact perineum. Compared with women with a spontaneous laceration, episiotomy tripled the risk of faecal incontinence at three months (95% confidence interval 1.3 to 7.9) and six months (0.7 to 11.2) postpartum, and doubled the risk of flatus incontinence at three months (1.3 to 3.4) and six months (1.2 to 3.7) postpartum. A non-extending episiotomy (that is, second degree surgical incision) tripled the risk of faecal incontinence (1.1 to 9.0) and nearly doubled the risk of flatus incontinence (1.0 to 3.0) at three months postpartum compared with women who had a second degree spontaneous tear. The effect of episiotomy was independent of maternal age, infant birth weight, duration of second stage of labour, use of obstetric instrumentation during delivery, and complications of labour.
Conclusions: Midline episiotomy is not effective in protecting the perineum and sphincters during childbirth and may impair anal continence.
Comment in
- Midline episiotomy and anal incontinence. A prospective study is needed.Boer K.Boer K.BMJ. 2000 Jun 10;320(7249):1601.BMJ. 2000.PMID:10896429No abstract available.
- Midline episiotomy and anal incontinence. Training is needed in the recognition and repair of perineal trauma.Chaliha C, Sultan AH.Chaliha C, et al.BMJ. 2000 Jun 10;320(7249):1601.BMJ. 2000.PMID:10896430Free PMC article.No abstract available.
- Midline episiotomy and anal incontinence. Results should be interpreted with caution in British context.Mills MS, Murphy DJ.Mills MS, et al.BMJ. 2000 Jun 10;320(7249):1601-2.BMJ. 2000.PMID:10896431No abstract available.
- Midline episiotomy and anal incontinence. Is episiotomy ethically acceptable?Olayinka Oyelese K, Porter A, Wai C.Olayinka Oyelese K, et al.BMJ. 2000 Jun 10;320(7249):1602.BMJ. 2000.PMID:10896432No abstract available.
Similar articles
- Obstetric anal sphincter injury and anal incontinence following vaginal birth: a systematic review and meta-analysis.LaCross A, Groff M, Smaldone A.LaCross A, et al.J Midwifery Womens Health. 2015 Jan-Feb;60(1):37-47. doi: 10.1111/jmwh.12283.J Midwifery Womens Health. 2015.PMID:25712278Review.
- Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States.Fenner DE, Genberg B, Brahma P, Marek L, DeLancey JO.Fenner DE, et al.Am J Obstet Gynecol. 2003 Dec;189(6):1543-9; discussion 1549-50. doi: 10.1016/j.ajog.2003.09.030.Am J Obstet Gynecol. 2003.PMID:14710059
- Anal incontinence and fecal urgency following vaginal delivery with episiotomy among primiparous patients.Rusavy Z, Karbanova J, Jansova M, Kalis V.Rusavy Z, et al.Int J Gynaecol Obstet. 2016 Dec;135(3):290-294. doi: 10.1016/j.ijgo.2016.06.025. Epub 2016 Aug 29.Int J Gynaecol Obstet. 2016.PMID:27641426
- [Uncomplicated obstetric injury as a risk factor for anal incontinence? Objective assessment of manometric measurements].Franz HB, Schneider D, Benda N, Erz W, Neuer A, Gonser M.Franz HB, et al.Z Geburtshilfe Neonatol. 1999 Jan-Feb;203(1):24-8.Z Geburtshilfe Neonatol. 1999.PMID:10427669German.
- [Perineal tears and episiotomy: Surgical procedure - CNGOF perineal prevention and protection in obstetrics guidelines].Marty N, Verspyck E.Marty N, et al.Gynecol Obstet Fertil Senol. 2018 Dec;46(12):948-967. doi: 10.1016/j.gofs.2018.10.024. Epub 2018 Nov 2.Gynecol Obstet Fertil Senol. 2018.PMID:30392991Review.French.
Cited by
- Care needs and self-induced measures of women with postpartum pelvic floor disorder- Results of a social media-based survey of 2930 women.Thangarajah F, Soff J, Lenz C, Jeschke J, Kössendrup J, Papior D, Hagenbeck C, Kirn V, Scholten N.Thangarajah F, et al.Arch Gynecol Obstet. 2024 Apr;309(4):1467-1473. doi: 10.1007/s00404-024-07369-6. Epub 2024 Feb 14.Arch Gynecol Obstet. 2024.PMID:38353721Free PMC article.
- Childbirth in Palestine.Wick L, Mikki N, Giacaman R, Abdul-Rahim H.Wick L, et al.Int J Gynaecol Obstet. 2005 May;89(2):174-8. doi: 10.1016/j.ijgo.2005.01.029.Int J Gynaecol Obstet. 2005.PMID:15847891Free PMC article.
- The Effectiveness of Mostafa Maged Technique in Closure of the Episiotomy during Vaginal Delivery.Ali MM.Ali MM.Ethiop J Health Sci. 2023 Jan;33(1):49-54. doi: 10.4314/ejhs.v33i1.7.Ethiop J Health Sci. 2023.PMID:36890932Free PMC article.
- Midline episiotomy and anal incontinence. Training is needed in the recognition and repair of perineal trauma.Chaliha C, Sultan AH.Chaliha C, et al.BMJ. 2000 Jun 10;320(7249):1601.BMJ. 2000.PMID:10896430Free PMC article.No abstract available.
- Perineal body length as a risk factor for ultrasound-diagnosed anal sphincter tear at first delivery.Geller EJ, Robinson BL, Matthews CA, Celauro KP, Dunivan GC, Crane AK, Ivins AR, Woodham PC, Fielding JR.Geller EJ, et al.Int Urogynecol J. 2014 May;25(5):631-6. doi: 10.1007/s00192-013-2273-x. Epub 2013 Dec 12.Int Urogynecol J. 2014.PMID:24337585
References
- MacArthur C, Bick DE, Keighley MRB. Faecal incontinence after childbirth. Br J Obstet Gynaecol. 1997;104:46–50. - PubMed
- Sultan AH, Kamm MA, Hudson CN, Thomas JM, Bartram CI. Anal sphincter disruption during vaginal delivery. N Engl J Med. 1993;329:1905–1911. - PubMed
- Leigh RJ, Turnberg LA. Faecal incontinence: the unvoiced symptom. Lancet. 1982;i:1349–1351. - PubMed
- Sultan AH, Kamm MA. Faecal incontinence after childbirth. Br J Obstet Gynaecol. 1997;104:979–982. - PubMed
- Isager-Sally L, Legarth J, Jacobsen B, Bostofte E. Episiotomy repair—immediate and long-term sequelae. A prospective randomised study of three different methods of repair. Br J Obstet Gynaecol. 1986;93:420–425. - PubMed
Publication types
MeSH terms
Related information
LinkOut - more resources
Full Text Sources