Anal incontinence and fecal urgency following vaginal delivery with episiotomy among primiparous patients
Abstrakt
Objective: To investigate anal incontinence following mediolateral or lateral episiotomy during a first vaginal delivery. Methods: The present prospective follow-up study enrolled primiparous patients who underwent vaginal delivery includingmediolateral or lateral episiotomy between April 1, 2010 andMarch 31, 2012.
Participants completed interviews before delivery, and were given anal-incontinence questionnaires to be returned for analysis at 3 months and 6 months postpartum. Anal incontinence was defined as a St Mark's incontinence score above four and individual anal-incontinence components were analyzed separately; results were compared between the two episiotomy techniques.
Results: Questionnaires were returned by 300 and 366 patients who underwent mediolateral and lateral episiotomies, respectively; baseline characteristics were similar. Anal incontinence at 3 months and 6 months was recorded among 21 (7.0%) and 9 (3.0%) patients who underwent mediolateral and 27 (7.4%) and 20 (5.5%)who underwent lateral episiotomy, respectively.
The studywas underpowered to confirm equivalence between the groups; however, no statistically significant differences were observed in the rates of anal incontinence, flatus, solid or liquid incontinence, and de novo incontinence. Fecal urgency (P=0.017) and de novo fecal urgency (P=0.008) weremore prevalent among patientswho underwent lateral episiotomies at 6 months.
Conclusion: Anal incontinence was comparable between primiparous patients who underwent mediolateral or lateral episiotomy. The association between lateral episiotomy and fecal urgency merits further scientific interest.