Obstetrical anal sphincter injury and unnecessary episiotomy are both associated with anal incontinence 8 years after childbirth: A nationwide database analysis. Issue 1 (7th February 2022)

• Record Type: Journal Article
• Authors: Levaillant, Mathieu; Legendre, Guillaume; Rebmann, Emeline; Hamel, Jean‐François; Venara, Aurélien
• Is Part Of: International journal of gynaecology and obstetrics. Volume 159:Issue 1(2022)
• Page Start: 284
• Page End: 289
• Publication Date: 2022-02-07
• Subjects: episiotomy -- incontinence -- obstetrical anal sphincter injury -- postpartum -- risk factors; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.14101
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To assess the relationship between anal incontinence (AI) 8 years after childbirth and the occurrence of obstetrical anal sphincter injuries (OASIS) and/or performance of an episiotomy during childbirth. Methods: This is a nationwide database analysis performed on two national medico‐administrative databases, including all the women aged 18 years or older who delivered infants in France in 2012. The main outcome measure was AI in the 8 years after delivery. Results: Of the 163 443 perineal tears reported, 0.47% were grade 3 ( n = 3173) and 0.08% were grade 4 ( n = 579); 8938 women experienced AI (1.33%) and 261 women experienced severe AI (0.04%). Episiotomies performed in the absence of risk factors for OASIS were significantly associated with an increased risk of AI (odds ratio [OR] 1.59, 95% confidence interval [CI]1.49–1.69; P < 0.001). Grade 3 and 4 OASIS also significantly increased the risk of AI and severe AI. Mediolateral episiotomy was preventive of OASIS when performed in women at risk (OR 0.26, 95% CI 0.23–0.30; P < 0.001) but contributed to OASIS in the absence of risk (OR 2.18, 95% CI 1.98–2.40; P < 0.001). Conclusion: OASIS present a risk factor for AI. Episiotomies could reduce the occurrence of OASIS, but they could also increase the risk of long‐term AI in the absence of risk factors for OASIS. Abstract : Episiotomy has a detrimental effect on continence 8 years after childbirth if the women have no risk factors for OASIS.