Anal incontinence, urinary incontinence and sexual problems in primiparous women – a comparison between women with episiotomy only and women with episiotomy and obstetric anal sphincter injury
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© 2014 stedenfeldt et al.; licensee bio med central. this is an open access article distributed under the terms of the creative commons attribution license (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. the creative commons public domain dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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Stedenfeldt, M., Pirhonen, J., Blix, E., Wilsgaard, T., Vonen, B. & Øyan, P. (2014). Anal incontinence, urinary incontinence and sexual problems in primiparous women - a comparison between women with episiotomy only and women with episiotomy and obstetric anal sphincter injury. BMC Women's Health, 14(157). doi:10.1186/s12905-014-0157-y http://dx.doi.org/10.1186/s12905-014-0157-yAbstract
Background: Obstetric anal sphincter injuries (OASIS) might cause anal incontinence (AI) and sexual dysfunction,
and might be associated with urinary incontinence (UI). Episiotomy has been identified both as a risk and a
protective factor of OASIS. Lately, episiotomies with specific characteristics have shown to be protective against the
risk of OASIS. However, little is known about episiotomy characteristics and pelvic floor dysfunction. This study
investigates AI, UI, and sexual problems in primiparous women with episiotomy, comparing women with and
without OASIS. Associations between episiotomy characteristics and AI, UI, and sexual problems were assessed.
Methods: This is a matched case–control study investigating 74 women with one vaginal birth, all with an
episiotomy. Among these, 37 women sustained OASIS and were compared to 37 women without OASIS. The two
groups were matched for vacuum/forceps. AI, UI and sexual problem symptoms were obtained from St. Mark’s
scoring-tool and self-administered questionnaires. The episiotomy characteristics were investigated and results
assessed for the whole group.
Results: The mean time from birth was 34.5 months (range1.3-78.2) for those with OASIS and 25.9 months (range
7.0-57.4) for those without OASIS, respectively. More women with OASIS reported AI: 14 (38%) vs. 3 (8%) p = 0.05
(OR 4.66, 95% CI 1.34-16.33) as well as more problem with sexual desire p = 0.02 (OR 7.62, 95% CI 1.30-44.64)
compared to women without OASIS. We found no association between episiotomy with protective characteristics
and dysfunctions.
Conclusion: Women with OASIS had more AI and sexual problems than those without OASIS. Episiotomy
characteristics varied greatly between the women. Episiotomy with protective characteristics was not associated
with increased dysfunctions. OASIS should be avoided, and correct episiotomy used if indicated.