Advertisement

Long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse: a systematic review

  • Matteo FrigerioEmail author
  • Salvatore A. Mastrolia
  • Federico Spelzini
  • Stefano Manodoro
  • David Yohay
  • Adi Y. Weintraub
Review
  • 57 Downloads

Abstract

Purpose

To focus attention on the long-term effects of episiotomy on urinary incontinence and pelvic organ prolapse.

Methods

A systematic review was conducted including only studies with mean follow-up ≥ 5 years. We searched using combinations of the following keywords and text words: “episiotomy”, “perineal laceration”, “perineal tear”, “perineal damage” and “long term”, “long term outcomes”, “prolapse”, “pelvic organ prolapse”, “pelvic floor”, “pelvic floor dysfunction”, “urinary incontinence”, “hysterocele”, “cystocele” and “rectocele”.

Results

The electronic database search provided a total of 6154 results. After exclusions, 24 studies were included yielding the following results: (1) episiotomy might be detrimental with respect to urinary incontinence symptoms; (2) the relationship between episiotomy and anti-incontinence surgery is not clear; (3) episiotomy does not seem to negatively influence genital prolapse development and might even be protective with respect to prolapse severity and prevalence; (4) episiotomy does not seem to affect genital prolapse surgery rate.

Conclusions

We did not find evidence for a long-term beneficial effect of episiotomy in the prevention of urinary incontinence symptoms and anti-incontinence surgery. Episiotomy does not seem to negatively influence genital prolapse development and might even be protective with respect to prolapse severity and prevalence without affecting surgery rates.

Keywords

Episiotomy Long-term outcomes Pelvic organ prolapse Pelvic floor dysfunction Urinary incontinence Systematic review 

Notes

Author contributions

MF: project development, data collection, manuscript writing. SAM: project development, data collection, manuscript writing. FS: project development, data collection, manuscript writing. SM: project development, data collection, manuscript writing. DY: project development, data collection, manuscript writing. AYW: project development, data collection, manuscript writing.

Funding

None.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

404_2018_5009_MOESM1_ESM.docx (30 kb)
Supplementary material 1 (DOCX 29 kb)

References

  1. 1.
    Nygaard I, Barber MD (2008) Prevalence of symptomatic pelvic floor disorders in US women. JAMA 300(11):1311–1316CrossRefGoogle Scholar
  2. 2.
    Rortveit G, Subak LL, Thom DH, Creasman JM, Vittinghoff E, Van Den Eeden SK et al (2010) Urinary incontinence, fecal incontinence and pelvic organ prolapse in a population-based, racially diverse cohort. Female Pelvic Med Reconstr Surg 16(5):278–283CrossRefGoogle Scholar
  3. 3.
    Sung VW, Washington B, Raker CA (2010) Costs of ambulatory care related to female pelvic floor disorders in the United States. Am J Obstet Gynecol 202(5):483.e1–483.e4CrossRefGoogle Scholar
  4. 4.
    Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW (2011) Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol 205(3):230.e1–230.e5CrossRefGoogle Scholar
  5. 5.
    Minassian VA, Yan XS, Lichtenfeld MJ, Sun H, Stewart WF (2012) The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J 23(8):1087–1093CrossRefGoogle Scholar
  6. 6.
    Ben-Shlomo Y, Kuh D (2002) A life course approach to chronic disease epidemiology: conceptual models, empirical challenges and interdisciplinary perspectives. Int Epidemiol Assoc 31:285–293CrossRefGoogle Scholar
  7. 7.
    DeLancey JOL, Low LK, Miller JM, Patel DA, Tumbarello JA (2008) Graphic integration of causal factors of pelvic floor disorders: an integrated life span model. Am J Obstet Gynecol 199:610.e1–610.e5CrossRefGoogle Scholar
  8. 8.
    Hallock JL, Handa VL (2016) The epidemiology of pelvic floor disorders and childbirth: an update. Obstet Gynecol Clin North Am 43(1):1–13CrossRefGoogle Scholar
  9. 9.
    Handa VL, Blomquist JL, Knoepp LR, Hoskey KA, McDermott KC, Muñoz A (2011) Pelvic floor disorders 5–10 years after vaginal or cesarean childbirth. Obstet Gynecol 118:777–784CrossRefGoogle Scholar
  10. 10.
    Ould F (1748) A treatise on midwifery in three parts. Oli Nelson and Charles Connor, DublinGoogle Scholar
  11. 11.
    DeLee JB (1920) The prophylactic forceps operation. Am J Obstet Gynecol 1:34–44CrossRefGoogle Scholar
  12. 12.
    Aldridge AH, Watson P (1935) Analysis of end-results of labor in primiparas after spontaneous versus prophylactic methods of delivery. J Obstet Gynecol 30:554–565CrossRefGoogle Scholar
  13. 13.
    Nugent FB (1935) The primiparous perineum after forceps delivery. Am J Obstet Gynecol 30:249–256CrossRefGoogle Scholar
  14. 14.
    Steiner N, Weintraub AY, Wiznitzer A, Sergienko R, Sheiner E (2012) Episiotomy: the final cut? Arch Gynecol Obstet 286(6):1369–1373CrossRefGoogle Scholar
  15. 15.
    Viktrup L, Lose G (2001) The risk of stress incontinence 5 years after first delivery. Am J Obstet Gynecol 185:82–87CrossRefGoogle Scholar
  16. 16.
    Tegerstedt G, Miedel A, Maehle-Schmidt M, Nyrén O, Hammarström M (2006) Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol 194:75–81CrossRefGoogle Scholar
  17. 17.
    Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Lohr KN (2005) Outcomes of routine episiotomy: a systematic review. JAMA 293:2141–2148CrossRefGoogle Scholar
  18. 18.
    Akkus Y, Pinar G (2016) Evaluation of the prevalence, type, severity, and risk factors of urinary incontinence and its impact on quality of life among women in Turkey. Int Urogynecol J 27(6):887–893CrossRefGoogle Scholar
  19. 19.
    Ge J, Yang P, Zhang Y, Li X, Wang Q, Lu Y (2015) Prevalence and risk factors of urinary incontinence in Chinese women: a population-based study. Asia Pac J Public Health. 27(2):NP1118–NP1131CrossRefGoogle Scholar
  20. 20.
    Zhang W, Song Y, He X, Xu B, Huang H, He C et al (2005) Prevalence and risk factors of lower urinary tract symptoms in Fuzhou Chinese women. Eur Urol 48(2):309–313CrossRefGoogle Scholar
  21. 21.
    Doğan B, Gün İ, Özdamar Ö, Yılmaz A, Muhçu M (2017) Long-term impacts of vaginal birth with mediolateral episiotomy on sexual and pelvic dysfunction and perineal pain. J Matern Fetal Neonatal Med. 30(4):457–460CrossRefGoogle Scholar
  22. 22.
    Foldspang A, Mommsen S, Djurhuus JC (1999) Prevalent urinary incontinence as a correlate of pregnancy, vaginal childbirth, and obstetric techniques. Am J Public Health 89(2):209–212CrossRefGoogle Scholar
  23. 23.
    Kılıç M (2016) Incidence and risk factors of urinary incontinence in women visiting Family Health Centers. Springerplus. 5(1):1331CrossRefGoogle Scholar
  24. 24.
    Oliveira E, Zuliani LMM, Ishicava J, Silva SV, Albuquerque SSR, Souza AMB et al (2010) Evaluation of factors related to the occurrence of female urinary incontinence. Rev Assoc Med Bras 56(6):688–690CrossRefGoogle Scholar
  25. 25.
    Rincón AO (2015) Caracterización clínica de la incontinencia urinaria y factores asociados en usuarias de la Unidad de la Mujer del Centro de Salud Familiar “Ultraestación” en la ciudad de Chillán, Chile. Rev Méd Chile 143(2):203–212CrossRefGoogle Scholar
  26. 26.
    Samuelsson E, Victor A, Svärdsudd K (2000) Determinants of urinary incontinence in a population of young and middle-aged women. Acta Obstet Gynecol Scand 79(3):208–215CrossRefGoogle Scholar
  27. 27.
    Thom DH, Brown JS, Schembri M, Ragins AI, Creasman JM, Van Den Eeden SK (2011) Parturition events and risk of urinary incontinence in later life. Neurourol Urodyn 30(8):1456–1461CrossRefGoogle Scholar
  28. 28.
    Torkestani F, Zafarghandi N, Davati A, Hadavand SH, Garshasbi M (2009) Case-controlled study of the relationship between delivery method and incidence of post-partum urinary incontinence. J Int Med Res. 37(1):214–219CrossRefGoogle Scholar
  29. 29.
    Alling Møller L, Lose G, Jørgensen T (2000) Risk factors for lower urinary tract symptoms in women 40 to 60 years of age. Obstet Gynecol 96(3):446–451CrossRefGoogle Scholar
  30. 30.
    Handa VL, Blomquist JL, McDermott KC, Friedman S, Muñoz A (2012) Pelvic floor disorders after vaginal birth: effect of episiotomy, perineal laceration, and operative birth. Obstet Gynecol 119(2 Pt 1):233–239CrossRefGoogle Scholar
  31. 31.
    Viktrup L (2002) The risk of lower urinary tract symptoms five years after the first delivery. Neurourol Urodyn 21(1):2–29CrossRefGoogle Scholar
  32. 32.
    Song YF, Zhang WJ, Song J, Xu B (2005) Prevalence and risk factors of urinary incontinence in Fuzhou Chinese women. Chin Med J (Engl). 118(11):887–892PubMedGoogle Scholar
  33. 33.
    Abdel-Fattah M, Familusi A, Fielding S, Ford J, Bhattacharya S (2011) Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open 1(2):e000206CrossRefGoogle Scholar
  34. 34.
    Persson J, Wolner-Hanssen P, Rydhstroem H (2000) Obstetric risk factors for stress urinary incontinence: a population-based study. Obstet Gynecol 96(3):440–445PubMedGoogle Scholar
  35. 35.
    Uma R, Libby G, Murphy DJ (2005) Obstetric management of a woman’s first delivery and the implications for pelvic floor surgery in later life. BJOG 112(8):1043–1046CrossRefGoogle Scholar
  36. 36.
    Aytan H, Tok EC, Ertunc D, Yasa O (2014) The effect of episiotomy on pelvic organ prolapse assessed by pelvic organ prolapse quantification system. Eur J Obstet Gynecol Reprod Biol 173:34–37CrossRefGoogle Scholar
  37. 37.
    Espitia de la Hoz FJ (2015) Factores de riesgo asociados con prolapso genital femenino: estudio de casos y controles. Urol Colomb 24:12–18CrossRefGoogle Scholar
  38. 38.
    Gürel H, Gürel SA (1999) Pelvic relaxation and associated risk factors: the results of logistic regression analysis. Acta Obstet Gynecol Scand 78(4):290–293CrossRefGoogle Scholar
  39. 39.
    Gyhagen M, Bullarbo M, Nielsen TF, Milsom I (2013) Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG 120(2):152–160CrossRefGoogle Scholar
  40. 40.
    Garshasbi A, Faghih-Zadeh S, Falah N (2006) The status of pelvic supporting organs in a population of iranian women 18–68 years of age and possible related factors. Arch Iran Med. 9(2):124–128PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyMilano-Bicocca University, ASST Monza, Ospedale San Gerardo, Monza, University Milano-BicoccaMonzaItaly
  2. 2.Department of Obstetrics and Gynecology, Ospedale dei Bambini Vittore BuzziUniversity of MilanMilanItaly
  3. 3.Department of Obstetrics and GynecologyAUSL Romagna, Ospedale InfermiRiminiItaly
  4. 4.Department of Obstetrics and Gynecology, Soroka University Medical CenterBen Gurion University of the NegevBeer ShevaIsrael

Personalised recommendations