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



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


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”.


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.


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.


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


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.



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)


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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

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