An episiotomy is an incision made in the tissue between the vaginal opening and anus (perineum) during childbirth and was once a routine surgical part of the childbirth process; however, episiotomies aren’t always necessary. Traditionally, it was believed that an episiotomy would help prevent more extensive vaginal tears and that an episiotomy incision would heal better than a natural tear. The procedure was also thought to reduce the risk of incontinence following childbirth by preventing the bladder and rectum from drooping into the vagina. Researchers have found that routine episiotomies don’t prevent these problems after all. In fact, routine episiotomies offer no benefits, recovery is uncomfortable, and—in some cases—the surgical incision is more extensive than a natural tear would have been. Up to one million American women per year may be receiving a needless surgery that is contributing to incontinence in those women, an expert panel concluded Wednesday.
Routine episiotomy should be curtailed, experts say, and is generally only warranted in cases when extensive vaginal tearing appears likely, the baby is in an abnormal position or the childbirth is complex, or the baby needs to be delivered quickly or is in distress. If an episiotomy is necessary, the patient receives an injection of a local anesthetic to numb the tissue if she hasn’t had any other type of anesthesia or anesthesia is no longer numbing the area.
C. Seth Landefeld—lead on an expert consensus panel on fecal and urinary incontinence that was sponsored by the National Institutes of Health—states that the routine use of episiotomy should be seriously reconsidered. Katherine Hartman, MD, PhD—a professor of obstetrics and gynecology at the University of North Carolina, Chapel Hill—concurs, stating that episiotomy can damage the anal muscles, which in turn may cause up to 1,000 cases of fecal incontinence yearly, adding that episiotomy has a proven risk of damage; that there is a direct link between episiotomy and incontinence.
Incontinence is the involuntary loss of urine or stool. The risk of fecal and urinary incontinence increase with age and are more common in women than men, although both sexes are affected: Estimates indicate five percent of adults 65 to 74 and 20% of those over 85 experience fecal incontinence and one in five women and one in 20 men suffer urinary incontinence by age 45. And, while the problem of incontinence is widespread, the shame, embarrassment, and stigma associated with it, leave many to suffer without treatment, the panel warns. Worse, most health plans don’t pay doctors to conduct an independent evaluation for incontinence or counsel on weight loss, exercise, or specialized pelvic floor exercises that may help prevent it. Articles in women’s magazines often include suggestions for women to perform Kegel exercises to strengthen pelvic floor muscles; however, experts say Kegel exercises are frequently done incorrectly and urge more formal training to teach women how to isolate the pelvic floor muscles in a way that can be effective against urinary incontinence.
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