Obstetrical anal sphincter injury and unnecessary episiotomy are both associated with anal incontinence 8 years after childbirth: A nationwide database analysis

Int J Gynaecol Obstet. 2022 Jan 19. doi: 10.1002/ijgo.14101. Online ahead of print.

ABSTRACT

OBJECTIVE: to assess the relationship between anal incontinence (AI) 8 years after childbirth and the occurrence of Obstetrical Anal Sphincter Injury (OASI) 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 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 and 0.08% were grade-4; 8,938 women experienced AI (1.33%) and 261 women experienced severe AI (0.04%). Episiotomies performed in the absence of risk factors for OASI 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 OASI also significantly increased the risk of AI and severe AI. Mediolateral episiotomy was preventative of OASI when performed in subjects at risk (OR=0.26; 95% CI:0.23-0.30; p<0.001) but contributed to OASI in the absence of risk (OR=2.18; 95% CI:1.98-2.40; p<0.001).

CONCLUSIONS: OASI is a risk factor for AI. Episiotomies could reduce the occurrence of OASI, but they could also have a increase the risk of long-term AI in the absence of risk factors for OASI.

PMID:35044683 | DOI:10.1002/ijgo.14101