Common Procedure During Delivery Linked to Lasting Rectal Injuries
Jan. 6, 2000 (New York) -- Episiotomy, one of the most common medical
procedures performed on women, can cause long-lasting injury to the rectum,
according to study in the Jan. 8 issue of the British Medical Journal.
Women who had an episiotomy -- the surgical cutting of the perineal tissue
between the vagina and anus to widen the birth canal -- during labor reported a
significantly higher inability to control bowel movements and gas, a condition
known as anal incontinence, after giving birth than women who did not require
an episiotomy or whose perineum tore naturally during labor.
Although major reasons for performing an episiotomy include preventing
severe tearing of the perineum that may be difficult to heal and protecting the
anal sphincter muscle from damage, the study of more than 600 women calls that
theory into question, according to lead study author Lisa B. Signorello,
"There have been a number of studies over the past two decades that have
looked at all sorts of outcomes such as pain, healing, sexual functioning. Our
study is maybe the first to look at anal incontinence, but it just adds to the
literature showing that there really does not seem to be a widespread benefit
to using episiotomy routinely," says Signorello, an epidemiologist at the
International Epidemiology Institute, Rockville, Md.
The study compared characteristics of 209 women who received an episiotomy,
206 women who experienced spontaneous tearing of the perineum, and 211 women
who did not sustain injury to the perineum during labor.
Women who had episiotomies had a five times higher rate of uncontrolled
bowel movements three months after giving birth compared with the group with no
perineum injury, which decreased to about a four times higher rate six months
after birth. Compared with the group with spontaneous tearing of the perineum,
uncontrolled bowel movements were three times higher at three months and six
months after birth. The rate of uncontrolled gas was twice as high at three and
six months after birth in the episiotomy group compared with those who had
Some studies had implicated both episiotomy and the use of forceps during
delivery, or instrumental birth, in causing the damage to the anal sphincter
that leads to the uncontrolled bowel movements and gas, but the new study was
able to rule out forceps as well as any other factors.
"It's been a difficulty in previous studies because many did not have a
large enough sample size to separate out women who had an instrumental birth
from those who didn't," Signorello tells WebMD. "But in our study the
results are still strong and significant after you exclude anybody who had an
instrumental birth or who had any labor complication. There was nothing else
going on in these women except for the episiotomy."