Relationship between episiotomy and fecal incontinence after delivery

Document Type : Research/Original Article


1 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of Surgery, Najaf University, Najaf, Iraq


Background: Fecal incontinence is an embarrassing problem and decreases the woman’s quality of life. The literature has shown that women with obstetric trauma especially by episiotomy had damaged anal sphincter (Internal and External). We aimed to find the role of episiotomy in the fecal incontinence in women after delivery.
Methods: In this study, 71 females with previous vaginal deliveries were investigated by endoanal ultrasonography. The degree of FI was measured using the incontinence score of Wexner. The number of episiotomies was measured for each patient.
Results: The mean Wexner score was 9.0±0.7 in the incontinent patients. The mean of normal vaginal delivery was 3.48±0.3 and 33.8% of the patients whom had a history of hemorrhoidectomy. Of patients, 70% had undergone one or more prior episiotomies during their deliveries.
Conclusion: Episiotomy could be one of the risk factors in fecal incontinence but we did not find any significant difference in Wexner score between patients with or without episiotomy. Endoanal sonography seems an effective tool to evaluate and prediction of anal injury during episiotomy in some critical cases.


1.            Fynes M, O'Herlihy C. The influence of mode of delivery on anal sphincter injury and faecal continence. The Obstetrician & Gynaecologist. 2001;3(3):120-5.
2.            Simic M, Cnattingius S, Petersson G, Sandstrom A, Stephansson O. Duration of second stage of labor and instrumental delivery as risk factors for severe perineal lacerations: population-based study. BMC Pregnancy Childbirth. 2017;17(1):72.
3.            Martinez Hernandez Magro P, Villanueva Saenz E, Jaime Zavala M, Sandoval Munro RD, Rocha Ramirez JL. Endoanal sonography in assessment of fecal incontinence following obstetric trauma. Ultrasound Obstet Gynecol. 2003;22(6):616-21.
4.            Richter HE, Nager CW, Burgio KL, Whitworth R, Weidner AC, Schaffer J, et al. Incidence and Predictors of Anal Incontinence After Obstetric Anal Sphincter Injury in Primiparous Women. Female Pelvic Med Reconstr Surg. 2015;21(4):182-9.
5.            Signorello LB, Harlow BL, Chekos AK, Repke JT. Midline episiotomy and anal incontinence: retrospective cohort study. Bmj. 2000;320(7227):86-90.
6.            Karacam Z, Ekmen H, Calisir H, Seker S. Prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, wound healing 3 weeks postpartum, in Turkey: A prospective follow-up study. Iran J Nurs Midwifery Res. 2013;18(3):237-45.
7.            Mohammed Ali Hussein Al Hurry A, kalaf Hassan A, Hosseini SV, Khazraei H, Abdzaid Akool M, Moosavi L, et al. Does perineal body thickness affect fecal incontinence in multiparous patients?2019.
8.            Schlomer G, Gross M, Meyer G. [Effectiveness of liberal vs. conservative episiotomy in vaginal delivery with reference to preventing urinary and fecal incontinence: a systematic review]. Wien Med Wochenschr. 2003;153(11-12):269-75.
9.            LaCross A, Groff M, Smaldone A. Obstetric anal sphincter injury and anal incontinence following vaginal birth: a systematic review and meta-analysis. J Midwifery Womens Health. 2015;60(1):37-47.
10.          Stedenfeldt M, Pirhonen J, Blix E, Wilsgaard T, Vonen B, Oian P. Anal incontinence, urinary incontinence and sexual problems in primiparous women - a comparison between women with episiotomy only and women with episiotomy and obstetric anal sphincter injury. BMC Womens Health. 2014;14:157.
11.          Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Jr., Lohr KN. Outcomes of routine episiotomy: a systematic review. Jama. 2005;293(17):2141-8.
12.          Menees SB, Smith TM, Xu X, Chey WD, Saad RJ, Fenner DE. Factors associated with symptom severity in women presenting with fecal incontinence. Diseases of the colon and rectum. 2013;56(1):97-102.
13.          Zetterstrom JP, Mellgren A, Madoff RD, Kim DG, Wong WD. Perineal body measurement improves evaluation of anterior sphincter lesions during endoanal ultrasonography. Dis Colon Rectum. 1998;41(6):705-13.
14.          Oberwalder M, Connor J, Wexner SD. Meta-analysis to determine the incidence of obstetric anal sphincter damage. Br J Surg. 2003;90(11):1333-7.