Effect of Delivery and Episiotomy on the Emergence of Urinary Incontinence in Women: Review of Literature

Abstract

SUMMARY -Episiotomy is obstetric procedure during which the incision extends the vestibule of the vagina during the second stage of labor. Episiotomy was extensively spread with gradual increase of rates in the fi rst half of the 20 th century and was performed mediolaterally in all nulliparous women with the idea to protect fetal head from trauma and pelvic fl oor from injuries. However, reports claiming that episiotomy had no such benefi ts were published. It was shown that routine mediolateral episiotomy did not protect against the appearance of urinary incontinence after vaginal delivery, while the risk of anal incontinence could be increased. Th e role of episiotomy in development of pelvic fl oor dysfunction remains quite unclear. Due to the mentioned reason, restricted episiotomy approach should be accepted. Th e origin of stress incontinence during pregnancy is controversial and not definitely scientifi cally proven. Pregnancy per se and older age at fi rst delivery may have impact on the onset of pelvic fl oor dysfunction. Urinary incontinence in pregnancy increases the risk of later urinary incontinence, both postpartum and later in life. Vaginal delivery is just one of the potential risk factors for development of urinary incontinence. Mechanical pressure by fetus on the pelvic fl oor structures, limited denervation of the pelvic fl oor and soft tissue damage during delivery are some of explanations for the onset of stress urinary incontinence. On the other hand, cesarean delivery might not be protective against emergence of urinary incontinence. Further research in this fi eld is needed.

Predictive factors for time to cessation of urinary incontinence in primiparous adolescents after vaginal delivery

“…20 The findings of previous studies on the association between episiotomy and UI after delivery are inconsistent. While some studies suggested increased frequency and intensity of the complaint of postpartum UI in the presence of episiotomy, 21,22 others concluded that the procedure is not associated with the dysfunction. 4,5 Variations in the instruments used to define UI in the characteristics of the studied population (adult age group) and in the event observation period may explain the divergence between the results.…”

Stress urinary incontinence after labor and satisfaction with sex life

“…This may suggest that perineum damage during labor, irrespective of its underlying cause, increases the risk of incontinence occurrence. This assumption is further confirmed by the fact that routine episiotomy during labor, as incontinence prophylaxis, is controversial amongst vari-ous authors [10,[19][20][21][22]. Presumptions about the protective effect of surgical labor on urinary incontinence on the basis of the accumulated data have to be attempted very carefully as it is not clear whether urinary incontinence occurred during pregnancy, which ended in Caesarean section due to various causes.…”

Correlation of Normal Labor and Vacuum Extraction with Postlabor Stress Urinary Incontinence

“…A urodynamic test is performed when the diagnosis is doubtful, for diagnostic confi rmation, and the patient will undergo a surgical therapy process. This is justifi cation because of research shows low morbidity and cost reasons 14 .…”

“…Of these patients, 10% -30% are found to have symptoms of detrusor instability (alone or together with SUI). Rare events that can cause SUI symptoms are urethral diverticulum, genitourinary fi stula, ectopic ureter, and urethral instability 14 . Clinics must recognize occured clinical situations that diagnoses SUI based solely on clinical symptoms still have a range of uncertainties.…”