title: Anal incontinence and fecal urgency following vaginal delivery with episiotomy among primiparous patients.
abstract: OBJECTIVE
  To investigate anal incontinence following mediolateral or lateral episiotomy during a first vaginal delivery.
  
  
  METHODS
  The present prospective follow-up study enrolled primiparous patients who underwent vaginal delivery including mediolateral or lateral episiotomy between April 1, 2010 and March 31, 2012. Participants completed interviews before delivery, and were given anal-incontinence questionnaires to be returned for analysis at 3 months and 6 months postpartum. Anal incontinence was defined as a St Mark's incontinence score above four and individual anal-incontinence components were analyzed separately; results were compared between the two episiotomy techniques.
  
  
  RESULTS
  Questionnaires were returned by 300 and 366 patients who underwent mediolateral and lateral episiotomies, respectively; baseline characteristics were similar. Anal incontinence at 3 months and 6 months was recorded among 21 (7.0%) and 9 (3.0%) patients who underwent mediolateral and 27 (7.4%) and 20 (5.5%) who underwent lateral episiotomy, respectively. The study was underpowered to confirm equivalence between the groups; however, no statistically significant differences were observed in the rates of anal incontinence, flatus, solid or liquid incontinence, and de novo incontinence. Fecal urgency (P=0.017) and de novo fecal urgency (P=0.008) were more prevalent among patients who underwent lateral episiotomies at 6 months.
  
  
  CONCLUSIONS
  Anal incontinence was comparable between primiparous patients who underwent mediolateral or lateral episiotomy. The association between lateral episiotomy and fecal urgency merits further scientific interest.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic; Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic. Electronic address: rusavyz@fnplzen.cz.
authors.forename: Zdenek
authors.initials: Z
authors.lastname: Rusavy
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic.
authors.forename: Jaroslava
authors.initials: J
authors.lastname: Karbanova
authors.affiliation: European Centre of Excellence NTIS - New Technologies for Information Society, Faculty of Applied Sciences, University of West Bohemia, Pilsen, Czech Republic.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Jansova
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic; Biomedical Centre, Faculty of Medicine in Plzen, Charles University, Prague, Czech Republic.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Kalis
mesh_terms: D000328:Adult; D018153:Czech Republic; D004841:Episiotomy / Q000009:adverse effects*; D005242:Fecal Incontinence / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010298:Parity; D010502:Perineum / Q000601:surgery*; D049590:Postpartum Period; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Anal incontinence; Childbirth; Episiotomy; Fecal urgency; Vaginal delivery