How is the Vaginal Opening Affected by Childbirth – And by Episiotomy?

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Injuries to the perineum and vaginal opening affect 35-75% of women during vaginal birth.  Even after careful repair, permanent weakening may create vaginal ‘looseness’.  Some women notice a bulging sensation near the vagina and rectum, or loss of sensation during intercourse.  When the anal area is involved in the injury, it can lead to incontinence of gas and/or stool.

‘Episiotomy’ refers to an intentional cutting of the perineum during childbirth.  Aside from cutting the umbilical cord, episiotomies are the most common obstetrical operations performed.  Although episiotomies have an important place in the labor room, several studies have indicated that they may increase the likelihood of maternal bladder, bowel and pelvic floor problems afterwards.  As a result, the general trends have favored the strategy of avoiding episiotomy whenever possible.

Can Incontinence and Prolapse Occur, Even If I Never Gave Birth?
Pelvic floor problems, even incontinence and prolapse, absolutely can occur even if you’ve never had a baby.  Up to 47% of women with no previous pregnancy report some degree of incontinence by age 68.  And although the ‘Women’s Health Initiative’ showed previous childbirth to be associated with significantly higher rates of pelvic prolapse later on, 19% of women with no previous delivery also had prolapse.

Do ‘Big Babies’ Increase the Risk of Problems?
“Macrosomia” is associated with more likely occurrence of perineal injury and episiotomies, nearly 21/2 times the usual risk of rectal injury, and a higher risk of pudendal nerve injury.  One study found that delivery of a newborn weighing more than 8.8 pounds carried twice the usual risk of urinary incontinence later on, and a higher risk of having to undergo later surgery to correct the problem.  If you are found to be carrying a very large baby, it would be appropriate to discuss these issues with your doctor or midwife.

Adapted From:  “Ever Since I Had My Baby: Understanding, Treating and Preventing the Most Common Physical Aftereffects of Pregnancy and Childbirth”, by Roger P. Goldberg, MD MPH

(Crown Publishers, Random House, NY 2003)

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The risks and benefits of the combined oral contraceptive pill   Common breast problems   Adenomyosis: More common than you think   Managing Urinary Incontinence   Urinary Incontinence and Urinary Tract Infection   Does hysterectomy cause urinary incontinence?   Risk for Stress-Urinary-Incontinence Surgery After Hysterectomy May Be Doubled   Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study   Hysterectomy: A Risk Factor for Urinary Incontinence?   Hysterectomy and stress urinary incontinence   Why Not Request a Cesarean Delivery, to Prevent Incontinence?   I’ve Had a Cesarean in the Past.  What is the ‘best’ way to have my next baby?   Checklist for a Healthy Pelvic Floor Before & After Childbirth   How Can I Prepare My Pelvic Floor, To Avoid Problems After Delivery?   Which Pelvic Floor Symptoms Are Most Common After Childbirth?

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