A sacral nerve stimulator implant, which works like a heart pacemaker, can provide impulses to the pelvic floor muscles which tighten up the pelvic floor, improving control over the large bowel and compensating for faecal incontinence. The incision commences from the centre of the fourchette and extends on the posterior side along the midline for 2. This technique bifurcates the perineal body , which is essential for the integrity of the pelvic floor. Controversy[ edit ] Traditionally, physicians have used episiotomies in an effort to deflect the cut in the perineal skin away from the anal sphincter muscle, as control over stool faeces is an important function of the anal sphincter, i. Conversely, one of the reasons episiotomy is performed is to prevent tearing of the anal sphincter, which is also associated with faecal incontinence. The cut is repaired with stitches sutures. Whether episiotomy reduces, or indeed increases, the chances of faecal incontinence is difficult to say. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy".
Since about the s, routine episiotomies have been rapidly losing popularity among obstetricians and midwives in almost all countries in Europe , Australia , Canada , and the United States. Both are depicted in the above image. Impacts on sexual intercourse[ edit ] Some midwives compare routine episiotomy to female genital mutilation. This procedure is also not widely practised. The incision commences from the centre of the fourchette and extends on the posterior side along the midline for 2. These effects can interfere with breastfeeding and the care of the infant. Drawbacks include the chance of injury to the Bartholin's duct , therefore some practitioners have strongly discouraged lateral incisions. Pain can come from possible lacerations, incisions, uterine contractions and sore nipples. The incision is made downward and outward from the midpoint of the fourchette either to the right or left. Appropriate medications are usually administered. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy". There are four main types of episiotomy: A sacral nerve stimulator implant, which works like a heart pacemaker, can provide impulses to the pelvic floor muscles which tighten up the pelvic floor, improving control over the large bowel and compensating for faecal incontinence. Illustration of infant crowning and midline and medio-lateral incision sites for possible episiotomy during delivery. In the oblique technique, the perineal body is avoided, cutting only the vagina epithelium, skin, and muscles transversalius and bulbospongiosus. It is directed diagonally in a straight line which runs about 2. This technique aids in avoiding trauma to the perineal body by either surgical or traumatic means. At least one study has recommended that routine episiotomy be abandoned for this reason. This technique bifurcates the perineal body , which is essential for the integrity of the pelvic floor. Uses[ edit ] Vaginal tears can occur during childbirth, most often at the vaginal opening as the baby's head passes through, especially if the baby descends quickly. In , a Cochrane meta-analysis based on studies with over 5, women concluded that: The midwife or obstetrician may decide to make a surgical cut to the perineum with scissors or a scalpel to make the baby's birth easier and prevent severe tears that can be difficult to repair. While episiotomy is employed to obviate issues such as post-partum pain, incontinence, and sexual dysfunction , some studies suggest that episiotomy surgery itself can actually cause all of these problems. Tears can involve the perineal skin or extend to the muscles and the anal sphincter and anus. Therefore, the oblique technique is often applied also pictured above. The incision begins in the centre of the fourchette and is directed posteriorly along the midline for about 1. Damage to the anal sphincters is more common, especially during prolonged or difficult childbirth, or where forceps are used, than has been traditionally acknowledged.
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