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Counseling after perineal laceration: does it improve functional outcome?
Ashley Vasseur1, Karine Lepigeon1, David Baud1
1Department Woman-Mother-Child, Lausanne University Hospital, Avenue Pierre Decker 2, 1011, Lausanne, Switzerland.
International Urogynecology Journal
|July 8, 2018
Summary
Most patients with severe perineal tears experience mild incontinence symptoms that improve over time, especially with physiotherapy. Subsequent deliveries show a low recurrence rate of severe tears, with cesarean sections reducing incontinence risks.
Area of Science:
- Obstetrics and Gynecology
- Pelvic Floor Disorders
- Maternal Health
Background:
- Severe perineal tears (third-/fourth-degree) can lead to long-term urinary and anorectal incontinence.
- The Lausanne University Hospital (CHUV) has provided specialized postpartum perineum consultations since 2006.
- Understanding the impact of subsequent deliveries on incontinence symptoms is crucial for patient management.
Purpose of the Study:
- To evaluate the outcomes of subsequent deliveries in patients with severe perineal tears.
- To assess the prevalence and severity of urinary and anorectal incontinence symptoms post-consultation.
- To determine the recurrence rate of severe perineal tears and factors influencing incontinence.
Main Methods:
- Retrospective follow-up of 160 patients who attended a 12-week postpartum perineum consultation.
- Patients completed questionnaires on delivery history and validated instruments for urinary (UDI-6, IIQ-7) and anorectal (Wexner-Vaizey) incontinence.
- Analysis focused on subsequent delivery modes and current incontinence symptom status.
Main Results:
- Severe tears predominantly occurred after operative vaginal deliveries (62%).
- The recurrence rate of third-/fourth-degree tears in subsequent vaginal deliveries was 3.6%.
- Most patients reported mild or no incontinence; symptoms improved or resolved in 30-60% post-consultation. Cesarean sections were associated with less incontinence.
Conclusions:
- Anal sphincter lacerations are linked to incontinence, but symptoms are generally manageable and improve over time.
- Perineal physiotherapy appears beneficial for symptom resolution.
- While fertility is unaffected, the rate of cesarean sections is elevated; further research into sexual and emotional sequelae is recommended.
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