Introduction
The perineum is the group of muscles that in humans are located below the pelvis and around the anus and genitals. The perineum consists of numerous muscles whose tasks are to maintain the stability of the trunk and to carry out holding procedures. The perineal muscles are particularly important during continence and birth.
The perineal muscles cannot always be moved consciously (usually only after pelvic floor training). The perineal muscles also enclose and limit the outer female genital organs. They also play a decisive role during birth.
The perineal muscles are only stretchable to a limited extent. During the birth process, the child slides out of the uterus and travels through the vagina, which is stretched to the maximum by the perineal muscles. Since the entrance to the vagina has to stretch many times its normal size at birth, there is a risk that both the vagina and the perineal muscles will tear during the birth process.
In order to prevent this, a piece of the perineal muscles is severed as a precautionary measure in women who are expected to have a tear. This increases the stretching capacity of the muscular part in this area and the child can be born without any problems. After birth, the severed ends of the muscles are sewn together again.
While no anaesthetic is used for the episiotomy (the woman does not feel the incision during birth), a local anaesthetic is used for suturing. Who has to have an episiotomy is usually decided spontaneously by the obstetricians during the birth. Several factors are decisive for this.
Firstly, it must be taken into account how narrow the patient’s vaginal outlet is and how strongly the perineal muscles are developed (a weaker developed musculature tends to give way during the birth process and in most cases does not need to be cut through). Secondly, it must be considered whether the child is of above-average size. For smaller children, an episiotomy is usually not necessary, whereas for larger children an episiotomy is often necessary. and complications during birth
Risks
Compared to other surgical interventions, the risks of an episiotomy are relatively low. The muscles in the area of the perineum that are cut through are only incised by 1-2 cm. This area is sutured immediately after birth and usually heals well.
There are risks of a wound healing disorder, i.e. the sutured muscle ends do not grow together properly and cannot withstand the pressure. In this case, the muscles can tear open again and the wound can become infected. However, infections in this area occur relatively rarely.
It is also important that despite an episiotomy the outer edge of the vaginal entrance is stabilised by the obstetrician. Because despite an episiotomy, the vagina and the surrounding perineal muscles can tear uncontrollably. Perineal tears are a costly complication.
They have to be elaborately sutured or reconstructed. After an episiotomy, the muscles in this area cannot yet be fully used again due to a lack of stability. It can therefore happen that immediately after a birth the urine cannot be held as usual. However, this temporary incontinence should disappear as soon as the musculature has grown together completely. Despite all the precautions taken, it is still possible for a longer lasting to permanent incontinence to occur after an episiotomy.
