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 Pelvic Floor Dysfunction and Episiotomy

  The pelvic diaphragm supports the pelvic viscera. The levator

   ani   muscles are involved in supporting the foetal head during

  cervix dilation in childbirth. During the second phase of

  childbirth, the  levator ani muscles are at high risk  

  damagee. Pubococcygeus and puborectalis are the most prone

  to injury due to them being situated most medially.

 

  Due to their role in supporting the vagina, urethra and anal

  canal, injury to these muscles can lead to a number of

  problems. The primary problems include urinary stress

  incontinence and rectal incontinence. Urinary incontinence is

   most  noticeable during activities where there are increased

   abdominal pressure – coughing, sneezing and lifting heavy

   objects.

 

   Prolapse of the pelvic viscera (such as the bladder and vagina)

   can occur if there is trauma to the pelvic floor or if the muscle

   fibres have poor tone. Prolapse of the vagina can also occur if

   there is damage to the perineal body in childbirth.

   This may be avoided by episiotomy (surgical cut in the

   perineum), which itself can cause damage to the vaginal

   mucosa and   submucosa but helps prevent uncontrolled

   tearing of the perineal muscles.