{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T18:18:53Z","timestamp":1791915533656,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100014688","name":"Region Uppsala","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014688","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Anal incontinence can have a significant negative impact on quality of life. The leading cause of anal incontinence among women of child\u2010bearing age is obstetric\u2010related perineal injury. The objective of this study was to examine the impact of episiotomy on the incidence of anal incontinence among primiparous women with second\u2010, third\u2010, or fourth\u2010degree perineal tears at 8\u2009weeks and 1\u2009year postpartum and to assess change in incidence over time across varying degrees of perineal tears.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods<\/jats:title>\n                    <jats:p>\n                      This Swedish cohort study included 12\u2009658 primiparous women who sustained a second\u2010 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095309), third\u2010 (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096771), or fourth\u2010degree tear (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009578), either spontaneously or in association with an episiotomy, between 2014 and 2019. Data were collected from national health and quality registers. The primary outcomes assessed were fecal and gas incontinence at 1\u2009year postpartum. Secondary outcomes included lifestyle alteration and Wexner score. Logistic regression analyses were performed, and results were presented as odds ratios (ORs) with 95% confidence intervals (CIs), using spontaneous tear as the reference group. Models were adjusted for age, body mass index, prepregnancy diabetes, gestational age, mode of delivery, length of the second stage, fetal presentation, birth weight, and head circumference.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The incidence of gas incontinence 1\u2009year after second\u2010, third\u2010, or fourth\u2010degree tears was 11.0%, 23.6%, and 37.8%, respectively. The incidence of fecal incontinence was 1.8%, 5.2%, and 14.5% for loose stool, and 0.8%, 2.1%, and 6.6% for solid stool, respectively. Women with a second\u2010degree tear and episiotomy had an adjusted OR of 1.26 (95% CI 1.02\u20131.55) for gas incontinence and 1.38 (95% CI 0.90\u20132.10) for fecal incontinence at 1\u2009year postpartum. Episiotomy did not increase the risk of anal incontinence among women with third\u2010degree and fourth\u2010degree tears. Anal incontinence, lifestyle changes, and Wexner score decreased over time across all types of tears.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Anal incontinence increases with the severity of perineal tears; however, the risk of incontinence is primarily determined by the grade of injury rather than the presence or absence of an episiotomy. Symptoms decline over time across all degrees of tears.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aogs.70124","type":"journal-article","created":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T16:30:12Z","timestamp":1767285012000},"page":"1210-1220","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of episiotomy on anal incontinence following second\u2010 to fourth\u2010degree perineal tears\u2014A cohort study"],"prefix":"10.1111","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-6577-3963","authenticated-orcid":false,"given":"Mette L.","family":"Josefsson","sequence":"first","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3299-8437","authenticated-orcid":false,"given":"Eva","family":"Uustal","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Sohlberg","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6396-3930","authenticated-orcid":false,"given":"Cecilia","family":"Ek\u00e9us","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Lampa","sequence":"additional","affiliation":[{"name":"Epistat  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Jonsson","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,1]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-0976-9"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.15.3276"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00004031"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/GCO.0b013e3282ef4142"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-079014"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jmwh.12283"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14101"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-017-4368-y"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2393-13-59"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-536x.1999.00011.x"},{"key":"e_1_2_13_12_1","article-title":"Perineal care","volume":"2008","author":"Kettle C","year":"2008","journal-title":"BMJ Clin Evid"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0001-6349.2001.10182.x"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.11.1279"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2006.00799.x"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-7292(98)00017-4"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-020-00989-5"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-021-04700-6"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-023-05609-y"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0412.2010.01057.x"},{"key":"e_1_2_13_21_1","unstructured":"Swedish National Quality Register of Gynecological Surgery.2018https:\/\/www.gynop.se\/home\/"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.11.030"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2018.02.015"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-022-00947-5"},{"key":"e_1_2_13_25_1","first-page":"603","article-title":"Reliability of the hospital registry. 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