Episiotomies: When and If They Help


To optimize outcomes, be sure to address patient expectations, and remind them that the return to normal muscle and sphincter function is slow, and can take up to 3 months. Kegel exercises can help strengthen the muscles during recovery, she said. Infection rates are low—less than 8%-in overlapping sphincteroplasty patients, but the presence of infection increases the failure rate.

The most significant factor in a successful sphincter repair is its durability, and constipation must be prevented to preserve the intactness of the repair in the immediate postoperative period.

“Constipation is the enemy of a sphincter repair in the first week or two,” Dr. Mahmoud said. She uses a combination of treatments including milk of magnesia, fiber, and stool softeners, and mineral oil, to help steer patients through recovery.


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