Does hysterectomy cause incontinence?

Summarized by Robert W. Griffith, MD
September 14, 2000 (Reviewed: January 15, 2003)

In the USA, hysterectomy is a common major surgical procedure, second only to cesarean section. In f act, about 40% of women have had a hysterectomy by the age of 60. The operation is usually done to cure symptoms produced by uterine fibroids (large benign tumors of the uterus muscle), excessive uterine bleeding, or prolapse of the uterus (descent of the uterus into the vaginal canal). The operation itself is safe - complications, such as hemorrhage requiring transfusion, may occur in up to 10% of cases, but they are easily managed. However, the studies summarized here show that one particular long-term complication - incontinence - may be commoner than expected.

The medical publications over a 2-year period were searched for reports of studies about hysterectomy and urinary incontinence. Out of the 45 articles found, 12 provided information comparing urinary incontinence in women who had hysterectomies with those who did not. For each of these studies the likelihood of developing incontinence was determined, and then the overall likelihood based on information from all the studies was calculated. Differences between findings in over- and under-60-year-olds, and also according to the type of hysterectomy (total, or partial), were estimated.

The overall likelihood of developing urinary incontinence was about 40% greater in women who had a hysterectomy than in women who had not had the operation. In other words, they were 1.4 times as likely to develop incontinence. Looked at by age groups, the likelihood was about 60% greater in women over 60, compared with just 10% greater in women under 60. The authors of the article suggest that this difference in age groups is due to the time-lag between surgery and development of the complication - a matter of years.

It was not possible to determine if one particular type of incontinence (e.g. "stress", or "urge", or mixed incontinence) was especially related to a previous hysterectomy. Also, there was no evidence that there was a difference in the effects of total or partial hysterectomy.

The hysterectomy procedure can damage the pelvic nerves or the pelvic support structures, either of which may increase the risk of urinary incontinence. The reason for the delay in its appearance is unclear. However, this timing resembles that associated with incontinence after childbirth. Damage to the nerves supplying the pelvic floor has been found shortly after childbirth, but incontinence is not substantially more frequent until 5 to 10 years later.

The frequency of hysterectomy differs considerably in various countries, but it is unlikely that operative techniques are sufficiently varied to make a difference in long-term outcome. Hysterectomy is a selective rather than an emergency procedure. Based on these findings, women contemplating the operation should be counseled on the slight but real increased risk of incontinence developing years after the operation.

If you want to read about other risk factors for urinary incontinence, visit "Can one prevent incontinence?".

Source

• Hysterectomy and urinary incontinence: a systematic review. JS. Brown, G. Sawaya, D. Thom, D. Grady, Lancet, 2000, vol. 356, pp. 535--539

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