Hysterectomy May Boost Incontinence Risk

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The risk of having to undergo surgery for stress urinary incontinence was 2.4 times higher in the hysterectomy group than in the control group, regardless of what type of surgical technique was used for the hysterectomy.

The highest risk was during the first five years after the hysterectomy, when the risk was 2.7 times higher.

The lowest risk was more than 10 years down the line, when the risk was only 2.1 times higher for patients who had undergone a hysterectomy compared with those who had not.

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The most logical explanation for the association, according to the authors, was surgical trauma that can occur when the uterus and cervix are detached from the pelvic-floor supportive tissues during a hysterectomy.

"This is a big, well done and population-based study," noted one outside expert, Dr. Tristi Wood Muir, assistant professor of obstetrics and gynecology, Texas A&M Health Science Center College of Medicine and director of female pelvic medicine and reconstructive surgery for Scott & White in Temple. "Certainly, the uterus and bladder are intimately related, and, certainly, dissecting the bladder off can cause problems down the road. When we do a hysterectomy, we have to reestablish support, and it may be that a lack of support is causing the stress urinary incontinence. But it could also be a whole host of other reasons. It could be any number of things."

According to the accompanying comment article, several other reasons might explain the incidence of stress urinary incontinence, some of which might have nothing to do with the hysterectomy.

Regardless of the cause, most of the experts agreed that hysterectomy is not something to be undertaken lightly.

"With any sort of surgical intervention, there are possible risks and side effects, and the way the body tissues and nerves react to incisions and stitches is quite variable between patients," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "This is something to consider when patients are thinking about surgery like a hysterectomy for a benign indication. There will always be some sort of need for hysterectomy whether it's for cancer or for severe bleeding or severe pain, but patients need to realize that while it can cure some problems, it can also be the source of other problems, so it is something patients will need to talk about with their doctors."

More information

There's more on urinary incontinence in women at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

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