Hysterectomies May Lead to Loss of Bladder Control

August 10, 2000
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Women who have had hysterectomies have a higher risk of losing bladder control later in life, according to a study by doctors at UCSF Medical Center. The study was published in the Aug. 12 issue of the journal Lancet.

Doctors conducted a systematic review of research literature and found that women who had a hysterectomy had a 60 percent increased risk of incontinence, an involuntary leakage of urine, by age 60 or older. Most women who undergo a hysterectomy have the surgery in their 40s and 50s. But incontinence often does not develop until several years after the hysterectomy.

"After careful review of the literature, we found that there is an increased risk of incontinence after hysterectomy later in life," said Dr. Jeanette S. Brown, an obstetrician and gynecologist at UCSF Medical Center who specializes in women's incontinence. "Women need to put that information into their decision making process."

Hysterectomies are the second most common major surgical procedure for women after Caesarean section, according to the study. More than 600,000 women have hysterectomies in the United States each year and about 40 percent of all women in the country have had a hysterectomy by the time they are 60 years old.

Nearly 90 percent of hysterectomies are done for benign (non-cancerous) disorders, such as uterine fibroids, vaginal bleeding and pelvic pain. Most are elective.

"Women need to decide how much their uterine symptoms are affecting their quality of life today," Brown, a UCSF professor of obstetrics, gynecology and reproductive sciences, said. "Women should weigh what the immediate benefits are of a hysterectomy versus the long term risks later in life. And we as surgeons need to think about how the things we do today have consequences 20 or 30 years later."

It is unclear why it may take several years after having a hysterectomy for incontinence to develop. But this pattern is similar to that of childbirth and incontinence, according to the study.

Childbirth can cause damage to the nerves of the pelvic floor, but incontinence is usually not seen right after childbirth. However, it increases substantially five to 10 years later. Hysterectomies also can cause chronic or progressive damage to the pelvic nerves that eventually leads to incontinence. But, like childbirth, the effects of hysterectomy on continence can take years to emerge.

"We virtually never see incontinence right after hysterectomy," Brown said. "We think the physiology behind this is that hysterectomies can cause damage, but it takes 20 or 30 years for the risk associated with this damage to be seen, which explains why the risk is so prominent in older women."

The researchers identified 45 articles registered on MEDLINE from January 1966 to December 1997 reporting on the association of urinary incontinence and hysterectomy. Twelve papers met their selection criteria.

Incontinence is a condition that affects more than 13 million people in the United States, according to the National Kidney and Urologic Diseases Information Clearing House. It is especially common and chronic in many older women, who often go without treatment for this condition. About 40 percent of women over age 60 old suffer from incontinence.

UCSF co-authors are Dr. George Sawaya, assistant professor of obstetrics and gynecology, and Dr. Deborah Grady, professor in residence of epidemiology and biostatistics. Dr. David H. Thom, of the Division of Family and Community Medicine at Stanford University also co-authored the study. The National Institute of Aging funded this study.