15 April 2019

Will I suffer from a leaky bladder after a hysterectomy?

Worried that you might suffer from urinary incontinence after a hysterectomy? Find out if there is any link between this procedure and incontinence.

A common question is whether urinary incontinence can be a side-effect of a hysterectomy. A hysterectomy is the surgical removal of the uterus and sometimes the cervix as well. This invasive procedure is often recommended for conditions such as heavy periods, fibroids, prolapse of the uterus or cancer of the reproductive system.

Causes of urinary incontinence after a hysterectomy

According to the National Association for Continence, incontinence is commonly reported after a hysterectomy because of damage to bladder nerves, which are close to the uterus.

A study published in the Lancet stated that women 60 years and older who have undergone hysterectomies have a 60% higher risk of urinary incontinence later in life than those who didn't have the procedure.

Urinary incontinence also commonly occurs when the pelvic floor is weakened, or when one loses the normal function of the muscle that closes the urethra.

Although this is theoretically possible after a hysterectomy, a report presented at the European Society of Gynaecological Oncology Congress in Vienna showed evidence that pelvic floor function in terms of urinary, bowel and prolapse symptoms were unlikely to worsen following abdominal or laparoscopic hysterectomy.

This means that women who for example need to undergo a hysterectomy for cancer can rest assured that surgery alone will probably not cause urinary incontinence.

Another reason why urinary incontinence might occur, involves structural changes in the muscles that control the urine flow (pelvic floor muscles) caused by surgery. Urge incontinence due to an overactive bladder after a hysterectomy may be caused by changes in the pelvic floor muscles.

Urinary incontinence may also occur after a hysterectomy because of the accidental creation of a fistula (an abnormal connection between two body parts) between the vagina and the bladder, which can cause continual leakage of urine. This is, however, a rare occurrence and not a common cause of urinary incontinence after a hysterectomy.

What should I do if I’m told I need a hysterectomy?

If your condition is not cancerous, it’s worth talking to your doctor or gynaecologist about other treatment options before undergoing such an invasive procedure. If you do decide to have a hysterectomy, you should be briefed about all the possible side-effects you may experience, including urinary incontinence.

So should I be afraid?

Even though urinary incontinence might only occur years after the surgery, patients willing to undergo a hysterectomy should be aware of all the risks and possible after-effects of the procedure.

The study published in the Lancet is not the most recent, and it’s worth noting that treatment for urinary incontinence has progressed since then.

What should I do if I experience urinary incontinence?

If you experience urinary incontinence, experts advise that you shouldn’t suffer in silence and consult your gynaecologist as soon as possible.

Remember that any sudden, uncontrolled form of urinary incontinence is cause for concern and should be discussed with your medical professional, despite any feelings of embarrassment.

There are treatment options available, such as pelvic exercises, medication and surgical procedures, depending on the severity of your condition. 

Image credit: iStock


Ask the Expert

Incontinence Expert

Dr Prenevin Govender completed his MBChB at the University of Cape Town in 2001. He obtained his Fellowship of the College of Urologists in 2009 and graduated with distinction for a Masters in Medicine from the University of Cape Town in 2010. His special interests include laparoscopic, pelvic organ prolapse and urinary incontinence surgery. He consults full-time at Life Kingsbury Hospital in Claremont.

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