Women who have undergone a hysterectomy have a substantially higher risk of developing urinary incontinence later in life compared to women who have not had a hysterectomy, according to a University of California, San Francisco study. The study will be published in the August 12 issue of the journal Lancet.
Researchers conducted a systematic review of the literature and found that women who had a hysterectomy had a 60 percent increased risk of incontinence by the time they were 60 years 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. Incontinence is an involuntary leakage of urine that can have a profound impact on quality of life.
"After careful review of the literature, we found that there is an increased risk of incontinence after hysterectomy later in life," said lead author Jeanette S. Brown, MD, UCSF professor of obstetrics, gynecology and reproductive sciences and a specialist 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 cesarean section, according to the study. More than 600,000 women have hysterectomies in the U.S. each year and about 40 percent of all women in the U.S. 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 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 ten 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 English language and non-English language articles registered on MEDLINE from January 1966 to December 1997 and found 45 articles 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 60 years old suffer from incontinence.
UCSF co-authors are George Sawaya, MD, assistant professor of obstetrics and gynecology; Deborah Grady, MD, professor in residence of epidemiology and biostatistics. David H. Thom, MD, from the Division of Family and Community Medicine, Stanford University also co-authored the study. The National Institute of Aging funded this study.
Journal
The Lancet