Incontinence Hysterectomy

Urinary Incontinence & Hysterectomy

by Tori Hudson, N.D., Medical Director for Women’s Health Clinic Center, Author Women’s Encyclopedia of Natural Medicine

One of the most common problems I see in my women’s health practice is urinary incontinence. In fact, nearly 40% of all women will be affected by urinary incontinence at some point in their lives. While there are numerous causes of urinary incontinence, such as menopause, vaginal delivery, chronic constipation and medications, the relationship of hysterectomy to incontinence hasn’t got a lot of attention.

We need a structurally sound bladder, bladder neck, urethra (where the urine exits), surrounding muscles, nerves and supporting tissue, in order to have normal bladder function. Hysterectomy can possibly negatively alter that supporting structure and impact on bladder control.

There are different kinds of hysterectomies that may have different impacts on incontinence. It doesn’t seem to matter if the hysterectomy is done through the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). The main concern is what was removed during the surgical procedure.

If the hysterectomy procedure removes the whole uterus, it could also remove some of the structures that are required to provide pelvic support for bladder control. If the hysterectomy removes not only the whole uterus, but also both ovaries, then the procedure will cause not only the structural damage mentioned above, but also cause the dramatic decrease of hormone levels. Both the damage of pelvic supporting structure and lowered hormone levels can contribute to urinary incontinence.

Whenever possible, a hysterectomy that spares ovaries and the bottom part of the uterus (called a supra-cervical hysterectomy) is preferred. This type of procedure can avoid the drastic changes in hormone levels to assure a close to normal menopause process, protect the tone of the pelvic floor and maintain bladder control, as well as the integrity and sensation of the vagina.

A large Swedish study has raised concerns about the impact of hysterectomy on incontinence. The study totaling 644,766 women for 30 years has shown that urinary incontinence related bladder surgery was 2.4 times higher in women who had hysterectomies. For women with multiple vaginal deliveries, the rate of incontinence surgery was increased to 16 times higher for those who had hysterectomies. The risk for stress incontinence surgery was especially high during the first 5 years after a woman has had a hysterectomy.

If you already had mild urinary incontinence before your hysterectomy, you may experience increased incontinence symptoms for the first two years after the hysterectomy. Therefore it becomes even more important for you to discuss with your surgeon about having a supra-cervical hysterectomy as well as keeping your ovaries, if you have a medical condition that warrants a hysterectomy.

If you are having a hysterectomy and already have significant incontinence or bladder prolapse, surgical incontinence repair for the bladder prolapse (cystocele), in association with the hysterectomy, will significantly increase the probability of improvement. For many women, while perhaps necessary, the benefits of these bladder prolapse surgeries may not be long-lasting. Unfortunately, they may need repeated surgeries. But this need may be reduced or prevented by the use of natural therapies and exercises.

As a ND, I always prefer the natural treatment first — “Do no harm” is the guiding principle for naturopathic medicine. When it comes to natural treatments for urinary incontinence with or without hysterectomy, I’ve been using a Chinese herbal formula, Better Woman, for my patients for more than two years now. I have found that most women experience significant improvement in their urinary leakage well within two months. I also recommend Kegel exercises to enhance the tone of the pelvic floor, and sometimes some special pelvic floor rehabilitation techniques with women’s heath physical therapies.

References:

Kjerulff KH, et al. Urinary incontinence and hysterectomy in a large prospective cohort study in American women. J Urol May 2002;167:2088-92.)

Altman D et al. Hysterectomy and risk of stress-urinary-incontinence surgery: Nationwide cohort study. Lancet 2007 Oct 27; 370:1494.)

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