UCSF study finds increased risk of incontinence in women who have hysterectomy

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.