The Hysterectomy and Incontinence Connection

Medically Reviewed By William C. Lloyd III, MD, FACS

Hysterectomies are the second most common operation that women undergo, after Caesarian sections. Some 600,000 women a year in the U.S. have hysterectomies, a medical procedure in which a woman’s uterus and possibly other reproductive organs are removed, and 40% of women have had one by age 60. Hysterectomies can be effective in treating abnormal vaginal bleeding, endometriosis, fibroid tumors and other medical issues.  However, they can also cause incontinence, in which your bladder leaks urine. Incontinence can be more than simply an annoyance; it can disrupt work, socializing, sex and exercise.

Why a hysterectomy can cause incontinence

When the uterus is removed, the muscles in the pelvis can lose strength and sag.  The same muscles support the bladder, and when they weaken, so does bladder control. Sometimes the ovaries are also removed during a hysterectomy, which makes your estrogen level drop since the ovaries are the main organs responsible for secreting the hormone. Because estrogen helps your pelvic floor remain strong and flexible, a lack of it can contribute to incontinence, particularly the type known as stress incontinence, in which pressure on the bladder from activities like jumping, coughing or laughing can cause urine leakage. Estrogen depletion can also contribute to more urgent and frequent urination.

The risk for incontinence after a hysterectomy

Women who have undergone a hysterectomy have a 60% higher risk of developing urinary incontinence later in life compared to women who haven’t had one. It often takes years for the symptom to develop after the procedure, because the muscles weaken over time, not right away. Most women who have the operation do so in their 40s and 50’s, and they may be over 60 when they begin to experience incontinence.

Treating and handling incontinence

There are many options, both surgical and non-surgical, for treating incontinence. There are several types of medication your doctor can prescribe. Your healthcare provider can also explain techniques for bladder retraining, where you develop the ability to hold more urine for a longer period of time. A group of exercises called Kegels, which your healthcare provider can advise you about, can also help strengthen the pelvic muscles. Some women use a device called a pessary, which is inserted into the vagina to support the bladder, and you can use pads to catch leakage that can help eliminate embarrassment and worry. There are various effective surgical procedures that can improve urinary retention.

If your doctor has suggested you have a hysterectomy, or you have incontinence after a hysterectomy, no matter how many years have passed, talk to a medical professional who can tell you more about your option if you find bladder control difficult. 

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 Aug 22
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