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Hysterectomy Patients May Face Incontinence Later

WebMD Health News

Aug. 15, 2000 -- Even after having suffered through bleeding or pain, then agonizing over the decision whether to have a hysterectomy, and then going through and recovering from the surgery, women may still have to face a possible side effect from the surgery later in life: incontinence.

Women 60 years old and older who have previously undergone hysterectomies have a 60% higher risk of urinary incontinence later in life than women who have not had the procedure. The incontinence can develop years after the procedure. So, anyone considering having a hysterectomy needs to take that risk into account, according to an article in the Aug. 12 issue of the Lancet.

A hysterectomy involves the surgical removal of the uterus. Hysterectomies are often done to resolve uterine bleeding, pain, collapsing of the pelvic organs, including the uterus, or when a uterine tumor is present. Approximately 600,000 hysterectomies are performed in the U.S. each year.

"One thing we haven't considered about hysterectomies is, are there long-term [consequences]?" article author Jeanette S. Brown, MD, tells WebMD. "Ninety percent of women deciding about hysterectomies are having one for a benign [noncancerous] condition. They need to weigh, 'How bad are my symptoms today compared to the risk of incontinence later in life?'"

Brown, a professor of obstetrics, gynecology, and reproductive sciences at the University of California in San Francisco, says some hysterectomies may well be worth that risk. She tells the story of two patients who were considering hysterectomies

"One was a patient of mine who had fibroids, and when she went to Europe she had to take an extra backpack full of sanitary pads because she bled so much. She said, 'My life is miserable. I can't travel, and sex is uncomfortable.' That patient's benefit was huge compared to the potential risk of incontinence later in life."

On the other hand, Brown had another patient who came to her for a second opinion after her doctor had recommended a hysterectomy as part of another surgical procedure.

"This patient had no symptoms, but her doctor had said, 'We're going to do a hysterectomy because we'll be in there anyway and you're done with childbearing.' She decided she preferred not to have her uterus removed, because she had no [immediate] benefit. That's the type of decision we're talking about," Brown tells WebMD.

In the article, Brown and colleagues looked at 12 different studies examining the potential link between hysterectomies and later incontinence. In the five studies that looked at women 60 years and older, researchers found an average 60% higher likelihood of incontinence in the women that had undergone hysterectomies, compared with those who had not. The researchers analyzed findings based on age because they assumed that "incontinence might not develop for many years after hysterectomy."

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