Hysterectomy Patients May Face Incontinence Later
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."
It's not clear why women who have their uteruses removed develop incontinence more often, but it may be that the procedure simply results in chronic, progressive damage to the pelvic area that takes years to show up, Brown and colleagues theorize. "It's like if you have a knee injury when you're 20; you don't start wearing a knee brace until you're 40, and all the other [aging] factors kick in," says Brown.
On the whole, hysterectomies are probably done too often in the U.S., she says. "In Scandinavia, the rate of hysterectomy among women is 11%; in the United Kingdom, it's about 20%, and in the U.S., it's 40%. That's a huge [percentage]."
Women considering hysterectomies should talk the matter over with their physicians and weigh all the risks and benefits, Brown tells WebMD. "You need to decide as an individual, 'How bad are my symptoms?' If you are miserable, I'd take the roll of the dice and go for the hysterectomy."
But, Shari Thomas, MD, MPH, assistant professor of obstetrics and gynecology at UCLA, does not agree. "You have to follow the basic indications for hysterectomy and not scare the patient and say, 'Wait until you?re miserable, because you might get incontinent later.'"
Also, Thomas is not convinced incontinence is a long-term outcome of hysterectomy.
She tells WebMD anywhere from 25 to 50% of these patients are having hysterectomies for conditions that "already have an underlying increased risk of urinary incontinence. So you have to take out the people who have had surgery for pelvic organ prolapse, and [Brown]hasn?t done that. She has built her own bias into the meta-analysis," says Thomas.